1. Mental Health and Sport Related Concussion: A Clinical Update
Aaron Jeckell M.D.
Assistant Professor of Child and Adolescent Psychiatry
@AJSportPsychMD

2. Disclosures
Full time employee of the Vanderbilt University Medical Center
No financial or other disclosures to report.

3. At the end of this session…
Rates of psychiatric illness in athletes
Links between mental health issues and Sport Related Concussion (SRC)
How and when to initiate treatment for SRC
Treatment options available for SRC
We are going to look at rates of psychiatric illness in athletes using the general population is at baseline to compare against. Will also look at why saying something like “are athletes more less likely to experience depression” is such a complicated question to answer.
Were going to look at some links between mental health issues and sport-related concussion, and why it is necessary have a good understanding of mental health issues when engaging in any conversation about sport concussion
We are going to look at how and when is the right time to seek a mental health specialist with specialization in the management of your athletes who have suffered concussion
And finally was going to spend a great deal of time talking about available treatments, and an examination of basically what I do on a daily basis when dealing with athletes who have been referred to me for concussion related pathology

4. Mental Health Issues in the U.S.
Saw mental health professional: 29 million (9.2%)
Lifetime prevalence of Mood Disorder1
Adolescent: 14.4%
Adult: 21.4%
Anxiety Disorder
Adolescent: 32.4%
Adult: 33.7%
18-64 year-olds who saw mental health professional between 2012 in 2013 (any kind of MH worker)
Mood disorder (depression, anxiety, and bipolar disorder) in adolescence we see that it is about 14% in adults about 21%. Approximately 1 and 5 adults at some point in the life experiencing a mood disorder.
About 1 and 3 adults will experience anxieties disorder in their lifetime.
1: Kessler, Petukhova, Sampson, Zaslavsky, & Wittchen, 2012

5. Mental Health Issues in the U.S.
“Mentally unhealthy days”/month
Men: 2.9 (95% CI= )
Women: 4.0 (95% CI= )
Annual cost: $210.5 billion
Would you say that in general your health is excellent, very good, good, fair or poor?
Now thinking about your physical health, which includes physical illness and injury, how many days during the past 30 days was your physical health not good?
Now thinking about your mental health, which includes stress, depression, and problems with emotions, how many days during the past 30 days was your mental health not good?
During the past 30 days, approximately how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

6. 12-month Prevalence of Major Depressive Episode Among US Adults

7. How does the rate of depression in athletes compare to the general population?

8. Mental Health Issues in Athletes Depression: Mixed Data
Less likely
HS athletes compared to general population1
Male collegiate team athletes (16%) compared to control (29%)2
Lower rates of depression after retirement3
More likely
Athletes with injuries may be at ↑ risk of short term depressive symptoms4
College athletes without injury (27%) vs with injury (33%)5
Current collegiate athletes > former athletes6
“Athlete” encompasses a heterogeneous population.
Many of these papers utilize self-reports her psychometric data. Gorczynski has been vocal in calling for a move away from psychometric testing towards clinical eval for diagnostic purposes in these populations.
Oler and colleagues: HS athletes were less likely to endorse depressive symptoms compared to the general population
Proctor and Boan-Lenzo: male collegiate level athletes were nearly half as likely to endorse symptoms of depression compared to college matched peers (n=66 vs 51)
Gouttebarge: Population of rugby players where rates of depression were lower but rates of anxiety and alcohol abuse were higher.
But then you have specific populations within the athletic community that have been found to be at higher risk for experiencing depression
Yang and colleagues: college football players maybe be at increased risk of experiencing depression in the short term after suffering an injury
Brewer and Petrie: male and female athletes who have suffered injuries have a statistically significant increase in likelihood of endorsing depressive symptoms
We also have papers that suggest that current collegiate athletes are at higher risk of depression than retired collegiate athletes.
1: Oler et al., 1994; 2: Proctor & Boan-Lenzo, 2010; 3: Gouttebarge, Kerkhoffs, Lambert, 2016; 4: Yang et al., 2007; 5: Brewer, Petrie, 1995; 6: Weigand, Cohen, Merenstein, 2013

9. Mental Health Issues in Athletes Depression
Equally likely
Elite athletes vs. control1
Female soccer players with comparable rates of depression but less anxiety2
DI athletes similar to general college population3
Athletes similar to the general population4
1: Yang et al., 2007; 2: Brewer B, Petrie TA, 1995; 3: Weigand, Cohen, Merenstein, 2013; 4: Gouttebarge V, Kerkhoffs G, Lambert M, 2016

