Neuropsychiatry of sport-related concussion

Changes in mood, emotions, and behavior are common components of the acute clinical picture of sport-related concussion (SRC). Common concussion symptom inventories such as the Sport Concussion Assessment Tool-5 (SCAT5) contain a large number of questions that assess these neuropsychiatric domains. In fact, of 22 items assessed by the SCAT5, arguably only five of the items do not overlap with symptoms assessed by standard measures of anxiety and depression, suggesting that concussion is best viewed as a neuropsychiatric syndrome. Furthermore, it is important to understand the complex relationship between preinjury psychologic health, acute injury symptom profile, and the role that changes in mood, emotions, and behavior play in the recovery trajectory after concussion. Some research suggests that there may also be long-term neuropsychiatric effects of concussion, repetitive concussion, and repetitive head impacts. This chapter provides a review of the neuropsychiatric sequelae of acute SRC, the current evidence for long-term neuropsychiatric effects of repetitive concussion, and the impact of neuropsychiatric symptoms on recovery trajectory. Clinical principles relevant to management are described.