Alternative MethodsConventional Methods


March 29

Concussions: A Growing Psychiatric Epidemic

Grace Armstrong
Core Spirit member since Dec 24, 2020
Reading time 3 min.

Also known as “concussion,” chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease believed to be the result of multiple mild traumatic brain injuries (mTBIs).

CTE was first described by Martland in 1928 as being “punch drunk,” a syndrome of confusion and ataxia in boxers having suffering repeated blows to the head.1 In 1937, Millspaugh described “dementia pugilistica,” symptoms of cognitive and motor dysfunction, once again mainly observed in boxers.

The term “chronic traumatic encephalopathy” was first coined by Miller in 1966 to encompass the mood, cognitive, and motor dysfunctions of dementia pugilistica.3 In 1973, Corsellis introduced a pattern separating CTE from other neurodegenerative diseases.

The modern definition of CTE was brought to the national spotlight by the case studies of Omalu et al. that highlighted neuropsychiatric and neuropathologic changes in National Football League (NFL) players,5 inspiring the movie “Concussion.” This article focuses on CTE in American football and why it is of importance to psychiatrists and mental health professionals.

Epidemiology and Risk Factors

The most common risk factor across case studies of CTE is a history of at least one mTBI. Onset generally occurs in mid-life, usually after retirement from professional play.6 Timing is variable, given the heterogeneity of career length among NFL players; many begin their careers in junior high school, but some start at the tender age of 6.

Of 1.2 million interscholastic football players in any given year, up to 5.6% sustain an mTBI. The majority (53%) of cases, however, remain unreported to medical personnel.

Although the literature supports a correlation between repeated mTBIs and CTE, definitive causation has not been determined.9 Still, 63% to 71% of players with repetitive mTBIs eventually develop CTE.

Among NFL players, the reported prevalence of CTE ranges from 3.7%6 to 90%.10 This disparity is largely due to disagreement among clinicians regarding what constitutes an mTBI, and the consequences faced by NFL players, their coaches, equipment managers, and team clinicians reporting them.

Players who are running-backs, begin play before age 12, and have a history of previous mTBI are at a high risk of re-injury.12 A relationship between number of years played, development of CTE, and the stage of phosphorylated Tau (pTau) pathology has also been suggested.

Retired NFL players who have had 3 or more mTBIs have a 5-fold increased risk for mild cognitive impairment, and 3-fold higher risk for depression. The APOE ε4 genotype increases the risk for cognitive impairment in CTE.

Pathophysiologic Features

Evidence suggests that repetitive disturbance of axons along with altered neurotransmission is linked to widespread glutamate release, ionic fluxes, and metabolic uncoupling.15 These changes may generate a chain of events leading to CTE.

Animal models have shown decreased serum and cerebrospinal fluid (CSF) levels and activity of tissue-nonspecific alkaline phosphatase (TNAP), an enzyme that dephosphorylates the p-Tau protein essential for microtubule assembly. Accumulation of p-Tau eventually causes neuronal death.

A recent consensus conference defined the irregular pattern of p-Tau immunoreactivity deposition surrounding microvasculature in the depths of cortical sulci as pathognomonic for CTE, a distinction from other tauopathies.

Supportive features include abnormal p-Tau neurofibrillary tangles (NFTs) distributed in layers I-II of the cortex; p-Tau thorn-like astrocytes in the subpial and periventricular regions of the cortex; pretangles, extracellular tangles, or NFTs; and dendritic swellings in the hippocampus.

Also supportive of CTE are dot-like structures and TDP-43 immunoreactive neuronal inclusions in the antromedial temporal cortex, amygdala, and the hippocampus, as well as septal abnormalities, atrophy of mammillary bodies, and third ventricle dilation.17 Staging for CTE pathology has been proposed.

There are some similarities between Alzheimer’s disease (AD) and CTE, suggesting a separate classification of CTE-AD; the presence of Aβ plaques correlates with more severe p-Tau pathology and advanced stages and clinical presentations.

Plaques in CTE-AD are more likely to be found within the sulci, contrasting with the gyral depositions observed in AD. Death tends to occur 10 years earlier, suggesting that repetitive mTBI may accelerate and change the deposition and accumulation of Aβ; presence of Aβ plaques may correlate with CTE progression and may speed up the aging process of the brain. The presence of Aβ plaques is believed to increase the odds of developing cognitive dysfunction in CTE by 4.5 times in individuals with Aβ pathology.

Although CTE cannot currently be diagnosed via imaging, there are a few PET ligands for p-Tau that show some promise. DPA-713 has detected TBI-related neuronal inflammation in 9 former NFL players with clinically-suspected CTE. The PiB amyloid ligand is also being investigated for utility in PET neuroimaging.

Image 1 depicts the different stages of CTE.

Neuropsychiatric Symptoms

The average age of symptom onset is between 30 and 64 years of age. Within the first 48 hours to 2 weeks after an mTBI, cognitive deficits are common.20 Four stages of neuropsychiatric symptoms were proposed in 201310, and are similar to the posthumous progression described in 2011 by Omalu et al.5

Stage I symptoms include memory loss, executive dysfunction, difficulty concentrating, inattention, aggression, depression, explosivity, and suicidality. Headache is fairly common. At this stage, very few individuals will see a psychiatrist.

by Psychiatry Advisor

Comments

Leave your questions here

To write a comment you must
or
Services
Category filter
Concern filter
Type filter
Sort
 
All categories
Oracle Cards Reading
$22 USD
Clarity Session

Hello from Eclectic Healing & Wellness. Thank you for this oppitunity to connect with you. This private clarity sessoon we will take a deep dive to discov…

Tyisha Morris
United States of America flag icon
Spiritual Healing
$270 USD
One-On-One Healing Session

I connect with your higher self/soul to channel the messages, blockages, guidance you need to hear for all life issues. From chronic pain, anxiety, depression,…

Dawn Cady
Australia flag icon
Wellness Coaching
$10 USD
Your Missing Manual for Health & Life!

