Posttraumatic Subsyndrome in CHIT (PTCHITS)

The post-traumatic subsyndrome represents a spectrum of posttraumatic symptoms commonly referred to within the context of DSM IV as acute stress disorder and post- traumatic stress disorder. This constellation of symptoms is considered functional in nature and represents a psychological reactivity to the traumatic event. It is assumed that when an individual experiences trauma to the head during an event such as assault, moving vehicle accident, slip & fall, or other traumatic circumstances, there is the potential, inherent in these situations, for the development of predictable characteristic symptoms considered to be posttraumatic in nature.

The primary basis for the development of posttraumatic symptoms is a functional response by the individual to the traumatic event. There may be other physical findings associated with the event that may occur as a consequence of the trauma, but these are considered secondary with respect to etiology. It is obviously of clinical importance for the clinician to differentiate post-traumatic subsyndrome from postconcussive subsyndrome. While many patients with postconcussive symptoms also may develop posttraumatic symptoms, clearly there are those patients, who experience trauma to the head, which is not concussive in nature, and present with minimal changes in intellectual and cognitive functioning, but seem to develop posttraumatic symptomatology.

The most appropriate methodology for differentiating this potential diagnostic overlap is to have the patient complete neuropsychological testing, in order to provide a more comprehensive diagnostic assessment of cognitive functioning. Patients with posttraumatic symptoms may have some cognitive difficulties, but not of the same frequency or intensity as patients who have experienced mild to moderate brain injury. Neuropsychological testing is fairly robust in being able to reveal primary cognitive impairment versus cognitive problems that may be associated with a posttraumatic disorder.