Relationship between posttraumatic stress disorder symptoms and the course of whiplash complaints

Size: px
Start display at page:

Download "Relationship between posttraumatic stress disorder symptoms and the course of whiplash complaints"

Transcription

1 Journal of Psychosomatic Research 61 (2006) Relationship between posttraumatic stress disorder symptoms and the course of whiplash complaints Jan Buitenhuis a,b, 4, Peter J. de Jong c, Jan P.C. Jaspers d, Johan W. Groothoff e a Medical Department, Univé Insurance The Netherlands b Department of Social Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands c Department of Clinical and Developmental Psychology, University of Groningen, Groningen, The Netherlands d Medical Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands e Department of Social Medicine, Northern Centre for Health Care Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Received 12 October 2005; received in revised form 6 July 2006; accepted 11 July 2006 Abstract Objective: This study investigates the relationship between posttraumatic stress disorder (PTSD) symptoms (avoidance, reexperiencing, and hyperarousal) and the presence, severity, and duration of neck complaints after motor vehicle accidents. Methods: Individuals who had been involved in traffic accidents and had initiated compensation claim procedures with a Dutch insurance company were sent questionnaires (Q1) containing complaint-related questions and the Self-Rating Scale for PTSD. Of the 997 questionnaires that were dispatched, 617 (62%) were returned. Only car accident victims were included in this study (n=240). Complaints were monitored using additional questionnaires that were administered 6 months (Q2) and 12 months (Q3) after the accident. Results: PTSD was related to the presence and severity of concurrent. More specifically, the intensity of hyperarousal symptoms that were related to PTSD at Q1 was found to have predictive validity for the persistence and severity of at 6 and 12 months follow-up. Conclusion: Results are consistent with the idea that PTSD hyperarousal symptoms have a detrimental influence on the recovery and severity of whiplash complaints following car accidents. D 2006 Elsevier Inc. All rights reserved. Keywords: Post-whiplash ; Whiplash-associated disorder; Anxiety; Posttraumatic stress disorder; Hyperarousal; Vigilance Introduction Whiplash is one of the most prevalent posttraumatic diagnoses following traffic accidents. The term whiplash refers to the presumed movement of the neck during an accident. The distortion of the neck that can follow from such movement usually declines over subsequent days or weeks. Even in the absence of identifiable structural injuries, victims may suffer from long-lasting complaints that are characterized by persistent neck pain, often 4 Corresponding author. P.O. Box 15, 9400 AA, Assen, The Netherlands. Tel.: ; fax: address: (J. Buitenhuis). accompanied by cognitive complaints. This persistent is usually known as whiplash-associated disorder or. Studies on the etiology of this chronic have led to conflicting opinions regarding the nature of the complaints and the relevance of psychological factors [1 3]. Although the majority of victims show spontaneous recovery within the first months after the traffic accident, as many as 40% of the victims suffer from long-lasting symptoms, sometimes with severely disabling effects [4]. Insight into factors that are responsible for this chronic course is therefore of great importance. The determination of such predictive factors may provide clues for effective interventions, in addition to its utility in the context of /06/$ see front matter D 2006 Elsevier Inc. All rights reserved. doi: /j.jpsychores

2 682 J. Buitenhuis et al. / Journal of Psychosomatic Research 61 (2006) prevention. Several prognostic factors have already been identified by earlier research [5]. First, it has been found that high initial pain intensity, female gender, and increasing age are predictive of delayed recovery [3,4,6]. In addition, studies have shown that individual coping style may be involved in the course of whiplash complaints. More specifically, a palliative coping style has been proven to be predictive of a chronic course [3,6]. The presence of posttraumatic stress symptoms is another factor that may play an important role in the persistence of whiplash symptoms following a motor vehicle accident [7]. Post-whiplash and posttraumatic stress disorder (PTSD) are both relatively common conditions following traffic accidents [8 11]. As many as 23% of traffic accident victims are reported to have developed PTSD, which is known to have high psychiatric and medical comorbidity [12 15]. The symptoms of PTSD may be involved in the development of in several ways. First, anxiety is an important feature of most PTSD symptoms. Because anxiety is known to influence the perception and experience of pain, PTSD symptoms may alter the perception and experience of acute neck pain [16]. Inflated pain levels may subsequently fuel (avoidance) behaviors that facilitate a chronic course [17 19]. Second, PTSD symptoms may result in heightened vigilance, which may inflate the perception of pain [20]. Third, PTSD symptoms may give rise to a dysfunctional (catastrophic) interpretation of acute neck pain, which may subsequently inflate pain intensity, disability, and psychological distress, independent of the level of the actual physical impairment [21]. Finally, PTSD shares several symptoms with acute whiplash, including insomnia, irritability, and cognitive problems. These symptoms may further intensify the perception of symptoms or lead to misattribution. In support of the idea that the presence of PTSD symptoms affects the symptomatology of whiplash, earlier research has provided preliminary evidence to indicate that the acute posttraumatic stress response (i.e., reexperiencing and avoidance symptoms) is related to the intensity of whiplash symptoms 4 weeks after the accident [22]. In addition, the results of a recent study have provided further evidence that PTSD symptoms may also influence the course of whiplash symptoms. More specifically, the study revealed the reexperiencing and avoidance subscales of the Impact of Events Scale to be associated with relatively persistent whiplash complaints at 6 months follow-up [23,24]. Unfortunately, both previous studies tested only two of the three PTSD symptom scales and neither included the hyperarousal symptom cluster scale. Nonetheless, these symptoms may be highly relevant to the proper understanding of the relationship between PTSD and whiplash complaints [7]. A study by Mayou and Bryant did consider all three PTSD symptoms scales. The participants that they recruited, however, included only victims who had visited an emergency room following their accidents, thereby possibly biasing the results toward patients who were more frightened or whose injuries were more serious [25]. The present study was therefore designed to provide further testing of the robustness and validity of these earlier findings, which suggest that PTSD symptoms are related to the intensity of whiplash complaints and that they have predictive validity regarding recovery from whiplash complaints following motor vehicle accidents. This study includes the hyperarousal symptom cluster in addition to reexperiencing and avoidance symptoms. To test for generalizability, we did not restrict the range of victims to emergency-room visitors. Finally, we examined whether the relationship between PTSD symptoms and whiplash complaints had increased or decreased at prolonged (12-month) follow-up. More specifically, the present study addresses the following questions: 1. Are PTSD symptoms more frequent among individuals who have? 2. Are PTSD symptoms related to the severity of whiplash complaints? 3. Is the presence of PTSD symptoms predictive of delayed recovery from? Methods Study design We used a prospective longitudinal design. Participants were assessed at 1 month (Q1), 6 months (Q2), and 12 months (Q3) after their accidents. Participants and procedure Traffic accident victims who had initiated compensation claim procedures for personal injury with a Dutch insurance company were asked to participate in this study. In the Netherlands, settlement of personal injury claims is based on liability insurance; accident victims seek compensation from the insurance company of the driver who was at fault. The letter of invitation clearly communicated that the present study was independent of the compensation procedure. During the intake period, 997 questionnaires were dispatched. Questionnaires were not sent to claimants who were known to be younger than 18 or older than 65 years of age. The median time for dispatching the questionnaire was 21 days after the accident (mean=22.15 days, S.D.=11.197). The number of initial questionnaires that was returned was 617 (62%). The initial selection from the returned questionnaires included only the responses of victims who had been in

