Clinical Correlations of Posttraumatic Nightmares in Survivors of Motor Vehicle Accidents

Background: We evaluated the severity and clinical correlates of nightmares of persons injured in high impact motor vehicle accidents (MVAs). Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) were available and included scores on Item 2 of the PCL-5 (severity of repeated, disturbing dreams of the stressful event). Scores were also available on the Brief Pain Inventory (BPI), Morin’s Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whiplash Disability Questionnaire, and on three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA; all still experienced active post-MVA symptoms requiring therapy. Results: Clinically relevant levels of MVA nightmares were reported by 62.5% of post-MVA patients. Subjectively more aversive levels of MVA nightmares correlated with higher driving anxiety as measured by the Whetstone questionnaire and DAQ, with higher levels of average post-accident pain and insomnia, with post-accident neuropsychological symptoms as measured by the Rivermead and SNPSS, and with higher post-accident levels of depression, anger, and generalized anxiety. Discussion and Conclusions: Almost two-thirds of our post-MVA patients reported MVA nightmares and their level of subjectively aversive impact correlated with most variables within the typical polytraumatic symptom pattern of these patients.

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Phantom Brake Phenomenon in Survivors of Car Accidents

European Journal of Clinical Medicine ◽

10.24018/clinicmed.2021.2.3.68 ◽

2021 ◽

Vol 2 (3) ◽

pp. 9-13

Author(s):

Zack Z. Cernovsky ◽

Milad Fattahi

Keyword(s):

Motor Vehicle ◽

Brief Pain Inventory ◽

Severity Index ◽

High Impact ◽

Generalized Anxiety ◽

Vehicle Accidents ◽

Symptom Pattern ◽

Car Accidents ◽

And Gender ◽

Almost All

Background: Survivors of high impact car accidents, when traveling in cars as passengers, may exhibit the phantom brake reaction. The reaction consists of involuntarily pressing the foot on the floor of the car in a reflexive attempt "to brake", even though there is no brake pedal in front of the passenger seat. This study examines the incidence and correlates of this special phenomenon. Method: De-identified data of 114 survivors (37 men, 77 women; mean age 38.6, SD=12.4) of high impact motor vehicle accidents (MVAs) were available, with their responses to the Brief Pain Inventory, Insomnia Severity Index, Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), PTSD Checklist for DSM-5 (PCL-5), ratings of depression and of generalized anxiety, and 3 questionnaire measures of driving anxiety, i.e., Whetstone’s, Steiner’s, and the Driving Anxiety Questionnaire (DAQ). One item of the DAQ assesses the phantom brake phenomenon on a 4-point scale (0=No, 1=Mild, 2=Moderate, 3=Severe): this is the key variable in the present study. Results: Mild to severe forms of the phantom brake reaction were reported by 92.1% of the post-MVA patients. Significant correlations (p<0.05, 2-tailed) were found of the intensity of phantom brake reaction to the intensity of post-MVA pain (rs from 0.20 to 0.33), insomnia (r=0.40), the Rivermead post-concussion scale (r=.29), other post-concussive and whiplash symptoms as measured by the SNPSS (r=0.19), depression (r=0.30), generalized anxiety (r=0.32), and to DAQ (r=0.47) and Whetstone’s (r=0.50) measures of driving anxiety. No significant relationships were found of the phantom brake reaction to age and gender. Discussion and Conclusion: The phantom brake reaction was reported by almost all post-MVA patients and can be considered as a part of their post-MVA polytraumatic symptom pattern.

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Neuropsychological Correlates and Frequency of Tinnitus in Patients Injured in Motor Vehicle Accidents

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.771 ◽

2021 ◽

Vol 3 (2) ◽

pp. 103-106

Author(s):

Zack Z. Cernovsky ◽

Stephan C. Mann ◽

Varadaraj R. Velamoor

Keyword(s):