Are you constantly reading books, blogs and listening to podcasts trying to figure out what to do to be healthy?

With so much conflicting information out ther…

Pamela Malo
United States of America flag icon
Positive Psychology
$10 USD
Initial Video Consult

Explore the fit and hear how I would address your therapeutic goal

Alex Guthrie, LMFT
United States of America flag icon
Spiritual Healing
$10 USD
HEALING / Life- Coaching Session

When you aren’t sure which way to turn or who to turn to for help in making decisions, I will help you come home to yourself and forge a plan to manifest your …

Dr. Michele S. Zirkle
United States of America flag icon
Life Coaching
$50 USD
Transformative Coaching Session

You will receive a private 1:1 transformative coaching session, focused on the area(s) in your life which you are most looking to improve, expand, and/or trans…

Tyisha Morris
United States of America flag icon
Tarot Reading
$10 USD
Tarot Reading - Checking in with the universe

“What does the universe want me to know?” is a common question. During uncertain times, it may be difficult to identify a single topic to focus upon. During th…

Jessica Karels
United States of America flag icon
Personal Development Coaching
$120 USD
Spiritual Life Coach Session-Personalized Session

Personalized Sessions

Because Everyone Is Unique

Sessions are based on the area of focus requested by the client.

Each session is a LIVE Session Goals will…

Deborah Lucero
United States of America flag icon
Chakra Balancing
$60 USD
Soul To Soul Reading Session

Energetic Reading

Complete Chakra System Reading to identify energy blocks. Techniques are provided to restore balance.

What Is An Energetic Reading?

Debo…

Deborah Lucero
United States of America flag icon
Channeling
$50 USD
Healing guidance session

You prepare your questions and I channel the root cause of the issue, as easy as that!

Every session looks different. We dive deep into the root and heal it f…

Nanna
5
Sweden flag icon
Spiritual Healing
$20 USD
Compassionate energy healing

For those times when we feel we need the energetic space to let our whole being restore itself. The healing is meant to give you a sense of safety and feel lik…

Nanna
Sweden flag icon
Distance Healing
$10 USD
Reiki and Energy Healing (Distant)

Reiki and energy healing is done by distance while a client is resting and the practitioner sends healing energy to the client. Clients have found that the en…

Beverly Lynn
Canada flag icon
Spiritual Healing
$80 USD
Soul Healing and Spiritual Advice

If you need a change in your life, if you are stuck and really want to move forward, if you see unwanted repeated patterns of life events or people’s behaviour…

Yavenirie - Spiritual Witchery Practice and…
United Kingdom of Great Britain and Northern Ireland flag icon
Spiritual Healing
$10 USD
Initial consultation for Spiritual Advice or Soul Healing Journey

You can book an initial spiritual consultation with me to touch base on your struggles and ways we can work together. The session will be online for around 15 …

Yavenirie - Spiritual Witchery Practice and…
United Kingdom of Great Britain and Northern Ireland flag icon
Shamanic Healing
$10 USD
Light the Path to Your Desired Life

If you want find what is that in life that makes you happy and fulfilled you need to heal all levels of your existence- Body, Mind, and Spirit. We are all ener…

Change Naturopathy
New Zealand flag icon
Emotional Freedom Technique
$10 USD
The Power Of Emotional Healing - EFT Program

“The Power of Emotional Healing” is energy psychology education in the Emotional Freedom Technique with the perfect balance of information, instructions, video…

Dawn Cady
Australia flag icon
Art Therapy
$50 USD
Artist Teacher Workshop Or Tutoring

“Life Force” guiding our history, our body and spirits. Self portrait art, life drawing from the live model, gesture, and plein air painting. And extended cont…

Bryan Prillwitz
United States of America flag icon
Tarot Reading
$100 USD
Timeline Reading

EGYPTIAN TAROT READINGS using unique methods developed by Nelise Carbonare, a Brazilian healer with more than 40 years of experience in tarot consultations, as…

Nelise Carbonare
United States of America flag icon
Tarot Reading
$120 USD
THE SYNERGY OF THE PYRAMID

THE SYNERGY OF THE PYRAMID focuses on a specific relationship: One side for the consultant and one for their partner. (the partner does not need to be present …

Nelise Carbonare
United States of America flag icon
Tarot Reading
$10 USD
Pick one card

Many questions can be answer with just one Arcane.

Do you want to try?

Nelise Carbonare
United States of America flag icon
Personal Development Coaching
$50 USD
Spiritual Coaching - Removing Energy Blocks - Expansion

> “Who looks outside dreams. Who looks inside awakens.” Jung

Spiritual coaching is about moving you into a profound state of empowerment and involution m…

Kimla Rose (Kim Desrosiers)
United States of America flag icon
Life Coaching
$10 USD
Life Purpose and Soul Wisdom

What is your deeper truth, your deeper knowing, your MOJO, your deepest desires, those feelings that you can’t explain but that are so pure and so clear…or may…

Anna Beale
United States of America flag icon
Nutritional Therapy
$150 USD
Nutritional Therapy Consultation

Hi my name is Aria and I am the founder of Heal with Nutrition. I am a registered Nutritional Therapist and a Naturopath who has a passion on Nutrition and Hea…

Aria Alexandrou
United Kingdom of Great Britain and Northern Ireland flag icon
Tarot Reading
$10 USD
THOTH AND HERMETIC DECKS READING

With a deep knowledge of hermeticism and being introduced to the kabbalah tradition of the emanation process from the tree of life, I provide a deep insight co…

James Marchiori
Ireland flag icon

Related Articles