3 J. Buitenhuis et al. / Journal of Psychosomatic Research 61 (2006) car accidents (n=293). To rule out the potentially confounding influence of concurrent complaints and to obtain a homogeneous sample of participants with only soft-tissue injuries, we excluded 30 victims because of a history of whiplash or neck pain, 15 victims because of one or more fractures, and 8 victims because of the absence of physical complaints. In the final sample, therefore, the responses of 240 participants were eligible for further analysis. Questionnaires and outcome variables After a median time of 21 days after the accident, we sent each claimant a questionnaire (Q1) concerning the accident, the injuries that they had sustained, and their complaints at that time. Table 1 provides an overview of the questionnaire items. Consistent with our previous studies on, claimants who suffered from neck pain, a loss of consciousness of no longer than 1 min, and no self-reported previous neck complaints were included as patients [3,26]. The presence of PTSD was assessed using the Self-Rating Scale for PTSD (SRS-PTSD) [27]. This questionnaire was Table 1 Overview of variables analyzed Variable Values Age Years Gender Male, female Loss of consciousness No, for a moment, b1 min, b10 min, and N10 min Hospital visit No; immediately by ambulance; immediately, on own initiative; later, after visit to GP Hospital admittance No, b1 day, and N1 day General practitioner visit No, b1 day, b1 week, and N1 week Back-pain intensity 1 (no pain) to 10 (severe pain) Neck-pain intensity a 1 (no pain) to 10 (severe pain) Headache intensity a 1 (no pain) to 10 (severe pain) Neck stiffness a 1 (no stiffness) to 10 (severe stiffness) Severity of neck 1 (no restrictions) to 10 (severe restriction) movement restriction a Radiating pain in arms a 1 (no pain) to 10 (severe pain) Severity of paresthesia in 1 (no paresthesia) to 10 (severe paresthesia) the arms a Concentration complaints a 1 (no complaints) to 10 (severe complaints) Difficulty reading a 1 (no complaints) to 10 (severe complaints) Difficulty concentrating 1 (no complaints) to 10 (severe complaints) on a conversation a Dizziness a 1 (no dizziness) to 10 (severe dizziness) Use of medication since accident No/yes (includes analgesics and/or muscle relaxants) Sleep disturbance No/yes Frequency of neck pain a,b 1 (daily) to 4 (at least once a month) Onset of neck complaints Hours after accident Posttraumatic stress Three scales questionnaire (SRS-PTSD) a Variable used in whiplash severity score. b Before analyses, recalculated by using the formula: 12 (2original value). designed as an abridged version of the Structured Interview for Posttraumatic Stress Disorder, which measures the presence and severity of PTSD symptoms from both a current and a lifetime perspective [28]. The SRS-PTSD consists of questions that assess the three major symptom groups of PTSD, as listed in the DSM-IV. Eight questions assess the five reexperiencing symptoms; 10 questions assess the seven avoidance symptoms, and 6 questions assess the five hyperarousal symptoms. In accordance with the DSM-IV criteria for PSTD, participants were considered as suffering from PTSD if they reported at least one reexperience, three avoidance symptoms, and two hyperarousal symptoms [29]. We monitored the course of complaints, in all participants, regardless of the presence of initial complaints, at 6 months (Q2) and 12 months (Q3) after the accident by means of the SRS-PTSD. In addition, two identical questionnaires containing questions regarding the complaints at that moment in time were completed. Data reduction PTSD symptoms A dichotomous variable was computed for each assessment point to indicate whether the diagnostic requirements for PTSD were met. In addition to this dichotomous variable, the actual number of avoidance, reexperiencing, and hyperarousal symptoms were used as independent variables. Whiplash complaints A severity score was calculated as the sum of the 11 complaint variables that are marked in Table 1 for each individual who was suffering from at each of the three assessment points. The reliability of these indices in terms of internal consistency was satisfactory (Q1: Cronbach s a=.88, n=134, mean=52.9, S.D.=20.2; Q2: Cronbach s a=.89, n=79, mean=53.5, S.D.=20.5; Q3: Cronbach s a=.91, n=62, mean=53.0, S.D.=20.2). In addition, a dichotomous variable was computed for each assessment point to indicate whether whiplash (i.e., persistent neck pain) was still present. Analysis Categorical variables were recoded into appropriate dummy variables before they were used in the regression analyses. The independent variables used in the regression analyses were first analyzed in associated groups. When analyzing the relationship between PTSD symptoms and the intensity of concurrent complaints (Section 3.3), the groups consisted of the following: first group: hospital visit, hospital admission, and visit GP; second group: medication since accident, backpain complaints, and onset of neck complaints. Variables with significant properties were then simultaneously included in the final regression analysis, together with

4 684 J. Buitenhuis et al. / Journal of Psychosomatic Research 61 (2006) age, gender, and the categorical PTSD variable or the PTSD symptoms. When analyzing the relationship between initial PTSD symptoms and the persistence and severity of at 6 and 12 months follow-up (Section 3.4), the groups consisted of the following: first group: hospital visit, hospital admission, and visit GP; second group: back pain intensity, headache intensity, use of medications since accident, concentration, difficulty reading, difficulty concentrating on a conversation, and dizziness; third group: neck-pain intensity, frequency of neck pain, onset of neck complaints, neck stiffness, severity of neck movement restriction, radiating pain in arms, and severity of paresthesia in the arms. Variables with significant properties were then simultaneously included in the final regression analysis, together with age, gender, and the categorical PTSD variable or the PTSD symptoms. Next, using a backward stepwise selection procedure, the least significant variables were removed (visit GP, headache intensity, back-pain intensity, and, when analyzing the PTSD symptoms, dizziness), using the drop-in-deviance test to compare the new model with the last model, while retaining age, gender, and the PTSD variable(s) in the model. The final models therefore contain age, gender, the PTSD variable(s), and significant confounders. Results General results Table 2 provides an overview of the basic characteristics of participants (n=240). Of the 240 participants in the final sample, 32 (20 with on Q1) did not return the second questionnaire, and 18 (11 with postwhiplash on Q1) did not return the third questionnaire. Analysis indicated no significant differences between those who did and those who did not return the questionnaire with respect to their scores during the first assessment. Table 2 provides an overview of the characteristics of both groups of participants (i.e., those with and those without) as well as descriptive variables on Q1. Using univariate logistic regression, Table 2 Basic characteristics of the eligible group (n=240) at Q1, 1 month after the accident Post-whiplash No Yes Whole group Number of participants Age, mean (S.D.) 35.6 (13.4) 36.3 (12.3) 36.0 (12.8) Male gender, n (%) a 48 (45.3) 39 (29.1) 87 (36.3) Loss of consciousness, n (%) No 95 (89.6) 120 (89.6) 215 (89.6) For a moment 8 (7.5) 14 (9.5) 22 (9.2) Less than 1 min 0 4 (3.0) 4 (1.7) Less than 10 min More than 10 min 3 (2.8) 0 3 (1.3) Hospital visit, n (%) No 62 (58.5) 70 (52.2) 132 (55.0) Immediately, by ambulance 32 (30.2) 38 (28.4) 70 (29.2) Immediately, on own initiative 7 (6.6) 13 (9.7) 20 (8.3) Later, after a visit to a general practitioner 5 (4.7) 13 (9.7) 18 (7.5) Hospital admission, n (%) No 96 (90.6) 123 (91.8) 219 (91.3) Yes, 1 day or shorter 7 (6.6) 8 (6.0) 15 (6.3) Yes, more than 1 day 3 (2.8) 3 (2.2) 6 (2.5) Visit to general practitioner, n (%) b No 48 (45.3) 20 (14.9) 68 (28.3) Yes, the same day 19 (17.9) 27 (20.1) 46 (19.2) Yes, within 1 week 31 (29.2) 71 (53.0) 102 (42.5) Yes, after more than 1 week 8 (7.5) 16 (11.9) 24 (10.0) Neck-pain intensity, n (%) c 6.5 (2.25) Neck-pain frequency, n (%) d Daily 116 (86.6) More then 3 h per week 8 (6) At least once a week 9 (6.7) At least once a month 0 a Univariate logistic regression, odds ratio=2.016, 95% CI= b Univariate logistic regression, reference category bno,q dummy variable (dv) 1: odds ratio=3.411, 95% CI= ; dv 2: odds ratio=5.497, 95% CI= ; dv 3: odds ratio=4.800, 95% CI= c Information on other variables available from the first author. d One missing case.

5 J. Buitenhuis et al. / Journal of Psychosomatic Research 61 (2006) the group of individuals with consisted of significantly more women than men. In addition, victims with had visited their general practitioners relatively frequently. None of the other variables showed significant differences between the groups. PTSD symptoms at 1, 6, and 12 months The presence of PTSD and the mean number of symptoms for each symptom cluster at each assessment point are shown in Table 3. At all assessment points (i.e., Q1, Q2, and Q3), PTSD was more prevalent in the group of victims with postwhiplash than it was among the participants who did not report these symptoms (chi-square with Yates continuity correction: v 2 =8.53, df=1, P=.003; v 2 =21.56, df=1, Pb.001; and v 2 =8.65, df=1, P=.003, respectively). For all assessments, the mean number of reexperiencing, avoidance, and hyperarousal symptoms was relatively high in the group with (t test, t values b 3.4, P values b.001). This pattern remained unaffected when the results were corrected for age and gender using analysis of covariance ( F values N13.73, P values b.001). Of the 26 individuals who conformed to the diagnosis of PTSD at Q1, 5 (19%) had not visited any doctor after the accident, 11 (42%) had been to a hospital immediately after the accident, and 5 (19%) had been admitted. PTSD symptoms and the intensity of concurrent complaints Using the whiplash severity score at the three assessment points as dependent variables and all remaining variables from Table 1 as independent variables, linear regression analysis yielded the following results. The use of medication (b=0.289, Pb.001), the severity of back pain (b=0.275, Pb.001), and the presence of PTSD (b=0.329, Pb.001) at Q1 were all associated with the whiplash severity score at Q1 (independent variables simultaneously included in the analysis: age, gender, back-pain intensity, use of medication, and categorical diagnosis of PTSD at Q1). In a subsequent regression analysis, we substituted the number of PTSD symptoms for the three symptom clusters for the categorical diagnosis of PTSD (independent variables simultaneously included in the analysis: age, gender, back-pain intensity, use of medication, number of reexperiencing, avoidance, and hyperarousal symptoms). This analysis revealed that the number of posttraumatic avoidance (b=0.303, Pb.001) and hyperarousal symptoms (b=0.471, Pb.001) was statistically significantly associated with the concurrent whiplash severity score at Q1, whereas the number of reexperiencing symptoms at Q1 (b= 0.091, P=.191) was not. The use of medication (b=0.247, P=.03), the severity of back pain (b=0.238, P=.026), and the presence of PTSD (b=0.285, P=.012) at Q2 were all associated with the concurrent whiplash severity score. In a subsequent regression analysis (independent variables simultaneously included in the analysis: age, gender, back-pain intensity, use of medication, and number of reexperiencing, avoidance, and hyperarousal symptoms), the number of avoidance symptoms (b=0.308, P=.028) 6 months after the accident was associated with the whiplash severity score at Q2. The number of reexperiencing (b=0.003, P=.980) and hyperarousal symptoms (b= 0.242, P=.088) at 6 months follow-up provided no statistically significant association with whiplash severity at Q2. The use of medication (b=0.267, P=.031) at Q3 was associated with the concurrent whiplash severity. No statistically significant relationship was found with the presence of PTSD at that assessment point (b=0.205, P=.102). In a subsequent regression analysis (independent variables simultaneously included in the analysis: age, gender, back-pain intensity, use of medication, and number of reexperiencing, avoidance, and hyperarousal symptoms), the number of hyperarousal symptoms (b=0.435, P=.007) at Q3 were associated with the concurrent whiplash severity score. The number of reexperiencing (b= 0.026, P=.869) and avoidance symptoms (b=0.167, P=.238) provided no significant association at Q3. Table 3 Frequency of PTSD and symptom scales at 1, 6 and 12 months Assessment point (months after the accident) Q1 (1) Q2 (6) Q3 (12) Without With Without With Without With Number of participants With PTSD, n (%) 4 (3.8) 22 (16.4) 4 (3.1) 20 (25.3) 5 (3.9) 11 (17.7) Reexperiencing symptoms, mean (S.D.) 1.16 (1.442) 2.11 (1.684) 0.63 (1.125) 1.59 (1.581) 0.67 (1.102) 1.44 (1.543) Avoidance symptoms, mean (S.D.) 0.66 (1.004) 1.38 (1.381) 0.50 (0.772) 1.80 (1.409) 0.45 (0.895) 1.77 (1.311) Hyperarousal symptoms, mean (S.D.) 0.49 (0.928) 1.66 (1.420) 0.42 (0.826) 1.95 (1.440) 0.37 (0.752) 1.79 (1.332)