Motor Vehicle ◽

Brief Pain Inventory ◽

Severity Index ◽

Motor Vehicle Accidents ◽

Hand Tremor ◽

Vehicle Accidents ◽

Post Concussion Syndrome ◽

Tinnitus Severity ◽

Neuropsychological Correlates ◽

Whiplash Trauma

Background: There is a lack of data on the frequency and neuropsychological correlates of tinnitus in distinct clinical populations such as persons injured in high impact motor vehicle accidents (MVAs). Method: Tinnitus severity and frequency were analyzed statistically in de-identified data of 106 post-MVA patients (mean age=39.5, SD=13.1; 31 males and 75 females). Correlations of tinnitus to the patients’ scores on the Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Brief Pain Inventory, Insomnia Severity Index, PTSD measure (PCL-5), and to ratings of depression, anger, and anxiety on the Whiplash Disability Questionnaire were evaluated. The patients were interviewed an average of 53.6weeks (SD=39.9) after their MVA; all continued to suffer from post-MVA symptoms requiring therapy. Results: Tinnitus was reported by 70 of the 106 post-MVA patients (66%). Slightly less than a half of the 70 rated their tinnitus as “frequent” or “persistent” and slightly more than a half as “occasional.” With respect to Rivermead and SNPSS items, the severity and frequency of tinnitus correlated significantly (at p<.01, 2-tailed) with oversensitivity to light, restlessness, word finding difficulty, hand tremor, stutter, and instances of reduced muscular control over hand or arm (rs ranging from .28 to .37). Tinnitus severity correlated also with tingling in the limbs (r=.31), and with impaired balance (r=.28). Tinnitus frequency correlated also with difficulty articulating words (r=.28). Tinnitus also significantly correlated with ratings of pain and of insomnia (rs ranging from .26 to .32), but not with variables such as PTSD, depression, or anxiety. Discussion and Conclusions: Tinnitus is correlated with some aspects of whiplash trauma and the post-concussion syndrome. However, the size of these relationships is rather weak.

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Validation of the PTSD Checklist for DSM-5 (PCL-5) on Patients Injured in Car Accidents

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.790 ◽

2021 ◽

Vol 3 (2) ◽

pp. 154-159

Author(s):

Zack Z. Cernovsky ◽

Milad Fattahi ◽

Larry C. Litman ◽

David M. Diamond

Keyword(s):

Convergent Validity ◽

Motor Vehicle ◽

Brief Pain Inventory ◽

Severity Index ◽

Criterion Validity ◽

Control Group ◽

Vehicle Accidents ◽

Dsm 5 ◽

Ptsd Checklist ◽

Neuropsychological Symptoms

Background: The PTSD Checklist for DSM-5 (PCL-5), is presently the most widely used psychological measure of PTSD along the criteria of DSM-5. We examined the criterion validity of PCL-5 separately for each of its 20 items by comparing scores of patients injured in high impact motor vehicle accidents (MVAs) to scores of persons in a control group. In addition, we evaluated criterion and convergent validity of the PCL-5 total scores. Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) included their scores on the PCL-5, Brief Pain Inventory (BPI), Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), ratings of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire), and three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA, but all still experienced active post-MVA symptoms requiring therapy. The PCL-5 scores were also available from 21 controls (mean age 43.0 years, SD=20.3). Results and Discussion: With respect to criterion validity of the PCL-5, the post-MVA patients differed significantly from the control group not only with respect to their total PCL-5 scores, but also on all 20 individual items of the PCL-5, and also on all 4 subscales of PCL-5 (Intrusion, Avoidance, Altered Cognitions/Mood, and Arousal). The PCL-5 total scores correlated significantly to all three measures of post-MVA driving anxiety, post-MVA pain and insomnia, post-MVA depression, anger, and generalized anxiety, and to post-MVA subjective neuropsychological symptoms in the post-concussion and whiplash spectrum. Conclusions: Both the criterion and convergent validity of the PCL-5 for the use on post-MVA patients are excellent.

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Validity of Steiner’s Automobile Anxiety Inventory

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.1.661 ◽

2021 ◽

Vol 3 (1) ◽

pp. 56-61

Author(s):

Zack Z. Cernovsky ◽

Milad Fattahi ◽

Larry C. Litman ◽

Silvia Tenenbaum ◽

Beta Leung ◽

...

