Course Title: CE 1. Persistent Neuropsychiatric Symptoms after Concussion: Evaluation, Effort, and Ethics.


Credit Hours: 3.0


Instructor(s) Jonathan M. Silver, MD


Persistent Neuropsychiatric Symptoms after Concussion: Evaluation, Effort, and Ethics

Attendees Please Note: The presenter has requested that slides from this talk not be distributed.

Abstract & Learning Objectives

Approximately 1.5 million Americans experience traumatic brain injury each year, the vast majority of which are mild. In the moments following a TBI, postconcussive symptoms are nearly universal. These include alterations of consciousness, disturbances of attention, slow processing speed, impaired declarative memory, and executive dysfunction, and frequently are accompanied by emotional and behavioral disturbances as well as sensory and motor problems. Over the days to weeks after mild TBI, recovery usually proceeds rapidly and typically is complete. When early symptoms are unrecognized, misunderstood, and/or inadequately addressed, early postconcussive symptoms may become chronic and engender secondary psychological health and psychosocial consequences. Pre-injury health and psychosocial factors also influence the short- and long-term effects of TBI. Understanding and improving outcomes after TBI therefore requires consideration not only of the effects of external physical forces on the brain but also the person sustaining that injury and the events preceding and following it. Ethical issues exist regarding the professionals participation in the legal and independent evaluations, as well as decisions as to return  to sports and work. This session will provide participants with new and emerging perspectives on mild TBI. A heuristic with which to understand the influences of pre-injury, injury-related, and post-injury factors on postconcussive symptoms will be presented.

Jonathan M. Silver, MD

Jonathan M. Silver, MD

Clinical Professor of Psychiatry
NYU School of Medicine
Fellow, American Neuropsychiatric Association
Diplomate, Behavioral Neurology & Neuropsychiatry

To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify pre-injury, injury-related, and post-injury factors that influence the development and persistence of postconcussive symptoms.
  2. Recognize the contributions of context and process to cognitive dysfunction following mild traumatic brain injury.
  3. Identify the effects of repetitive subconcussive impacts on short- and long-term cognitive performance.
  4. Recognize factors that influence effort and symptom reporting in the late period after mild traumatic brain injury.
  5. Recognize the contributions of context and process to cognitive dysfunction following mild traumatic brain injury.
  6. Recognize factors that influence effort and symptom reporting in the late period after mild traumatic brain injury.
  7. Recognize ethical issues that may influence the professionals opinion of the patients condition.

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Speaker Biography

Jonathan M. Silver, M.D. is Clinical Professor of Psychiatry at New York University School of Medicine.

Dr. Silver is a Fellow and past- President of the American Neuropsychiatric Association. He is a Diplomate in Behavioral Neurology & Neuropsychiatry by the United Council for Neurologic Subspecialties (UCNS), and is Chair of their committee that developed the first certification examination. He is a member of the examination committee for the newly approved specialty “Brain Injury Medicine” by the American Board of Medical Specialties (ABMS). He is Associate Editor of the Journal of Neuropsychiatry and Clinical Neurosciences, Journal of Neurology, Neurosurgery, and Psychiatry, Journal Watch Psychiatry, and Psychiatry Section Editor for UpToDate.

He has held past positions as Director of Neuropsychiatry at Columbia-Presbyterian Medical Center, and Assistant Chair of Clinical Services and Research and Director of Ambulatory Services in the Department of Psychiatry at Lenox Hill Hospital in New York City.

He has authored over 45 papers and 60 chapters, focusing on the neuropsychiatric problems subsequent to traumatic brain injury and the pharmacologic treatment of those problems. He has lectured on these topics, and has made over 160 presentations at scientific meetings. He is senior editor of the books “Neuropsychiatry of Traumatic Brain Injury,” and “Textbook of Traumatic Brain Injury.” He has been listed in “Best Doctors in America” since 1992 for the area of neuropsychiatry. He received the award for “Innovative Clinical Treatment” from the North American Brain Injury Society.