6 686 J. Buitenhuis et al. / Journal of Psychosomatic Research 61 (2006) Table 4 Multiple logistic regression model Variable Coefficient (b) S.E. Wald v 2 P value Odds ratio 95% CI Lower Upper Post-whiplash at Q2 Constant Gender Age PTSD Neck pain Dizziness Post-whiplash at Q3 Constant Gender Age PTSD Neck pain Dizziness Post-whiplash at Q2 and Q3 was used as the dependent variable. Explanatory variables are from Q1, including PTSD. Initial PTSD symptoms and the persistence and severity of at 6 and 12 months follow-up Table 4 shows the results of two multiple logistic regression models after stepwise backward modeling, while retaining age, gender, and the PTSD variable, using the presence of at Q2 and Q3 as the dependent variable and the variables from Q1 as independent variables. Most important for the present context, results indicated that the categorical presence of PTSD at Q1 had no independent predictive value for the presence of postwhiplash at Q2 and Q3. Since the inclusion of neck complaints in the equation may result in an underestimation of the actual strength of the association between PTSD and subsequent complaints (i.e., to the extent that neck pain lies in the causal pathway between PTSD and whiplash complaints), we performed an additional regression analysis in which we did not correct for neck pain at Q1. This additional regression analysis, with only age, gender, and the categorical presence of PTSD at Q1, revealed that the presence of PTSD at Q1 had an independent predictive value for the presence of postwhiplash at Q2 (odds ratio=13.941, 95% CI= ) and Q3 (odds ratio=7.518, 95% CI= ). In a subsequent analysis, we substituted the number of PTSD symptoms for the three symptom clusters at Q1 for the categorical diagnosis of PTSD. Table 5 shows the results Table 5 Multiple logistic regression model Variable Coefficient (b) S.E. Wald v 2 P value Odds ratio 95% CI Lower Upper Post-whiplash at Q2 Constant Gender Age Reexperiencing symptoms Avoidance symptoms Hyperarousal symptoms Neck pain Post-whiplash at Q3 Constant Gender Age Reexperiencing symptoms Avoidance symptoms Hyperarousal symptoms Neck pain Post-whiplash at Q2 and Q3 was used as the dependent variable. Explanatory variables are from Q1, including PTSD symptoms.

7 J. Buitenhuis et al. / Journal of Psychosomatic Research 61 (2006) of the two models. With respect to the PTSD symptoms, only the number of hyperarousal symptoms at Q1 provided additional predictive value for the presence of subsequent at 6 and 12 months follow-up. Linear regression using the whiplash severity score as the dependent variable yielded similar results, showing hyperarousal symptoms at Q1 to be related to the severity of whiplash complaints at 6 months (Q2) and 12 months (Q3; b=0.350, P=.013, and b=0.325, P=.045, respectively). No relationship emerged between the number of reexperiencing and avoidance symptoms at Q1 and the whiplash severity score at either Q2 or Q3. Discussion The major results of the present study can be summarized as follows: 1. PTSD and the number of its symptoms are more prevalent among car accident victims who have postwhiplash than they are among victims who do not have. 2. The presence of PTSD symptoms was associated with relatively more severe concurrent complaints. 3. Specifically, the initial number of hyperarousal symptoms was found to have predictive validity for the persistence and severity of at 6 and 12 months follow-up. In accordance with earlier research, PTSD and its symptoms were found to be more prevalent among victims who had in the first 6 months following their accidents [22,23]. Since earlier research has shown that the development of PTSD is not substantially related to either the severity of the accident or the severity of the sustained injury, differences in the frequency of PTSD are not readily explained by any apparently terrifying aspect of the accident [30,31]. The current results seem to correspond with earlier research that suggests that victims with postwhiplash generally considered the accident more frightening than did other car accident victims [25]. Because perceived threat is of paramount importance in developing PTSD, it could be speculated that the presence of whiplash complaints is threatening and induces anxiety complaints. This would make the accident more frightening and could subsequently lead to a relatively high number of posttraumatic stress complaints. Previous research showing a relationship between postwhiplash and PTSD has relied predominantly on victims who were recruited in emergency rooms, thereby possibly biasing the results toward patients who were more frightened or whose injuries were relatively serious [25]. In the present study, only a small minority of the car accident victims who were included had actually visited a hospital following the accident. The present finding that the relationship between and PTSD can also be found in a broader sample underlines its generalizibility and indicates that this relationship reflects a robust phenomenon. The relationship between complaints and PTSD symptomatology was especially pronounced for the PTSD-related hyperarousal symptoms. The mean number of hyperarousal symptoms was three to five times higher among participants with at all three assessment points. Because the hyperarousal symptom cluster closely resembles anxiety disorder symptoms, this finding may indicate that general anxiety symptoms bear an important influence on the perceived severity of postwhiplash. The present finding that victims who reported neck complaints visited their general practitioners more frequently than did those who had no neck complaints provides further indication that anxiety is involved. In other words, although a visit to the general practitioner may be interpreted as indicating that the initial symptoms in this group were relatively severe, it may also reflect reassuranceseeking behavior due to relatively high levels of anxiety. One way to test this idea would be to focus on anxiety reduction during initial interventions. If indeed heightened anxiety levels act in a way to inflate whiplash complaints, anxiety reduction should have a beneficial influence on the intensity of whiplash complaints. In contrast to earlier research, we found no evidence of a relationship between reexperiencing symptoms and postwhiplash [22,23]. One possible explanation could be that we were able to control for hyperarousal symptoms in our analysis. Even after discarding the hyperarousal symptoms, however, we found no significant role for reexperiencing symptoms. The difference may therefore be caused by the present recruitment strategy. It may well be that the relationship between reexperiencing symptoms and is evident only in victims who have visited an emergency room. Several earlier studies of posttraumatic stress symptoms have used the Impact of Events Scale [23]. While this scale includes the first two major symptom clusters, it does not address hyperarousal symptoms. Our results clearly show that the hyperarousal symptoms have the most marked relationship with. We therefore recommend that future research on the role of PTSD in postwhiplash consider all three symptoms scales. In addition, future research should provide further investigation of the apparent role of hyperarousal symptoms in postwhiplash. It should be acknowledged that the present prognostic design does not allow for strong conclusions regarding causal mechanisms that may underlie the co-occurrence of and PTSD symptoms. Nonetheless, the present pattern of results is clearly consistent with the idea that the concurrent presence of PTSD may have an undesirable influence on the course of whiplash complaints.