10. Mental Health Issues in Athletes Depression
Female athletes were more likely to present with depressive symptoms than males1
There are also a number of papers a demonstrate that females are more likely to endorse symptoms of depression than males. Now it becomes unclear if this is females are more likely to endorse the symptoms of depression or experience symptoms of depression but from these studies we can say that more female athletes will present with symptoms of depression than a male counterpart. This first paper was based on findings looking at D1 athletes. And here we have the examination of how this varies by sport. Interestingly across all for the sports women were more likely to endorse symptoms of depression than their male peers.
1: Storch, 2005; 2: Wolanin, Hong, Marks, Panchoo, & Gross, 2016

11. Mental Health Issues in Athletes Depression
Diverse population, wide range of physical, emotional, and psychological stressors
Prone injury
May be less likely to endorse symptoms of depression or any other mental health disorder
Culture of mental illness in sport
May be less likely to endorse depression:
Play through the pain
Fear that it might affect her ability to play
Fear of appearing weak
Not knowing how to discuss these kinds of issues.
We as clinicians, coaches, trainers, parents, and many of us athletes ourselves need to be at the forefront of the culture change within sport where it is okay to open up about struggles and get help when needed. This is an exciting time because I feel like that culture shift is taking place. He can see people like the coach of the Toronto Maple leafs, Mike Babcock who was recently interviewed and made it clear that mental health has nothing to do with mental toughness.

12. Mental Health Issues in Athletes
Depression: Mixed results
Anxiety: Likely equal, perceived differently1,2
Schizophrenia: Possibly decreased
ADHD: Limited/unreliable data
Bipolar Disorder: Limited/unreliable data
Depression
Younger athletes typically score higher for depression. Females and athletes in pain also report higher symptoms of depression.
Anxiety
Athletes may perceive anxiety as helpful in that it motivates them to perform at a higher level, pushes them to practice her train harder, it may actually even sharpen their focus to some degree.
Schizophrenia
Limited, but is postulated that it is lower in athletes, especially in older athletes, as being able to engage with the team and participate in sport would become significantly more difficult as the positive and negative symptoms of schizophrenia begin to manifest.
ADHD and bipolar disorder both have fairly limited data.
1: Yang et al., 2007; 2: Rice et al., 2016

13. Benefits of Sports Physical activity = health benefits1
↑ mood, socialization, interconnectedness, wellbeing, self- esteem2-5
↓ rates of depression6
Team sports shown to ↓ anxiety7
Depression less likely in team sport athletes
Sports has been empirically proven to be a positive thing.
We know that just from getting out and exercising you’re providing your body and mind with numerous measurable benefits.
Athletes may have decreased rates of depression, improvements in feelings of socialization, interconnectedness and being part of a community, overall well-being, and higher levels of self-esteem.
Very specific to team sport, team athletes have been demonstrated to endorse lower levels of anxiety and less likely to experience depression.
1: Eime et al., 2013; 2: Boone & Leadbetter, 2006; 3: Dunn, Madhukar, Kampert, Clark, & Chambliss, 2005; 4: Findlay & Coplan, 2008; 5: Janssen & LeBlanc, 2010; 6: Pederson & Siedman, 2004; 7: Dimech & Seiler, 2011

14. SRC/Post Concussion Syndrome
SRC ranges from million per year1
Majority of concussions improve within 2-4 weeks2
Persistent symptomatology after a concussion lasting for an unexpected/prolonged duration after the initial insult3
Post-Concussion Syndrome
ICD-10
At least 3 new symptoms, but does not specify a duration of illness
DSM-IV
Presence of 3 or more symptoms that lead to impairment in daily functioning and lasts no less than 3 months (American Psychiatric Association, 2000)
DSM-5
No definition for PCS
Millions of individuals who suffer from sport-related concussion every year.
Vast majority of these individuals will recover within several weeks.
Miserable minority who go on to develop persistent symptomatology related to their concussion.
1: Langlois, Rutland-Brown, & Wald, : P. McCrory et al., 2017; Paul McCrory et al., 2009; Paul McCrory et al., 2013; 3: American Psychiatric Association, 2000, 2013; Rose, Fischer, & Heyer, 2015