Keyword(s):

Convergent Validity ◽

Motor Vehicle ◽

Quantitative Measure ◽

Brief Pain Inventory ◽

Severity Index ◽

Vehicle Accidents ◽

Pain Ratings ◽

The One ◽

Normal Controls ◽

Anxiety Questionnaire

Background: Steiner’s Automobile Anxiety Inventory (AAI) is a 23 item questionnaire which provides a quantitative measure of vehicular anxiety (amaxophobia), common in survivors of motor vehicle accidents (MVAs). The present study examines criterion and convergent validity of the AAI. Method: De-identified data from a sample of 50 patients (mean age=39.1, SD=12.1; 17 men, 33 women) injured in high impact MVAs included the scores on Steiner’s AAI, as well as the pain ratings on the Brief Pain Inventory (BPI), scores on the Insomnia Severity Index (ISI), the Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whetstone Vehicle Anxiety Questionnaire, and on Driving Anxiety Questionnaire (DAQ). The patients’ scores were compared to de-identified AAI data of 22 normal controls (mean age=45.9, SD=21.3; 10 men, 12 women). Results: Mean score of the patients on Steiner’s AAI (mean=15.0, SD=2.5) was significantly higher than the one of normal controls (mean=3.2, SD=3.8) in a t-test (t=15.6, df=70, p<.001). The underlying correlation is very high (r=.88): this indicates an excellent criterion validity. Satisfactory convergent validity is suggested by significant correlations (p<.001) of Steiner’s AAI scores to the Whetstone Vehicle Anxiety Questionnaire (r=.58) and Driving Anxiety Questionnaire (r=.52). The AAI correlated at p<.001 with post-accident neuropsychological impairments as measured by Rivermead (r=.89) and SNPSS (r=.72). Internal consistency of the AAI is satisfactory (Cronbach alpha=.95). Discussion and Conclusion: The results indicate satisfactory criterion and convergent validity of the Automobile Anxiety Inventory.

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Pain Related Functional Limitations of Persons Injured in Car Accidents

European Journal of Clinical Medicine ◽

10.24018/clinicmed.2021.2.5.118 ◽

2021 ◽

Vol 2 (5) ◽

pp. 6-10

Author(s):

Stephan C. Mann ◽

Varadaraj R. Velamoor ◽

Larry C. Litman ◽

Zack Z. Cernovsky

Keyword(s):

Convergent Validity ◽

Motor Vehicle ◽

Functional Limitations ◽

Brief Pain Inventory ◽

Severity Index ◽

Medical Psychology ◽

Medical Attention ◽

Functional Interference ◽

Neuropsychological Symptoms ◽

Average Pain

Background: In medical psychology, the Brief Pain Inventory (BPI) allows for a separate assessment of pain intensity (scales of worst, least, and average pain) and of daily functional limitations due to pain (impairments of mood, ability to walk, work, interpersonal relations, sleep, and enjoyment of life). The present study evaluates the convergent validity of BPI’s measure of such functional limitations by calculating its correlations to other relevant clinical measures of psychological impairments caused by motor vehicle accidents (MVAs). Method: De-identified archival data were available on 50 persons injured in MVAs (age 20 to 86 years, mean=42.1 years, SD=16.4; 23 males, 27 females). Their MVA occurred 11 to 280 weeks prior to psychological testing with the BPI (average time lapse 73.3 weeks, SD=53.8). All patients were still experiencing active post-MVA symptoms requiring medical attention and therapy. With respect to convergent validity, we examined Pearson correlations of the BPI to the Insomnia Severity Index (ISI), Rivermead Post-Concussion Symptoms Scale, Subjective Neuropsychological Symptoms Scale (SNPSS), and to measures of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire). Results: Functional interference of pain with daily activities (sum of BPI Items 9B to 9G) correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.39), post-MVA subjective neuropsychological symptoms (r=0.45), insomnia scores (r=0.41), and ratings of depression (r=0.52), anger (r=0.46), and anxiety (r=0.44). When the sum of BPI ratings of worst, least, and average pain was added to the functional interference/limitations score, then this sum of 9 BPI items correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.36), post-MVA subjective neuropsychological symptoms (r=0.46), insomnia scores (r=0.37), and ratings of depression (r=0.53), anger (r=0.50), and anxiety (r=0.40). Discussion and Conclusion: The results lend support to convergent validity of the BPI when applied to persons injured in vehicular accidents.