8 688 J. Buitenhuis et al. / Journal of Psychosomatic Research 61 (2006) One way in which PTSD symptoms may influence the course of whiplash complaints is via the anxiety features of PTSD that may alter the perception and experience of the physical complaints [16]. Furthermore, PTSD symptoms may fuel a vulnerability to the misinterpretation and catastrophization of the physical sensations that accompany hyperarousal and are associated with pain. These sensations may subsequently be attributed to or aggravate its symptoms [1,32 34]. In addition, anxiety-induced heightened vigilance may inflate the perception of pain [20]. Consistent with this idea, the present study has provided evidence that the intensity of PTSD symptoms at Q1 has predictive value for the course of whiplash complaints at follow-up. More specifically, it was found that the presence of a relatively large number of hyperarousal symptoms was related to more intense complaints at 6 and 12 months follow-up. These results suggest that general anxiety symptoms are more relevant in this respect than are PTSD symptoms that are more specific (e.g., reexperiencing and avoidance symptoms). The hyperarousal symptom cluster closely resembles irritability, insomnia, hypervigilance, and similar symptoms. Hypervigilance, which is unique to PTSD, is known to be correlated with higher reported pain intensity, negative affectivity, and catastrophic thinking [35]. Accordingly, it may be that symptom amplification and catastrophization may play a role in the consolidation and perceived severity of, independent of anxiety as such [1]. One way to explore this possibility would be to conduct a prospective study to test the predictive value of catastrophic thoughts regarding either the attribution of somatic complaints or the expected course of complaints. It is important to note that the PTSD hyperarousal scale addresses symptoms regarding concentration, memory function, feelings of insecurity, and nervousness. Some of these symptoms are also often attributed to. It is therefore possible that the predictive properties of the hyperarousal scale are at least partially caused by the fact that this scale measures complaints that are associated with. The present pattern of results, which indicates that only hyperarousal and none of the other PTSD symptoms are related to the prognosis of postwhiplash, further substantiates this idea. The present pattern of results is also consistent with the idea that at least some complaints are actually symptoms of PTSD. The pattern further highlights the importance of considering PTSD, particularly the hyperarousal features, when diagnosing and treating individuals with apparent complaints [7]. With respect to earlier research, a number of comments regarding the relatively low number of participants who had PTSD and those who suffered from both and PTSD after 1 month (11% and 16%, respectively) are in order [30,36]. One explanation might be that research designs that rely on recruiting participants from among emergency-room visitors or from referring doctors may overestimate the frequency of PTSD after motor vehicle accidents, as they may concentrate on a group of victims who are more seriously injured or, more important, more frightened than the average victim is. The lower prevalence of PTSD may therefore have been caused by the fact that we were able to include a considerable number of participants who had not visited an emergency room, or even a medical doctor, following their accidents. The variable findings that are reported in the literature may thus reflect the nature of samples and methodology, at least in part [37]. Additional comments regarding the research sample are in order. The study group consisted of participants who had initiated compensation claim procedures. Since the threshold for starting such procedures is low in the Netherlands, there seems to be no strong reason to suspect that this introduced a bias toward patients whose complaints were more serious [38]. First, the damage-report forms that are used for claiming car damage, and which are usually completed within a few days after the accident, contain a section for the names of victims and their complaints. We invited all claimants directly from these forms, including victims who had not visited an emergency room or sought medical help at the time of the accident. Second, although the insurance company and victims can be seen as opposing parties, most personal injury claims in the Netherlands, even large ones that involve serious injuries, are settled out of court. None of the participants was in actual litigation. Nevertheless, some studies have recently found that compensation is a critical factor to consider when studying [39,40]. Therefore, the personal injury claimant context should be taken into account when interpreting or generalizing our findings. Furthermore, since the exact nature and expectations of compensation may vary greatly from country to country, we advise caution when extrapolating results of one population onto another. Finally, it should be acknowledged that PTSD is not a questionnaire diagnosis. The presence of the minimum number of symptoms required in the three major symptom clusters does not necessarily imply the presence of PTSD. Structured DSM interviews identify a smaller percentage of victims of PTSD than do self-report questionnaires [27]. Questionnaire results, including those that are used here, should therefore be interpreted with caution. Our results confirm earlier research, which showed that recovery from after 6 and 12 months is related to the severity of initial symptoms [3 6]. Furthermore, the present results replicated previous findings that indicated that women are overrepresented among accident victims with [3,6]. To conclude, a considerable number of individuals with were also found to suffer from

9 J. Buitenhuis et al. / Journal of Psychosomatic Research 61 (2006) posttraumatic stress symptoms. More specifically, the number of hyperarousal symptoms at 21 days after the accident was found to be related to the persistence and severity of symptoms at both 6 and 12 months follow-up. It is therefore worthwhile to consider symptoms of PTSD and anxiety in general when evaluating and treating patients with after motor vehicle accidents. Acknowledgments The authors wish to thank R.E. Stewart, MSc, for statistical advice. References [1] Barsky AJ, Borus JF. Functional somatic s. Ann Intern Med 1999;130: [2] Berry H. Chronic whiplash as a functional disorder. Arch Neurol 2000;57: [3] Buitenhuis J, Spanjer J, Fidler V. Recovery from acute whiplash: the role of coping styles. Spine 2003;28: [4] Mayou R, Bryant B. Outcome of dwhiplasht neck injury. Injury 1996;27: [5] Scholten-Peeters GG, Verhagen AP, Bekkering GE, et al. Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies. Pain 2003;104: [6] Harder S, Veilleux M, Suissa S. The effect of socio-demographic and crash-related factors on the prognosis of whiplash. J Clin Epidemiol 1998;51: [7] Jaspers JP. Whiplash and post-traumatic stress disorder. Disabil Rehabil 1998;20: [8] Brom D, Kleber RJ, Hofman MC. Victims of traffic accidents: incidence and prevention of post-traumatic stress disorder. J Clin Psychol 1993;49: [9] Mayou R, Bryant B, Duthie R. Psychiatric consequences of road traffic accidents. BMJ 1993;307: [10] Mayou RA, Black J, Bryant B. Unconsciousness, amnesia and psychiatric symptoms following road traffic accident injury. Br J Psychiatry 2000;177: [11] Versteegen GJ, Kingma J, Meijler WJ, et al. Neck sprain in patients injured in car accidents: a retrospective study covering the period Eur Spine J 1998;7: [12] Blanchard EB, Buckley TC, Hickling EJ, et al. Posttraumatic stress disorder and comorbid major depression: is the correlation an illusion? J Anxiety Disord 1998;12: [13] Blanchard EB, Hickling EJ, Freidenberg BM, et al. Two studies of psychiatric morbidity among motor vehicle accident survivors 1 year after the crash. Behav Res Ther 2004;42: [14] Blaszczynski A, Gordon K, Silove D, et al. Psychiatric morbidity following motor vehicle accidents: a review of methodological issues. Compr Psychiatry 1998;39: [15] Mayou R, Bryant B, Ehlers A. Prediction of psychological outcomes one year after a motor vehicle accident. Am J Psychiatry 2001;158: [16] Chibnall JT, Duckro PN. Post-traumatic stress disorder in chronic post-traumatic headache patients. Headache 1994;34: [17] Arntz A, de Jong PJ. Anxiety, attention and pain. J Psychosom Res 1993;37: [18] Arntz A, Dreesen L, de Jong PJ. The influence of anxiety on pain: attentional and attributional mediators. Pain 1994;56: [19] Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000;85: [20] Roelofs J, Peters ML, Vlaeyen JW. Selective attention for pain-related information in healthy individuals: the role of pain and fear. Eur J Pain 2002;6: [21] Severeijns R, Vlaeyen JW, van den Hout MA, et al. Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain 2001; 17: [22] Drottning M, Staff PH, Levin L, et al. Acute emotional response to common whiplash predicts subsequent pain complaints. Nord J Psychiatry 1995;49: [23] Sterling M, Kenardy J, Jull G, et al. The development of psychological changes following whiplash injury. Pain 2003;106: [24] Sundin EC, Horowitz MJ. Horowitz s impact of event scale evaluation of 20 years of use. Psychosom Med 2003;65: [25] Mayou R, Bryant B. Psychiatry of whiplash neck injury. Br J Psychiatry 2002;180: [26] Buitenhuis J, Jaspers JP, Fidler V. Can kinesiophobia predict the duration of neck symptoms in acute whiplash? Clin J Pain 2006;22: [27] Carlier IVE, Lamberts RD, Uchelen JJV, et al. Clinical utility of a brief diagnostic test for posttraumatic stress disorder. Psychosom Med 1998;60:42 7. [28] Davidson J, Smith R, Kudler H. Validity and reliability of the DSM-III criteria for posttraumatic stress disorder Experience with a structured interview. J Nerv Ment Dis 1989;177: [29] American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition. Washington DC7 American Psychiatric Association, [30] Ehlers A, Mayou RA, Bryant B. Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol 1998;107: [31] Osti OL, Gun RT, Abraham G, et al. Potential risk factors for prolonged recovery following whiplash injury. Eur Spine J [32] Bloom SL. The complex web of causation: motor vehicle accidents, comorbidity and PTSD. In: Hickling EJ, Blanchard EB, editors. The international handbook of road traffic accidents and psychological trauma. Oxford7 Elsevier Science Ltd, pp [33] McFarlane AC, Atchison M, Rafalowicz E, et al. Physical symptoms in post-traumatic stress disorder. J Psychosom Res 1994;38: [34] Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev 2001;21: [35] Crombez G, Eccleston C, Broeck A, et al. Hypervigilance to pain in fibromyalgia. The mediating role of pain intensity and catastrophic thinking about pain. Clin J Pain 2004;20: [36] Blanchard EB, Hickling EJ, Taylor AE, et al. Who develops PTSD from motor vehicle accidents? Behav Res Ther 1996;34:1 10. [37] Mayou R. Medical, social and legal consequences. In: Hickling EJ, Blanchard EB, editors. The international handbook of road traffic accidents and psychological trauma. Oxford7 Elsevier Science Ltd, pp [38] Swartzman LC, Teasell RW, Shapiro AP, et al. The effect of litigation status on adjustment to whiplash injury. Spine 1996;21:53 8. [39] Gun RT, Osti OL, O Riordan A, et al. Risk factors for prolonged disability after whiplash injury: a prospective study. Spine 2005;30: [40] Joslin CC, Khan SN, Bannister GC. Long-term disability after neck injury. A comparative study. J Bone Joint Surg Br 2004;86:

Relationship between post-traumatic stress disorder symptoms and the course of whiplash complaints