15. Mental Health Links to Concussion
Baseline depression  depression, anxiety after SRC1
Pre-injury anxiety predicts PCS2
Family history of psychiatric illness  increased risk for PCS3
Concussed HS athletes4
FPH & PPH > 5x more likely to develop PCS
FPH 2.5x more likely to develop PCS
If you experience baseline depression you are far more likely to experience a severe exacerbation of depression and anxiety after sport-related concussion.
Baseline anxiety predicts the development of postconcussion syndrome.
Family history of psychiatric illness puts you at a higher risk for postconcussion syndrome
Individuals with a family and personal history of psychiatric illness were 5 times more likely to develop postconcussion syndrome
Individuals with a family history of psychiatric illness alone work 2.5x more likely to develop PCS
1: J Yang, Peek-Asa, Covassin, & Torner, 2015; 2: McCauley et al., 2013; 3: McCrory et al., 2013; G. Solomon, Kuhn, & Zuckerman, 2015; 4: Legarreta, Brett, Solomon, Zuckerman, 2018

16. Factors Affecting Recovery From SRC
Concussion In Sport Group (CISG)
Prolonged symptoms
Loss of consciousness (LOC)
Convulsions
Decreased concussion threshold
Age
Comorbidities
Medications
Dangerous style of play
High-risk sport
Migraines
Mental health disorders
ADHD
Learning disability
Sleep disorders
10.3% of ~500,000 NCAA athletes = 50,000
1: McCrory et al., 2009; McCrory et al., 2013

17. General Treatment Recommendations
Gold Standard: Cognitive and physical rest as needed
Gradual return to action
Return to Learn (RTL)
Return to Play (RTP)
Psychoeducation (patient, family, coaches)
Consideration of pharmacotherapy if symptoms have…1-2
Exceeded a typical recovery
Negatively affect the patient’s life
All other treatment options unsuccessful
Return to learn before her return to play as a motivating factor to get back into the class room
Psychoeducation is crucial. There is abundant evidence that something as simple as a pamphlet or brief conversation with an athlete and his parents can decrease duration of symptoms, severity of symptoms. That being said if symptoms do persist beyond expected duration, it is reasonable to consider when and how to initiate treatment including pharmacotherapy.
1: Meehan, 2011; 2: Jeckell & Solomon, 2017

18. General Treatment Recommendations
NO guidelines for pharmacological treatment of concussion or FDA approved medications1
Treatment is symptom specific
The clinician is knowledgeable and experienced in SRC, concussive brain injury, pharmacotherapy and medication management2
Risks vs benefits
Persistent vs. pre-existing
No FDA approved medications for the treatment of concussion. That being said we can knowledgeably and effectively treat symptoms.
It is important to have a clinician or provider who is familiar with the nuances of sport-related concussion, typical versus atypical recovery, and has expertise in psychopharmacology
Every medication has risks and benefits and side effects but oftentimes we can use the medication side effects to her own advantage. By using a bit of pharmacological jujitsu we can use a single medication to treat a number of different symptoms.
I get a lot of referrals for a hypothetical individual who had a concussion 2 months ago and gets referred to me for PCS and on closer evaluation has been experiencing symptoms of depression for years. What I see a lot of is individuals who are suffering from some kind of a mental health issue but for whatever reason don’t get care until they have a head injury and after experiencing a head injury they can say “hey coach, you remember that hit? I’m really struggling and I think I need help.” This speaks to the culture in sports that we need work on changing.
1: Pinto et al., 2017; 2: Meehan, 2011; G. S. Solomon & Sills, 2013; Jeckell & Solomon, 2017

19. General Treatment Recommendations
Go low and slow1
Avoid meds that can ↑confusion, sedation, fatigue, drowsiness2
Consider metabolic pathways and drug interactions3
Metabolism can be affected by exertion and high rates of exercise4
Sleep Disturbance
Mood Disorder
Headache
Pain Syndrome
Cognitive Disfunction
With all of these medications and especially on young brains, go low and slow
Avoid medications that can impair neuropsychiatric testing
Athletes love going to GNC, getting on supplements to enhance performance. Numerous medications can interact with other medications. St. John’s Wort can interact with serotonin can potentially lead to disastrous interactions when combined with a serotonergic medication.
Other medications have specific metabolic concerns that can be affected by exercise, hydration, and other factors related to physical activity is important to have that conversation early and often with your athletes.
Cycle of symptoms where one influences all of the others
1: Halstead, 2016; Petraglia, Maroon, & Bailes, 2012; 2: Meehan, 2011; Reddy, Collins, & Gioia, 2008; 3: Deng et al., 2017; Honig & Gillespie, 1995, 1998; 4: Dossing, 1985; Lenz, 2011; Peng & Cheung, 2011; Ylitalo, 1991; Jeckell & Solomon, 2017