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Frequency of Formication Symptoms in Injured Motorists and in Normal Controls

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.751 ◽

2021 ◽

Vol 3 (2) ◽

pp. 48-52

Author(s):

Zack Z. Cernovsky ◽

Varadaraj R. Velamoor ◽

Stephan C. Mann ◽

L. Kola Oyewumi ◽

James D. Mendonça ◽

...

Keyword(s):

Motor Vehicle ◽

Control Sample ◽

Brief Pain Inventory ◽

Severity Index ◽

Lumbosacral Spine ◽

Whiplash Injuries ◽

Vehicle Accidents ◽

Whiplash Trauma ◽

Normal Controls ◽

As If

Background: Formication is the sensation or feeling as if insects were crawling on or under the skin. It is observed in a variety of clinical situations including drug intoxications, multiple sclerosis, and diabetic neuropathy, among many others. Furthermore, it can be associated with injuries incurred during motor vehicle accidents (MVAs). We examined the frequency of reports of formication in a normal control sample as well as in a sample of motorists who sustained concussive and whiplash injuries following high impact MVAs. We also evaluated the correlations of the formication to measures of pain, insomnia, and of various post-accident neuropsychological symptoms. Method: De-identified data on 23 injured motorists (mean age=38.0 years, SD=12.8) and on 20 normal controls (mean age 42.8 years, SD=19.9) were available. All motorists responded to the following True/False item: “I have pain in my body which seems to feel like bugs crawling under the surface of my skin.” Their data were also available on the Brief Pain Inventory, Post-MVA Neurological Symptoms (PMNS) scale, Insomnia Severity Index, and on the Rivermead Post-Concussion Symptoms Questionnaire. The data of normal controls included responses to the following specific item of the formication questionnaire: “Do you sometimes have an annoying feeling in some of your limbs or in some other part of your body as if insects were crawling on or under your skin?” The participants were to circle one of the following responses: “never, very rarely, sometimes, often, or almost constantly.” Results and Discussion: Almost a third (30.4%) of the motorists who sustained whiplash trauma in their MVA reported the formication. In contrast, only one of the 20 normal controls (i.e., 5%) reported formication (this was an elderly man with MRI documented pathology in lumbosacral spine). Notably, formication correlated significantly with the ratings of “reduced feeling in the limbs” (r=.55, p=.010), but not with ratings of “tingling in the limbs” (r=.21, p>.05). Conclusion: The painful form of formication has been reported by almost a third of motorists who sustained whiplash injuries in their accident.

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Symptom Profile of Injured Motorists on the Structured Inventory of Malingered Symptomatology

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.739 ◽

2021 ◽

Vol 3 (2) ◽

pp. 40-43

Author(s):

Zack Z. Cernovsky

Keyword(s):

Motor Vehicle ◽

Brief Pain Inventory ◽

Severity Index ◽

Medical Patients ◽

Vehicle Accidents ◽

Symptom Profile ◽

Postconcussive Symptoms ◽

Impaired Sleep ◽

Injured Patients ◽

Medical Symptoms

Background: Recent extensive content analyses demonstrated that the items of the Structured Inventory of Malingered Symptomatology (SIMS) have no capacity to differentiate malingerers from legitimate medical patients: all items list or assess legitimate medical symptoms. We examined which SIMS items are the most frequently endorsed by injured motorists. Method: De-identified archival data of 23 survivors (mean age=38.0, SD=12.8) of high impact motor vehicle accidents (MVAs) contained their SIMS scores, their responses to the Brief Pain Inventory, Morin’s Insomnia Severity Index, Rivermead Post-Concussion Symptoms Questionnaire, and to the Post-MVA Neurological Symptoms scale. Results: All SIMS items which were endorsed by more than 43% of the patients in the directions scored by the SIMS as indicative of “malingering” were selected. Twenty-five items met this criterion. On a closer examination, all these 25 items are legitimate psychological and neuropsychological symptoms typically experienced by injured motorists, such as depression, impaired sleep, and postconcussive symptoms (memory and concentration problems, impaired balance) and whiplash symptoms (numbness in the limbs, instances of reduced muscular control over some of the limbs). Discussion and Conclusions: The 25 endorsed items are consistent with the polytraumatic symptom profile of injured patients. In a travesty of psychological assessment, these symptoms are scored in the SIMS as denoting “malingering”.

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