Relationship between post-traumatic stress disorder symptoms and the course of whiplash complaints 5 Relationship between post-traumatic stress disorder symptoms and the course of whiplash complaints J. Buitenhuis, P.J. de Jong, J.P.C. Jaspers J.W. Groothoff Published in: Journal of Psychosomatic Research

More information

Work disability after whiplash: a prospective cohort study

Work disability after whiplash: a prospective cohort study 2 Work disability after whiplash: a prospective cohort study J. Buitenhuis, P.J. de Jong, J.P.C. Jaspers, J.W. Groothoff Published in: Spine 2009;34(3):262-7 29 Chapter 2 Abstract Study Design, Objective:

More information

Catastrophizing and Causal Beliefs in Whiplash

Catastrophizing and Causal Beliefs in Whiplash Catastrophizing and Causal Beliefs in Whiplash SPINE Volume 33, Number 22, pp 2427 2433 2008, Lippincott Williams & Wilkins J. Buitenhuis, MD,* P. J. de Jong, PhD, J. P. C. Jaspers, PhD, and J. W. Groothoff,

More information

Catastrophizing and Causal Beliefs in Whiplash

Catastrophizing and Causal Beliefs in Whiplash 6 Catastrophizing and Causal Beliefs in Whiplash J. Buitenhuis, P.J. de Jong, J.P.C. Jaspers, J.W. Groothoff Published in: Spine 2008;33(22):2427 33 93 Chapter 6 Abstract Study Design, Objective: Prospective

More information

Can kinesiophobia predict the duration of neck symptoms in acute whiplash?

Can kinesiophobia predict the duration of neck symptoms in acute whiplash? 4 Can kinesiophobia predict the duration of neck symptoms in acute whiplash? J. Buitenhuis, J. Jaspers, V. Fidler Published in: The Clinical Journal of Pain 2006;22(3):272-77 57 Chapter 4 Abstract Objectives:

More information

Recovery from acute whiplash: the role of coping styles

Recovery from acute whiplash: the role of coping styles 3 Recovery from acute whiplash: the role of coping styles J. Buitenhuis, J. Spanjer, V. Fidler Published in: Spine 2003;28(9): 896 901 43 Chapter 3 Abstract Study design: Prospective cohort study. Victims

More information

Improving Health for People with Compensable Injuries. Ian Cameron University of Sydney

Improving Health for People with Compensable Injuries. Ian Cameron University of Sydney Improving Health for People with Compensable Injuries Ian Cameron University of Sydney Summary Definitions Two stories Hypothesis 1 People with compensable injuries have worse health (than people without

More information

Prognostic factors of whiplash-associated disorders: A systematic review of prospective cohort studies. Pain July 2003, Vol. 104, pp.

Prognostic factors of whiplash-associated disorders: A systematic review of prospective cohort studies. Pain July 2003, Vol. 104, pp. Prognostic factors of whiplash-associated disorders: A systematic review of prospective cohort studies 1 Pain July 2003, Vol. 104, pp. 303 322 Gwendolijne G.M. Scholten-Peeters, Arianne P. Verhagen, Geertruida

More information

Handicap after acute whiplash injury A 1-year prospective study of risk factors

Handicap after acute whiplash injury A 1-year prospective study of risk factors 1 Handicap after acute whiplash injury A 1-year prospective study of risk factors Neurology 2001;56:1637-1643 (June 26, 2001) Helge Kasch, MD, PhD; Flemming W Bach, MD, PhD; Troels S Jensen, MD, PhD From

More information

Effect of mental health on long-term recovery following a Road Traffic Crash: Results from UQ SuPPORT study

Effect of mental health on long-term recovery following a Road Traffic Crash: Results from UQ SuPPORT study 1 Effect of mental health on long-term recovery following a Road Traffic Crash: Results from UQ SuPPORT study ACHRF 19 th November, Melbourne Justin Kenardy, Michelle Heron-Delaney, Jacelle Warren, Erin

More information

ISPI Newsletter Archive - Whiplash

ISPI Newsletter Archive - Whiplash ISPI Newsletter Archive - Whiplash March 2005 Widespread Sensory Hypersensitivity Is a Feature of Chronic Whiplash - Associated Disorder but not Chronic Idiopathic Neck Pain. Clin J Pain. 2005 Mar-Apr;21

More information

WHIPLASH. Risk Factors - Prognostic Factors - Therapy. D. Verhulst,W. Jak Geneeskundige Dagen Antwerpen 11 september 2015

WHIPLASH. Risk Factors - Prognostic Factors - Therapy. D. Verhulst,W. Jak Geneeskundige Dagen Antwerpen 11 september 2015 WHIPLASH Risk Factors - Prognostic Factors - Therapy D. Verhulst,W. Jak Geneeskundige Dagen Antwerpen 11 september 2015 Definition 1995 Quebec Task Force on Whiplash Associated Disorders (WAD): Whiplash

More information

1 Risk Factors for Prolonged Disability After Whiplash Injury: A Prospective Study. Spine: Volume 30(4), February 15, 2005, pp 386-391

1 Risk Factors for Prolonged Disability After Whiplash Injury: A Prospective Study. Spine: Volume 30(4), February 15, 2005, pp 386-391 1 Risk Factors for Prolonged Disability After Whiplash Injury: A Prospective Study Spine: Volume 30(4), February 15, 2005, pp 386-391 Gun, Richard Townsend MB, BS; Osti, Orso Lorenzo MD, PhD; O'Riordan,

More information

Overview of evidence: Prognostic factors following whiplash injury

Overview of evidence: Prognostic factors following whiplash injury Overview of evidence: Prognostic factors following whiplash injury Confidence in conclusions (that an association exists) are presented in both text and graphical format, using the following legend: =

More information

ARTICLE IN PRESS. Predicting alcohol and drug abuse in Persian Gulf War veterans: What role do PTSD symptoms play? Short communication

ARTICLE IN PRESS. Predicting alcohol and drug abuse in Persian Gulf War veterans: What role do PTSD symptoms play? Short communication DTD 5 ARTICLE IN PRESS Addictive Behaviors xx (2004) xxx xxx Short communication Predicting alcohol and drug abuse in Persian Gulf War veterans: What role do PTSD symptoms play? Jillian C. Shipherd a,b,

More information

Long-term consequence of injury on self-rated health

Long-term consequence of injury on self-rated health Long-term consequence of injury on self-rated health Bjarne Laursen SAFETY2010, London September 23, 2010 Bjarne Laursen, Hanne Møller, Anne Mette Hornbek Toft National Institute of Public Health Background

More information

Using ÖMPQ to Reduce Risk of Prolonged Disability in Workers Compensation Cases

Using ÖMPQ to Reduce Risk of Prolonged Disability in Workers Compensation Cases Using ÖMPQ to Reduce Risk of Prolonged Disability in Workers Compensation Cases International Forum on Disability Management Section: Mental Health September 21, 2010 Dr. Douglas Margison, Chief Medical

More information

Overcoming the Trauma of Your Motor Vehicle Accident

Overcoming the Trauma of Your Motor Vehicle Accident Overcoming the Trauma of Your Motor Vehicle Accident Chapter 1 Introductory Information for Therapists Case Study: Mary The day had begun like any other. Mary was on her way to work early in the morning.

More information

Whiplash Associated Disorder Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice

Whiplash Associated Disorder Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice Whiplash Associated Disorder Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice PROBLEM: WHIPLASH ASSOCIATED DISORDER (WAD) Injury Impact may result in bony

More information

Health Anxiety and Hypochondriasis in Older Adults: Overlooked Conditions in a Susceptible Population

Health Anxiety and Hypochondriasis in Older Adults: Overlooked Conditions in a Susceptible Population Health Anxiety and Hypochondriasis in Older Adults: Overlooked Conditions in a Susceptible Population Presented by: Renée El-Gabalawy, M.A., Ph.D Candidate Collaborators Dr. Corey Mackenzie Associate Professor

More information

Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries

Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries 1 Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries J Bone Joint Surg (Br) 2001 Mar;83(2):226-9 Ide M, Ide J, Yamaga M, Takagi K Department of Orthopaedic Surgery, Kumamoto University

More information

Association of Objective Measures of Trauma Exposure From Motor Vehicle Accidents and Posttraumatic Stress Symptoms

Association of Objective Measures of Trauma Exposure From Motor Vehicle Accidents and Posttraumatic Stress Symptoms Journal of Traumatic Stress, Vol. 21, No. 4, August 2008, pp. 425 429 ( C 2008) BRIEF REPORT Association of Objective Measures of Trauma Exposure From Motor Vehicle Accidents and Posttraumatic Stress Symptoms

More information

Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD

Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD Definition and Criteria PTSD is unlike any other anxiety disorder. It requires that

More information

CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment

CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment This chapter offers mental health professionals: information on diagnosing and identifying the need for trauma treatment guidance in determining

More information

The Prognosis Of Neck Injuries Resulting From Rear-end Vehicle Collisions. The Journal Of Bone And Joint Surgery (British)

The Prognosis Of Neck Injuries Resulting From Rear-end Vehicle Collisions. The Journal Of Bone And Joint Surgery (British) The Prognosis Of Neck Injuries Resulting From Rear-end Vehicle Collisions 1 S. H. Norris, I. Watt FROM ABSTRACT The Journal Of Bone And Joint Surgery (British) November 1983, Vol. 65-B. No. 5 Injury of

More information

Spine Vol. 30 No. 16; August 15, 2005, pp 1799-1807

Spine Vol. 30 No. 16; August 15, 2005, pp 1799-1807 A Randomized Controlled Trial of an Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions 1 Spine Vol. 30 No. 16; August 15,

More information

General Disclaimer (learned from Dr. Melhorn)

General Disclaimer (learned from Dr. Melhorn) Mild Traumatic Brain Injury: Postconcussion Syndrome, Persistent Posttraumatic Headache, etc. Robert J. Barth, Ph.D. Chattanooga, TN and Birmingham, AL General Disclaimer (learned from Dr. Melhorn) All

More information

Understanding PTSD and the PDS Assessment

Understanding PTSD and the PDS Assessment ProFiles PUTTING ASSESSMENTS TO WORK PDS TEST Understanding PTSD and the PDS Assessment Recurring nightmares. Angry outbursts. Easily startled. These are among the many symptoms associated with Post Traumatic

More information

Overcoming the Trauma of Your Motor Vehicle Accident

Overcoming the Trauma of Your Motor Vehicle Accident Overcoming the Trauma of Your Motor Vehicle Accident Chapter 1 Introduction Case Study: Janelle Janelle s accident happened so suddenly. She was simply making a left turn as she was leaving the shopping

More information

Executive Summary. 1. What is the temporal relationship between problem gambling and other co-occurring disorders?

