Abstract Details

Title Measuring the Influence of Symptom Validity Test Performance on DSM-IV-TR Criteria for Postconcussional Disorder in a Military Sample

Topic Behavioral Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 118

Objective

Background BACKGROUND: Postconcussive syndrome (PCS) and Postconcussional disorder (PCD) describe a collection of physical, cognitive, and/or psychological symptoms that may persist after a mild traumatic brain injury (MTBI). There are key differences between the criteria for PCD in the DSM-IV-TR and the criteria for PCS in the ICD-10. The most notable difference is the inclusion of objective neuropsychological evidence of impairment in attention or memory in the DSM-IV-TR. Previous work has shown that the requirement of objective cognitive impairment results in marked discrepancies in the rate of PCS and PCD in a civilian sample. Objective cognitive testing is susceptible to insufficient effort/symptom exaggeration and its impact on the PCD/PCS diagnosis has not been addressed.

Design/Methods DESIGN/METHODS: We reviewed medical records and included patients with a diagnosis of MTBI who completed the Neurobehavioral Symptom Inventory, Repeatable Battery of Neuropsychological Status, and one independent SVT. The sample included 66 active duty service members. Three different approaches in diagnosing PCS/PCD were assessed: 1) DSM-IV-TR criteria 2) ICD-10 criteria 3) DSM-IV-TR criteria with SVT.

Results RESULTS: Using ICD-10 criteria, 62.1% of the sample had PCS compared to 28.8% when using DSM-IV-TR criteria for PCD. This difference was magnified when accounting for insufficient effort with SVT testing. The rate of PCD when accounting for SVT failure was 16.7%.

Conclusions CONCLUSIONS: The results highlight the importance of including SVTs when diagnosing PCD. It also extends previous work demonstrating the difference between the two diagnostic criteria and its potential impact on clinical services in a military setting. The views expressed in this presentation are those of the authors and do not reflect the official policy of the Department of the Navy, Department of Defense, or the U.S. Government.

Authors/Disclosures
Angelica N. Dilay, MPH (Defense and Veterans Brain Injury Center) PRESENTER	No disclosure on file
Jason M. Bailie, PhD	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Mark Llewellyn, MD (Naval Hospital Camp Pendleton)	No disclosure on file
Tobias Derfuss	An immediate family member of Tobias Derfuss has received personal compensation for serving as an employee of Roche. The institution of Tobias Derfuss has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. The institution of Tobias Derfuss has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. The institution of Tobias Derfuss has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. The institution of Tobias Derfuss has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. The institution of Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene. The institution of Tobias Derfuss has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GeNeuro. The institution of Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. The institution of Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuraxpharm. The institution of Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. The institution of Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Johnson&Johnson. The institution of Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Sharp Dome. Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MedDay. Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Actelion. The institution of Tobias Derfuss has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Merck. Tobias Derfuss has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Roche. An immediate family member of Tobias Derfuss has stock in Novartis. An immediate family member of Tobias Derfuss has stock in Roche. The institution of Tobias Derfuss has received research support from Roche. The institution of Tobias Derfuss has received research support from Biogen. The institution of Tobias Derfuss has received research support from Alexion.

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