20. Who gets treatment after SRC?
Females may be more likely
Single center, retrospective observational study
n=100, age 12-18
24 athletes received medications
Female>Male, OR 3.8 (95% CI = – )
Limited data on who is more likely to get treatment after sport-related concussion.
- Females may be more likely consistent with the data suggesting that females are more likely to endorse symptoms of depression.
1: Pinto, Twichell, & Henry, 2017

21. Categories of Symptoms
Hypersomnia
Hyposomnia
Sleep initiation
Maintenance Issues
Fogginess
Fatigue
Poor memory
Attention problems
Sadness
Anxiety
Irritability
Dull emotions
Light sensitivity
Dizziness
Nausea
Headaches
Somatic
Emotions
Sleep
Cognition

22. Emotional Symptoms Causes
Multifactorial: injury, withdrawal from competition, identity
Screen for premorbid psychiatric illness
Athletes with non-concussive injury (ie. ACL) also show increases in depression1
Irritable, sad, depressed, nervous, mood lability, having a “shorter fuse”2
Mainwaring and colleagues found that athletes with ACL injury actually had more and longer duration of depressive sx after concussion.
1: Mainwaring, Hutchison, Bisschop, Comper, & Richards, 2010; 2: Reddy, Collins, & Gioia, 2008; Vargas, Rabinowitz, Meyer, & Arnett, 2015

23. Emotional Symptoms Incidence
84 college athletes with concussion, 41 individuals as a control
Depression scale done at baseline and post-concussion (two comparable intervals in control)
Reliable increase in depression:
2 control (5%)
17 athletes (20%)
1: Vargas, Rabinowitz, Meyer, & Arnett, 2015

24. Emotional Symptoms Tricyclic antidepressants
Block norepinephrine and serotonin reuptake
Sedating (may be beneficial with insomnia)1
Multiple side effects, narrow therapeutic index, potential cardiotoxicity2
May improve headache, mood, and insomnia
TCAs
Medication Name
Side Effects
Amitriptyline (Elavil®)
GI upset, sedation, weakness, blurry vision, dizziness
Most orthostatic hypotension
Nortriptyline (Pamelor®)
Less orthostatic hypotension
Less sedating
Doxepin (Silenor®)
Very antihistaminergic
Very sedating
- Anticholinergic, hypotension, decreased libido
- Nortriptyline is a breakdown product of amitriptyline
1: Broglio et al., 2015; Halstead, 2016; Solomon & Sills, 2013; 2: Harrigan & Brady, 1999

25. Emotional Symptoms SSRI
Block serotonin reuptake
Gold standard for emotional disturbance1
Studies have examined sertraline, fluoxetine, and citalopram in non- athletes with brain injury2
May take several weeks or even months to reach full efficacy
Adding CBT enhances safety and efficacy3
SSRIs
Medication name
Considerations
Sertraline (Zoloft®)
More likely to cause GI upset than other SSRIs
Fluoxetine (Prozac®)
Can be more activating, take in the AM
Escitalopram (Lexapro®)
Starting dose is close to max dose
Paroxetine (Paxil®)
Can be very sedating, cause weight gain
TADS: The clinical trial of 439 adolescents ages 12 to 17 with MDD compared four treatment groups—one that received a combination of fluoxetine and CBT, one that received fluoxetine only, one that received CBT only, and one that received a placebo only. After the first 12 weeks, 71 percent responded to the combination treatment of fluoxetine and CBT, 61 percent responded to the fluoxetine only treatment, 43 percent responded to the CBT only treatment, and 35 percent responded to the placebo treatment.
1: Reddy et al., 2008; 2: Arciniegas, Anderson, Topkoff, & McAllister, 2005; Chew & Zafonte, 2009; Silver, McAllister, & Arciniegas, 2009; Warden et al., : March, Silva, Petrycki, Curry, Wells, Fairbank, Burns, Domino, McNulty, Vitiello, Severe