Executive Summary. 1. What is the temporal relationship between problem gambling and other co-occurring disorders? Executive Summary The issue of ascertaining the temporal relationship between problem gambling and cooccurring disorders is an important one. By understanding the connection between problem gambling and

More information

A PROSPECTIVE EVALUATION OF THE RELATIONSHIP BETWEEN REASONS FOR DRINKING AND DSM-IV ALCOHOL-USE DISORDERS

A PROSPECTIVE EVALUATION OF THE RELATIONSHIP BETWEEN REASONS FOR DRINKING AND DSM-IV ALCOHOL-USE DISORDERS Pergamon Addictive Behaviors, Vol. 23, No. 1, pp. 41 46, 1998 Copyright 1998 Elsevier Science Ltd Printed in the USA. All rights reserved 0306-4603/98 $19.00.00 PII S0306-4603(97)00015-4 A PROSPECTIVE

More information

Summary. Pediatric traffic injuries: consequences for the child and the parents

Summary. Pediatric traffic injuries: consequences for the child and the parents Summary Pediatric traffic injuries: consequences for the child and the parents Injuries constitute an important health problem among children and adolescents, not only because they can be life threatening,

More information

indicates that the relationship between psychosocial distress and disability in patients with CLBP is not uniform.

indicates that the relationship between psychosocial distress and disability in patients with CLBP is not uniform. Chronic low back pain (CLBP) is one of the most prevalent health problems in western societies. The prognosis of CLBP is poor, as indicated by very low rate of resolution, even with treatment. In CLBP,

More information

Soft-tissue injuries of the neck in automobile accidents: Factors influencing prognosis

Soft-tissue injuries of the neck in automobile accidents: Factors influencing prognosis Soft-tissue injuries of the neck in automobile accidents: Factors influencing prognosis 1 Mason Hohl, MD FROM ABSTRACT: Journal of Bone and Joint Surgery (American) December 1974;56(8):1675-1682 Five years

More information

Management of Concussion/Mild Traumatic Brain Injury - Evidence Based Practice

Management of Concussion/Mild Traumatic Brain Injury - Evidence Based Practice Management of Concussion/Mild Traumatic Brain Injury - Evidence Based Practice Introduction 1) The Centers for Disease Control and Prevention has estimated that each year, approximately Americans survive

More information

PTSD IN PRIMARY CARE. Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington

PTSD IN PRIMARY CARE. Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington PTSD IN PRIMARY CARE Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington What to expect today? Defining and assessing PTSD Approach for doing differential

More information

The relationship among alcohol use, related problems, and symptoms of psychological distress: Gender as a moderator in a college sample

The relationship among alcohol use, related problems, and symptoms of psychological distress: Gender as a moderator in a college sample Addictive Behaviors 29 (2004) 843 848 The relationship among alcohol use, related problems, and symptoms of psychological distress: Gender as a moderator in a college sample Irene Markman Geisner*, Mary

More information

WHAT IS PTSD? A HANDOUT FROM THE NATIONAL CENTER FOR PTSD BY JESSICA HAMBLEN, PHD

WHAT IS PTSD? A HANDOUT FROM THE NATIONAL CENTER FOR PTSD BY JESSICA HAMBLEN, PHD WHAT IS PTSD? A HANDOUT FROM THE NATIONAL CENTER FOR PTSD BY JESSICA HAMBLEN, PHD Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur following the experience or witnessing of a

More information

Objectives. Significant Costs Of Chronic Pain. Pain Catastrophizing. Pain Catastrophizing. Pain Catastrophizing

Objectives. Significant Costs Of Chronic Pain. Pain Catastrophizing. Pain Catastrophizing. Pain Catastrophizing Effectiveness of a Comprehensive Pain Rehabilitation Program in the Reduction of Pain Catastrophizing Michele Evans, MS, APRN-C, CNS, March 27, 2007 Mayo Foundation for Medical Education and Research (MFMER).

More information

PTSD, Opioid Dependence, and EMDR: Treatment Considerations for Chronic Pain Patients

PTSD, Opioid Dependence, and EMDR: Treatment Considerations for Chronic Pain Patients PTSD, Opioid Dependence, and EMDR: Treatment Considerations for Chronic Pain Patients W. Allen Hume, Ph.D.,C.D.P. Licensed Psychologist www.drallenhume.com October 2, 2007 COD client with PTSD seeking

More information

C HAPTER 9 T RAUMA AND P OST-TRAUMATIC S TRESS D ISORDER IN P ATIENTS W ITH HIV/AIDS

C HAPTER 9 T RAUMA AND P OST-TRAUMATIC S TRESS D ISORDER IN P ATIENTS W ITH HIV/AIDS C HAPTER 9 T RAUMA AND P OST-TRAUMATIC S TRESS D ISORDER IN P ATIENTS W ITH HIV/AIDS Exposure to a traumatic event is normally accompanied by distress. For most individuals such distress resolves spontaneously

More information

THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL

THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL AFL Research board AFL MEDICAL OFFICERS' ASSOCIATION THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL This document has been published by the AFL

More information

Reduced or painful jaw movement after collision-related injuries A large population-based study

Reduced or painful jaw movement after collision-related injuries A large population-based study Reduced or painful jaw movement after collision-related injuries A large population-based study 1 Journal of the American Dental Association January 2007, Vol. 138, No. 1, pp. 86-93 Linda J. Carroll, PhD,

More information

Whiplash Associated Disorder

Whiplash Associated Disorder Whiplash Associated Disorder The pathology Whiplash is a mechanism of injury, consisting of acceleration-deceleration forces to the neck. Mechanism: Hyperflexion/extension injury Stationary vehicle hit

More information

Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario

Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario Page 1 Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario Injury Descriptions Developed from Newfoundland claim study injury definitions No injury Death Psychological

More information

W hiplash is essentially a symptom complex which has

W hiplash is essentially a symptom complex which has 1146 PAPER Whiplash following rear end collisions: a prospective cohort study L H Pobereskin... J Neurol Neurosurg Psychiatry 2005;76:1146 1151. doi: 10.1136/jnnp.2004.049189... Correspondence to: Dr Louis

More information

Medical Report Prepared for The Court on

Medical Report Prepared for The Court on Medical Report Prepared for The Court on Mr Sample Report Claimant's Address Claimant's Date of Birth Instructing Party Instructing Party Address Instructing Party Ref Solicitors Ref Corex Ref 1 The Lane

More information

Non-replication of interaction between cannabis use and trauma in predicting psychosis. & Jim van Os

Non-replication of interaction between cannabis use and trauma in predicting psychosis. & Jim van Os Non-replication of interaction between cannabis use and trauma in predicting psychosis Rebecca Kuepper 1, Cécile Henquet 1, 3, Roselind Lieb 4, 5, Hans-Ulrich Wittchen 4, 6 1, 2* & Jim van Os 1 Department

More information

Early Response Concussion Recovery

Early Response Concussion Recovery Early Response Concussion Recovery KRISTA MAILEY, BSW RSW, CONCUSSION RECOVERY CONSULTANT CAREY MINTZ, PH.D., C. PSYCH., PRACTICE IN CLINICAL NEUROPSYCHOLOGY FOR REFERRAL: Contact Krista Mailey at (204)

More information

Pragmatic Evidence Based Review Substance Abuse in moderate to severe TBI

Pragmatic Evidence Based Review Substance Abuse in moderate to severe TBI Pragmatic Evidence Based Review Substance Abuse in moderate to severe TBI Reviewer Emma Scheib Date Report Completed November 2011 Important Note: This report is not intended to replace clinical judgement,

More information

Cognitive Behavioral Therapy for PTSD. Dr. Edna B. Foa

Cognitive Behavioral Therapy for PTSD. Dr. Edna B. Foa Cognitive Behavioral Therapy for PTSD Presented by Dr. Edna B. Foa Center for the Treatment and Study of Anxiety University of Pennsylvania Ref # 3 Diagnosis of PTSD Definition of a Trauma The person has

More information

Medical aspects of Whiplash. and Minimal Impact Injuries

Medical aspects of Whiplash. and Minimal Impact Injuries Medical aspects of Whiplash and Minimal Impact Injuries ROBERT F. MCQUILLAN FRCSEd FFEM Embedded PowerPoint Video By PresenterMedia.com SIU TRAINING 29 TH APRIL 2015 Get ΔV from engineer Various interpretations

More information

This is a published version of a paper published in Rehabilitation Research and Practice.

