The condition known as "postconcussional syndrome" is difficult to define medically but is generally defined as a string of cognitive, physical or behavioral losses that occur after a head injury.
Forensic psychiatrist Dr. Richard C.W. Hall of the University of Florida says a proliferation of lawsuits driven by claims of postconcussional syndrome means more physicians are being asked to make high-stakes diagnoses -- often for patients who are tangled financially and psychologically in litigation.
In the new review -- which appears in the May-June edition of the journal Psychosomatics -- Hall and coauthors try to strip litigation out of the picture to uncover a clearer idea of the recovery times and pathology of postconcussional syndrome.
The vast majority of postconcussional syndrome symptoms -- like headache, dizziness and memory loss -- are subjective, which makes it hard for doctors to distinguish feigned or dramatized complaints from legitimate injuries.
So, Hall says, "it becomes very important to understand the nature of those symptoms that are likely to be real and who is likely to be producing fictitious symptoms."
The review finds that well-motivated, younger patients, who experience no loss of consciousness, are less likely to suffer from postconcussional syndrome. By contrast, some predictors of persistent postconcussional syndrome include female gender, pre-existing psychiatric illness -- and being involved in a lawsuit.
Hall and colleagues examined 71 studies. "Many of the researchers found that the extent and duration of injuries in the United States, where compensation is obtainable, are greater than in countries where financial compensation is less likely to occur," they write.