26. Emotional Symptoms SSRI – Side Effects
Black box warning for increased SI in adolescents1
38% experiencing one or more side effect
Most common side effects: Mood changes, insomnia, GI upset, sexual dysfunction, bleeding, activation
Side effects most common early on
Many dissipate after several weeks
Informed consent
Black box warning in 2004, increased risk of suicidality
Meta-analysis show that depression untreated is far more dangerous that treated
1: Bridge, Iyengar, Salary, Barbe, Birmaher, Pincus, Ren & Brent

27. Emotional Symptoms SSRI

28. Emotional Symptoms Others
Duloxetine (Cymbalta®)
Serotonin, norepinephrine, and dopamine reuptake inhibition
Good for headache, pain, mood
Mirtazapine (Remeron®)
Stimulates norepinephrine and serotonin release
Strong antihistamine
Very sedating, appetite increase

29. Sleep Disturbances Cause
Multi-factorial, many pathways1
Disruption of circadian rhythm, sleep/wake cycles
Disruptions in the:
Hypothalamic and brainstem nuclei
GABA, galanin, orexin, histamine, serotonin, noradrenaline pathways
Hypersomnia, hyposomnia, maintenance
Leads to fatigue, restlessness, and anxiety2
1: Wickwire et al., 2016; 2: Clinchot et al., 1998

30. Sleep Disturbances Incidence
Population of mixed severity TBI (non-athlete)1
50% reported sleep disturbance
29% reported insomnia
28% reported hypersomnia
~30% diagnosed with sleep disorder
Athletes with sleep disorder after SRC report more symptoms and for longer2,3
Sleep disturbance in SRC is correlated with cognitive disturbance2,3
1: Mathias & Alvaro, 2012; 2: Kostyun, Milewski & Hafeez, 2014; 3: Murdaugh, Ono, Reisner, & Burns, 2017

31. Sleep Disturbances Incidence
Retrospective review, yo
n=417
123 (34%) endorsed sleep disturbance
3-4x increase in recovery time
Non-SRC: 45%
SRC: 29% (P = .01)
Retrospective chart review was conducted at a regional concussion clinic on patients 13 to 18 years of age between 2005 and 2011.
417 met inclusion criteria
Patients with non–sport-related concussions are more likely to have sleep disturbances compared to patients with sport-related concussions, suggesting either a more severe concussion or other factors such as posttraumatic stress.
Sport sample: Total 303 (73) Football 96 (32) Soccer 45 (15) Basketball 30 (10) Field hockey 21 (7) Lacrosse 16 (5) Ice hockey 19 (6) Wrestling 13 (4) Other 63 (21)
Non-sport sample: Total 114 (27) Motor vehicle accident 40 (35) Fall 34 (30) Blunt object 18 (16) Bicycle 8 (7) Other 14 (12)
1: Bramley, Henson, Lewis…Silvis, 2017

32. Sleep Disturbances Treatments
Gold standard: behavioral interventions
Sleep hygiene
Limit caffeine
Limit electronics at bedtime
CBT-I (cognitive behavioral therapy)

33. Sleep Disturbances Melatonin
Produced naturally in the pineal gland
Involved in sleep timing
Improved sleep in patients with delayed sleep onset1,2
Evidence based after TBI1,2
Bramley’s paper showed improvement in 67% of patients receiving melatonin
1: Maldonado et al., 2007; 2: Samantaray et al., 2009

34. Sleep Disturbances Trazodone
Inhibits serotonin reuptake, also alpha-1 antagonist
Can be an effective antidepressant, but…
VERY sedating
Possible priapism (1/6,000 male patients)

35. Sleep Disturbances Other
Tricyclic antidepressants
Can improve headache and depressive symptoms1
Benzodiazepines
Potential amnestic properties and the potential for worsening cognition2
Zolpidem (Ambien®)
May mask symptoms, worsen confusion
1: Meehan, 2011; 2: Reddy et al., 2008

36. Cognitive Symptoms Cause - Dopamine
Frontal lobe function
Executive functioning, planning, attention, behaviors, judgement, and motor control1
Improvements in functional outcomes in TBI animals when treated with meds that facilitate dopamine transmission2
Meds that antagonize dopamine (i.e. antipsychotics) can have negative impact on recovery from concussion3
1: Bales, Kline, Wagner, & Dixon, 2010; Chen et al., 2017; 2: Kline, Massucci, Ma, Zafonte, & Dixon, 2004; Kline, Yan, Bao, Marion, & Dixon, 2000; 3: Feeney, Gonzalez, & Law, 1982; Kline, Hoffman, Cheng, Zafonte, & Massucci, 2008