This is a published version of a paper published in Rehabilitation Research and Practice. Umeå University This is a published version of a paper published in Rehabilitation Research and Practice. Citation for the published paper: Stålnacke, B. (2012) "Postconcussion symptoms in patients with

More information

12,6($&&,'(1760,125,1-85,(6$1'&2*1,7,9()$,/85(6

12,6($&&,'(1760,125,1-85,(6$1'&2*1,7,9()$,/85(6 12,6($&&,'(1760,125,1-85,(6$1'&2*1,7,9()$,/85(6 A.P. Smith Centre for Occupational and Health Psychology, Cardiff University, UK,QWURGXFWLRQ Smith (1990) reviewed studies of the effects of noise on accidents.

More information

FACT SHEET. What is Trauma? TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS

FACT SHEET. What is Trauma? TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS FACT SHEET TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS According to SAMHSA 1, trauma-informed care includes having a basic understanding of how trauma affects the life of individuals seeking

More information

Trauma Center Assessment Package

Trauma Center Assessment Package Page 1 of 8 Last Updated March, 2011 Trauma Center Assessment Package The Trauma Center has developed a package of self-administered questionnaires that assess psychological traumas and their sequelae,

More information

Frequent headache is defined as headaches 15 days/month and daily. Course of Frequent/Daily Headache in the General Population and in Medical Practice

Frequent headache is defined as headaches 15 days/month and daily. Course of Frequent/Daily Headache in the General Population and in Medical Practice DISEASE STATE REVIEW Course of Frequent/Daily Headache in the General Population and in Medical Practice Egilius L.H. Spierings, MD, PhD, Willem K.P. Mutsaerts, MSc Department of Neurology, Brigham and

More information

Outcome of in-patient Treatment for Severe Motor Conversion Disorder - does it work? A.S.David, R.McCormack and Lishman Unit MDT

Outcome of in-patient Treatment for Severe Motor Conversion Disorder - does it work? A.S.David, R.McCormack and Lishman Unit MDT Outcome of in-patient Treatment for Severe Motor Conversion Disorder - does it work? A.S.David, R.McCormack and Lishman Unit MDT Evidence to date: inpatient rehab Inpatient multi-disciplinary intervention

More information

Risk Factors for Alcoholism among Taiwanese Aborigines

Risk Factors for Alcoholism among Taiwanese Aborigines Risk Factors for Alcoholism among Taiwanese Aborigines Introduction Like most mental disorders, Alcoholism is a complex disease involving naturenurture interplay (1). The influence from the bio-psycho-social

More information

Is manual physical therapy more effective than other physical therapy approaches in reducing pain and disability in adults post whiplash injury?

Is manual physical therapy more effective than other physical therapy approaches in reducing pain and disability in adults post whiplash injury? Is manual physical therapy more effective than other physical therapy approaches in reducing pain and disability in adults post whiplash injury? Clinical Bottom Line Manual therapy may have a role in the

More information

A comparison of complaints by mild brain injury claimants and other claimants describing subjective experiences immediately following their injury

A comparison of complaints by mild brain injury claimants and other claimants describing subjective experiences immediately following their injury Archives of Clinical Neuropsychology 16 (2001) 689 695 A comparison of complaints by mild brain injury claimants and other claimants describing subjective experiences immediately following their injury

More information

Capita Clinical Conference Whiplash Injury and Medico-Legal reporting Tuesday 10 June 2014

Capita Clinical Conference Whiplash Injury and Medico-Legal reporting Tuesday 10 June 2014 Capita Clinical Conference Whiplash Injury and Medico-Legal reporting Tuesday 10 June 2014 Martin Gargan Consultant Orthopaedic Surgeon Law Other Medicine Common aims Prevent injury Treat injured Compensate

More information

MOTOR VEHICLE COMPENSATION CLAIM SUCCESS

MOTOR VEHICLE COMPENSATION CLAIM SUCCESS MOTOR VEHICLE COMPENSATION CLAIM SUCCESS 6 WAYS TO RUIN YOUR MOTOR VEHICLE COMPENSATION CLAIM 6 WAYS TO RUIN YOUR MOTOR VEHICLE COMPENSATION CLAIM In this guide, we have outlined the 6 most common ways

More information

DSM-5: A Comprehensive Overview

DSM-5: A Comprehensive Overview 1) The original DSM was published in a) 1942 b) 1952 c) 1962 d) 1972 DSM-5: A Comprehensive Overview 2) The DSM provides all the following EXCEPT a) Guidelines for the treatment of identified disorders

More information

Mid-term follow up of whiplash with Bournemouth Questionnaire: The significance of the initial

Mid-term follow up of whiplash with Bournemouth Questionnaire: The significance of the initial Mid-term follow up of whiplash with Bournemouth Questionnaire: The significance of the initial depression to pain outcome Introduction Symptoms from Whiplash Associated Disorder (WAD) impair patients quality

More information

Compassionate Allowance Outreach Hearing on Brain Injuries. Social Security Administration. November 18, 2008. Statement of

Compassionate Allowance Outreach Hearing on Brain Injuries. Social Security Administration. November 18, 2008. Statement of Compassionate Allowance Outreach Hearing on Brain Injuries Social Security Administration November 18, 2008 Statement of Jerome E. Herbers, Jr., M.D. Office of Healthcare Inspections Office of Inspector

More information

Anxiety Sensitivity 1

Anxiety Sensitivity 1 Anxiety Sensitivity 1 ANXIETY SENSITIVITY What You Should Know About Anxiety Sensitivity Margo C. Watt a,b & Sherry H. Stewart c,b Submitted to Strides August 2009 a Department of Psychology, Saint Francis

More information

Uncertainty: Was difficulty falling asleep and hypervigilance related to fear of ventricular tachycardia returning, or fear of being shocked again?

Uncertainty: Was difficulty falling asleep and hypervigilance related to fear of ventricular tachycardia returning, or fear of being shocked again? Manuel Tancer, MD Chart Review: PTSD PATIENT INFO 55 Age: Background: Overweight nurse with 6-month history of nightmares, hyperarousal, and flashbacks; symptoms began after implanted defibrillator was

More information

Rede ning medical students' disease to reduce morbidity

Rede ning medical students' disease to reduce morbidity Research papers Rede ning medical students' disease to reduce morbidity Rona Moss-Morris & Keith J Petrie Objectives To gain a clearer conceptual understanding of medical students' disease and its impact

More information

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí=

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= `çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= Overview: Common Mental What are they? Disorders Why are they important? How do they affect

More information

It is now well established that posttraumatic stress disorder

It is now well established that posttraumatic stress disorder Article Posttraumatic Stress Disorder and Depression Following Trauma: Understanding Comorbidity Meaghan L. O Donnell, Ph.D. Mark Creamer, Ph.D. Phillipa Pattison, Ph.D. Objective: Posttraumatic stress

More information

Psychological Impact of Disasters Clinical and General Approaches

Psychological Impact of Disasters Clinical and General Approaches Psychological Impact of Disasters Clinical and General Approaches Dr.V.D.Swaminathan Professor of Psychology & Director in charge University Students Advisory Bureau, University of Madras Disaster means

More information

Annotations for Determining Non-Secondary Psychiatric Impairment

Annotations for Determining Non-Secondary Psychiatric Impairment Annotations for Determining Non-Secondary Psychiatric Impairment Dr Michael Epstein and Dr Nigel Strauss December 2005 Annotations for Determining Non-Secondary Psychiatric Impairment Page 1 of 12 Annotations

More information

BODY STRESSING INJURIES. Key messages for rehabilitation providers

BODY STRESSING INJURIES. Key messages for rehabilitation providers BODY STRESSING INJURIES Key messages for rehabilitation providers CONTENTS BACKGROUND 4 DELAYS IN PROVIDING REHABILITATION OR RETURN TO WORK ASSISTANCE TO EMPLOYEES INJURED AT WORK 6 DELAYS IN LODGING

More information

BODY STRESSING INJURIES. Key messages for rehabilitation providers

BODY STRESSING INJURIES. Key messages for rehabilitation providers BODY STRESSING INJURIES Key messages for rehabilitation providers CONTENTS BACKGROUND 4 DELAYS IN PROVIDING REHABILITATION OR RETURN TO WORK ASSISTANCE TO EMPLOYEES INJURED AT WORK 6 DELAYS IN LODGING

More information

TITLE: Cannabinoids for the Treatment of Post-Traumatic Stress Disorder: A Review of the Clinical Effectiveness and Guidelines

TITLE: Cannabinoids for the Treatment of Post-Traumatic Stress Disorder: A Review of the Clinical Effectiveness and Guidelines TITLE: Cannabinoids for the Treatment of Post-Traumatic Stress Disorder: A Review of the Clinical Effectiveness and Guidelines DATE: 01 December 2009 CONTEXT AND POLICY ISSUES: Post-traumatic stress disorder

More information

Healing the Invisible Wound. Recovery and Rehabilitation from a Post Traumatic. Stress Injury. By Dr. Amy Menna

Healing the Invisible Wound. Recovery and Rehabilitation from a Post Traumatic. Stress Injury. By Dr. Amy Menna Healing the Invisible Wound Recovery and Rehabilitation from a Post Traumatic Stress Injury By Dr. Amy Menna Post Traumatic Stress Disorder can affect anyone. It is a term used to describe a reaction to

More information

Skate Australia Concussion Guidelines

Skate Australia Concussion Guidelines Skate Australia Concussion Guidelines Introduction Forces strong enough to cause concussion are common in all roller sports. Even though helmets are worn in most disciplines, the risk of concussion is

More information

Acute Stress Disorder and Posttraumatic Stress Disorder

Acute Stress Disorder and Posttraumatic Stress Disorder Acute Stress Disorder and Posttraumatic Stress Disorder Key Messages Traumatic Events Events that involve actual or threatened death or serious injury (real or perceived) to self or others (e.g., accidents,

More information

Bodily Distress Syndrome (BDS)

Bodily Distress Syndrome (BDS) Bodily Distress Syndrome (BDS) Patient drawing of her symptoms (Fatigue, dizziness, memory impairment, concentration difficulty, headache, migraine, insomnia, vomiting, muscular pain, nausea, feeling seedy,

More information

Post-Traumatic Stress Disorder (PTSD) and TBI. Kyle Haggerty, Ph.D.

