Reframing Postconcussional Syndrome as an Interface Disorder of Neurology, Psychiatry and Psychology

Camilla N. Clark; Mark J. Edwards; Bee Eng Ong; Luke Goodliffe; Hena Ahmad; Michael D. Dilley; Shai Betteridge; Colette Griffin; Peter O. Jenkins


Brain. 2022;145(6):1906-1915. 

In This Article


Persistent symptoms after mTBI represent a common and disabling problem resulting in major personal and societal impact. The use of broad syndromic labels for these symptoms, such as PCS and neurocognitive disorder, which build upon the very broad categorization of head injury severity encompassed by the term mTBI are directly unhelpful in advancing treatment, outcomes and scientific understanding. We conceptualize mTBI instead as an 'interface disorder'. This means that clinicians and researchers need to appreciate the complexity of the biological, psychological and ecological interfaces that are often present in people with mTBI. This does not equate to a simple, binary biological and psychological split. Recognizing this complexity and abandoning the current syndromic terms is an important first step in preventing the premature closure of the diagnostic and treatment pathways. Given the prevalence of the condition, not all patients can be, or indeed need to be, referred to specialist interdisciplinary teams. By supporting accurate diagnosis, patient education and early instigation of evidence-based treatment within primary and non-specialist services, the specialist multidisciplinary team is likely to be more effective in providing diagnostic and treatment input for those patients with higher levels of complexity and need.

This approach places the person with mTBI at the center of a diagnostic formulation, which can be used collaboratively to develop a rational and personalized therapeutic prescription. Such work, coupled with research developments in biomarkers and clinical trials, should result in better outcomes for the many people who experience persistent symptoms after mTBI.