37. Cognitive Symptoms Incidence
Athletes with ≥ 3 concussions take longer to recover1
Population with PCS (mixed)2 (n=221)
Concentration difficulty: 124 (56.1%)
Mental fogginess: 50 (22.6%)
Learning difficulties: 17 (7.7%)
Thinking time increased: 8 (3.6%)
Problem solving difficulties: 2 (0.9%)
Response speed slowed: 2 (0.9%)
Athletes who have had 3 concussions take longer to recover compared to athletes who have had 1 concussion
Very heterogeneous population, both SRC and non
Data collected from the patients’ clinical charts were from many sources including clinician’s notes, neuropsychological reports, imaging reports, referring physicians’ notes, other physicians’ notes, Sport Concussion Assessment Tools versions 2 and 3, and patient self reports. A total of 50 different symptoms were recorded from these sources, along with demographic information, previous medical history, imaging performed, duration of symptoms, medications, and other treatments.
1: Covassin, Moran, & Wilhelm, 2013; 2: Tator, Davis, Dufort, Tartaglia…Hiploylee, 2016

38. Cognitive Symptoms Stimulants
Controlled substance, monitoring, potential for abuse
Various formulations
Potential to negatively impact sleep, appetite, anxiety
Closely monitor vitals, weight, monitor diet

39. Cognitive Symptoms Methylphenidate
Binds to and blocks dopamine and norepinephrine reuptake transporters
Randomized, double-blind, placebo controlled trial1
Non-athlete adults with TBI
Improvement in the speed of performance on attention tasks as compared to the control group
Follow up findings have been mixed2
Methylphenidate
Name
Duration
Considerations
Ritalin®
3-5 hours
Dosed multiple times per day
Concerta®
~12 hours
OROS capsule
Metadate®
8-12 hours
Capsule can be opened and put on food
Leads to 3-4x increase in dopamine concentrations in the striatum and PFC
Research specific to athletes remains limited. (Halstead, 2016)
1: Whyte et al., 1997; 2: Plenger et al., 1996; Williams, Ris, Ayyangar, Schefft, & Berch, 1998

40. Cognitive Symptoms Amphetamines
Block the reuptake AND promote the release of dopamine and norepinephrine
Clinical evidence1
Randomized, double-blind, placebo- controlled, 12 week cross-over trial
Non-athlete adults with TBI
Significant improvements in attention, memory, response speed stability, endurance, and executive function.
Amphetamines
Name
Duration
Considerations
Adderall®
4-6 hours
Mixed amphetamine salts
Adderall XR®
8-12 hours
As above
Dexadrine®
3-5 hours
Vyvanse®
10-12 hours
Capsule can be opened and put on food
sustained attention, working memory, response speed stability, endurance, and executive function
1: Tramontana, Cowan, Zald, Prokop, & Guillamondegui, 2014

41. Cognitive Symptoms Stimulants
Additional considerations
How long to continue treatment?
Evidence for new onset ADHD?
Banned in many levels of sport (without clearance)

42. Cognitive Symptoms Treatment Options - Amantadine
Uses:
Parkinsonism
Influenza
Mechanism
Presynaptic release of dopamine and inhibits its reuptake
Increase in density of postsynaptic dopamine receptors1
SE: Dizziness, blurred vision, anxiety, insomnia2
Antiviral activity involves interference with the viral protein, M2, a proton channel
1: Reddy, Collins, Lovell, & Kontos, 2013; 2: Petraglia et al., 2012

43. Cognitive Symptoms Amantadine
Clinical evidence in SRC:
39 adolescents w/o recovery after 21 days vs. matched control1
SRC group given 100mg BID for 3-4 weeks
Compared pre/post SRC performance on the ImPACT
Greater improvements in SRC group: verbal memory and reaction time
Small sample, some significant disparities between the starting point in the experimental vs control group
1: Reddy, Collins, Lovell, & Kontos, 2013

44. When to contact Dr. Jeckell?
Conclusions
Rates of psychiatric illness in athletes
Links between mental health issues and Sport Related Concussion (SRC)
How and when to initiate treatment for SRC
Treatment options available for SRC
When to contact Dr. Jeckell?

45. Aaron Jeckell M.D. Assistant Professor of Child and Adolescent Village at Vanderbilt: (615)

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