Post-Traumatic Stress Disorder (PTSD) and TBI. Kyle Haggerty, Ph.D. Post-Traumatic Stress Disorder (PTSD) and TBI Kyle Haggerty, Ph.D. Learning Objects What is Brain Injury What is PTSD Statistics What to Rule Out PTSD and TBI Treatment Case Study What is Brain Injury

More information

A Review of Conduct Disorder. William U Borst. Troy State University at Phenix City

A Review of Conduct Disorder. William U Borst. Troy State University at Phenix City A Review of 1 Running head: A REVIEW OF CONDUCT DISORDER A Review of Conduct Disorder William U Borst Troy State University at Phenix City A Review of 2 Abstract Conduct disorders are a complicated set

More information

THE PHYSIO CENTRE. Motor Vehicle Accident. Instructions for Completing the Forms in this package

THE PHYSIO CENTRE. Motor Vehicle Accident. Instructions for Completing the Forms in this package THE PHYSIO CENTRE Motor Vehicle Accident Instructions for Completing the Forms in this package There are 2 forms enclosed in this package which are required for patients under MVA coverage. 1. Agree To

More information

Extended Abstract. Evaluation of satisfaction with treatment for chronic pain in Canada. Marguerite L. Sagna, Ph.D. and Donald Schopflocher, Ph.D.

Extended Abstract. Evaluation of satisfaction with treatment for chronic pain in Canada. Marguerite L. Sagna, Ph.D. and Donald Schopflocher, Ph.D. Extended Abstract Evaluation of satisfaction with treatment for chronic pain in Canada Marguerite L. Sagna, Ph.D. and Donald Schopflocher, Ph.D. University of Alberta Introduction For millions of people

More information

Non-epileptic seizures

Non-epileptic seizures Non-epileptic seizures a short guide for patients and families Information for patients Department of Neurology Royal Hallamshire Hospital What are non-epileptic seizures? In a seizure people lose control

More information

The relation between initial symptoms and signs and the prognosis of whiplash

The relation between initial symptoms and signs and the prognosis of whiplash Eur Spine J (2001) 10 :44 49 DOI 10.1007/s005860000220 ORIGINAL ARTICLE Samy Suissa Susan Harder Martin Veilleux The relation between initial symptoms and signs and the prognosis of whiplash Received:

More information

HOW TO ASSESS AND COMPENSATE PSYCHIATRIC INJURIES IN THE WORKPLACE Grace Lawson 1

HOW TO ASSESS AND COMPENSATE PSYCHIATRIC INJURIES IN THE WORKPLACE Grace Lawson 1 1 HOW TO ASSESS AND COMPENSATE PSYCHIATRIC INJURIES IN THE WORKPLACE Grace Lawson 1 Introduction Mental illness has become a major health problem in Australia. Work-related mental injuries have also become

More information

With Depression Without Depression 8.0% 1.8% Alcohol Disorder Drug Disorder Alcohol or Drug Disorder

With Depression Without Depression 8.0% 1.8% Alcohol Disorder Drug Disorder Alcohol or Drug Disorder Minnesota Adults with Co-Occurring Substance Use and Mental Health Disorders By Eunkyung Park, Ph.D. Performance Measurement and Quality Improvement May 2006 In Brief Approximately 16% of Minnesota adults

More information

Accident/Assault/ Road Traffic Accident Questionnaire

Accident/Assault/ Road Traffic Accident Questionnaire It is important that you provide as much information as you can remember. Where specific dates are unknown, please give approximations. Please use the section on the back page for any additional notes.

More information

Whiplash. Whiplash is part of our modern lives. One in 200 of us will suffer from it at some point but it is rarely serious.

Whiplash. Whiplash is part of our modern lives. One in 200 of us will suffer from it at some point but it is rarely serious. Whiplash www.physiofirst.org.uk Whiplash is part of our modern lives. One in 200 of us will suffer from it at some point but it is rarely serious. Most people make a full return to health. What you do

More information

PSYCHOLOGICAL DISORDERS AS CONSEQUENCES OF INVOLVEMENT IN MOTOR VEHICLE ACCIDENTS: A DISCUSSION AND RECOMMENDATIONS FOR A RESEARCH PROGRAM

PSYCHOLOGICAL DISORDERS AS CONSEQUENCES OF INVOLVEMENT IN MOTOR VEHICLE ACCIDENTS: A DISCUSSION AND RECOMMENDATIONS FOR A RESEARCH PROGRAM PSYCHOLOGICAL DISORDERS AS CONSEQUENCES OF INVOLVEMENT IN MOTOR VEHICLE ACCIDENTS: A DISCUSSION AND RECOMMENDATIONS FOR A RESEARCH PROGRAM Warren A Harrison Report No. 153 May 1999 Monash University Accident

More information

Taking Care: Child and Youth Mental Health ANXIETY WHAT IS IT?

Taking Care: Child and Youth Mental Health ANXIETY WHAT IS IT? Taking Care: Child and Youth Mental Health ANXIETY WHAT IS IT? Open Learning Agency 2004 WHAT IS IT? Anxiety is a normal human feeling characterized by worry, nervousness and fear. Not only does anxiety

More information

Cervical Whiplash: Considerations in the Rehabilitation of Cervical Myofascial Injury. Canadian Family Physician

Cervical Whiplash: Considerations in the Rehabilitation of Cervical Myofascial Injury. Canadian Family Physician Cervical Whiplash: Considerations in the Rehabilitation of Cervical Myofascial Injury 1 Canadian Family Physician Volume 32, September 1986 Arthur Ameis, MD Dr. Ames practices physical medicine and rehabilitation,

More information

Post Traumatic Stress Disorder & Substance Misuse

Post Traumatic Stress Disorder & Substance Misuse Post Traumatic Stress Disorder & Substance Misuse Produced and Presented by Dr Derek Lee Consultant Chartered Clinical Psychologist Famous Sufferers. Samuel Pepys following the Great Fire of London:..much

More information

Predictors of recovery and legal representation in a compensation setting 12 months post injury: The Whiplash Outcome Study [WOS]

Predictors of recovery and legal representation in a compensation setting 12 months post injury: The Whiplash Outcome Study [WOS] Predictors of recovery and legal representation in a compensation setting 12 months post injury: The Whiplash Outcome Study [WOS] Petrina Casey [PhD candidate], Rehabilitation Studies Unit, Sydney Medical

More information

Psychotherapeutic Interventions for Children Suffering from PTSD: Recommendations for School Psychologists

Psychotherapeutic Interventions for Children Suffering from PTSD: Recommendations for School Psychologists Psychotherapeutic Interventions for Children Suffering from PTSD: Recommendations for School Psychologists Julie Davis, Laura Lux, Ellie Martinez, & Annie Riffey California Sate University Sacramento Presentation

More information

Audit on treatment and recovery of ankle sprain

Audit on treatment and recovery of ankle sprain Hong Kong Journal of Emergency Medicine Audit on treatment and recovery of ankle sprain WY Lee Study Objectives: The object of this study is to audit the care of ankle sprain of different severity and

More information

Initial Evaluation for Post-Traumatic Stress Disorder Examination

Initial Evaluation for Post-Traumatic Stress Disorder Examination Initial Evaluation for Post-Traumatic Stress Disorder Examination Name: Date of Exam: SSN: C-number: Place of Exam: The following health care providers can perform initial examinations for PTSD. a board-certified

More information

Whiplash: a review of a commonly misunderstood injury

Whiplash: a review of a commonly misunderstood injury 1 Whiplash: a review of a commonly misunderstood injury The American Journal of Medicine; Volume 110; 651-656; June 1, 2001 Jason C. Eck, Scott D. Hodges, S. Craig Humphreys This review article has 64

More information

Henriëtte van der Horst VUmc Head of Department of General Practice and Elderly Care Medicine

Henriëtte van der Horst VUmc Head of Department of General Practice and Elderly Care Medicine MUS and psychiatry in primary care Henriëtte van der Horst VUmc Head of Department of General Practice and Elderly Care Medicine Double Dutch: two topics Major changes in the mental health care organisation

More information