Alcohol and Drug Use Before and During the First Year After Traumatic Brain Injury.

OBJECTIVES: To compare individuals with mild and moderate/severe traumatic brain injury (TBI) on alcohol and drug use and substance use disorders before and in the first year post-TBI; to explore sociodemographic and injury-related variables associated with substance use disorders. PARTICIPANTS: A total of 225 adults hospitalized in a level I trauma center after TBI. DESIGN: Observational cohort study with retrospective (pre-TBI) and prospective (4, 8, and 12 months post-TBI) assessments. MAIN MEASURES: Mini International Neuropsychiatric Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS: The percentage of participants using alcohol or drug declined shortly after the injury (4 months) but increased closer to preinjury levels by the end of the first year. Post-TBI alcohol use was higher after mild than moderate/severe TBI, but drug use was similar. About 11% of participants met criteria for a substance use disorder in the first year after TBI. Younger age, not being in a relationship, and suspected substance intoxication at the time of TBI were associated with the presence of a post-TBI substance use disorder. CONCLUSION: Individuals with milder injuries return to alcohol use earlier than those with more severe injuries. Given that substance use may alter recovery, preventive recommendations and systematic follow-ups are warranted regardless of injury severity and access to rehabilitation.

A feasibility study of a new computerised cognitive remediation for young adults with schizophrenia.

Cognitive remediation therapy is effective for improving cognition, symptoms and social functioning in individuals with schizophrenia; however, the impact on visual episodic memory remains unclear. The objectives of this feasibility study were: (1) to explore whether or not CIRCuiTS--a new computerised cognitive remediation therapy programme developed in England--improves visual episodic memory and other cognitive domains in young adults with early course schizophrenia; and (2) to evaluate acceptability of the CIRCuiTS programme in French-Canadians. Three participants with visual episodic memory impairments at baseline were recruited from clinical settings in Canada, and consented to participate. Neuropsychological, clinical and social functioning was evaluated at baseline and post-treatment. Intervention involved 40 sessions of cognitive remediation. First, the reliable change index (RCI) revealed that each participant demonstrated significant post-therapy change in episodic memory and in other cognitive domains. The response profile was characterised by the use of organisational strategies. Second, the treatment was considered acceptable to participants in terms of session frequency (number of sessions per week), intensity (hours per week; total hours), and number of missed sessions and total completed sessions. This preliminary study yielded encouraging data demonstrating the feasibility of the CIRCuiTS programme in French-Canadian young adults with schizophrenia.

Impact of divided attention during verbal learning in young adults following mild traumatic brain injury.

PRIMARY OBJECTIVE: The goal of the present study was to assess the impact of mild traumatic brain injury (MTBI) on episodic memory performance in relation to attentional and executive control processes in young adults. RESEARCH DESIGN/METHODS: A verbal memory paradigm manipulating attentional load (full attention or divided attention) and semantic congruency between pairs of category-target words during encoding was administrated to 13 individuals with MTBI and 12 normal control participants. Environmental supports during retrieval (free recall, cued recall and recognition modes) were also manipulated. MAIN OUTCOMES AND RESULTS: Results show that recall performances of individuals with MTBI were similar to those of controls when words were encoded under full attention. In contrast, individuals with MTBI performed worse than control participants when encoding under divided attention, whatever the semantic link between pairs of words. CONCLUSIONS: By using a sensitive test, one was able to objectively measure subtle impairments in memory performance, suggesting a diminished availability of attentional resources after MTBI. Young adults' learning of verbal material under divided attention might be compromised by the reduction of cognitive resources following MTBI. These findings are also discussed in light of different factors that can influence cognitive performance.