Thurber C A
Harborview Medical Center, Seattle, WA 98104-2499, USA.
Pediatr Rehabil. 1998 Oct-Dec;2(4):149-55. doi: 10.3109/17518429809060946.
The direct, subtle, complex, and even illusory relations between anxiety and closed head injury (CHI) in young people are frequently depreciated by professionals in paediatric rehabilitation settings. Neglecting these relations can slow recovery and complicate rehabilitation. As a brief clinical primer, this paper reviews evidence for 10 possible pathways by which closed head injury (CHI) can directly or indirectly cause, or appear to cause, anxiety in young people: (1) damage to brain structures that regulate emotion; (2) neurological damage that exacerbates pre-injury anxiety; (3) the trauma of sustaining and/or recovering from the CHI; (4) awareness of impaired cognitive functioning; (5) sustaining a CHI does not alter the progression of pre-injury anxiety; (6) emergence of anxiety is coincident but unrelated to the CHI; (7) parental stress caused by caring for an injured child transfers to the child; (8) parental stress caused by a child's disinhibited behaviour transfers to the child; (9) increased dependence/loss of functioning; and (10) impaired social cognition. Working to understand these pathways is critical to improving neuropsychological testing, rehabilitation, assessment of psychopathology, and provision of psychological services to paediatric rehabilitation patients and their families.
在儿科康复环境中，专业人员常常忽视年轻人焦虑与闭合性颅脑损伤（CHI）之间直接、微妙、复杂甚至虚幻的关系。忽视这些关系会延缓康复进程并使康复变得复杂。作为一篇简短的临床入门文章，本文回顾了闭合性颅脑损伤（CHI）可能直接或间接导致或看似导致年轻人焦虑的10条可能途径的证据：（1）调节情绪的脑结构受损；（2）神经损伤加剧伤前焦虑；（3）遭受CHI及/或从CHI中恢复的创伤；（4）意识到认知功能受损；（5）遭受CHI不会改变伤前焦虑的进程；（6）焦虑的出现与CHI同时发生但无关联；（7）照顾受伤儿童导致的父母压力转移到孩子身上；（8）孩子行为抑制解除导致的父母压力转移到孩子身上；（9）依赖性增加/功能丧失；（10）社会认知受损。努力理解这些途径对于改进神经心理学测试、康复、精神病理学评估以及为儿科康复患者及其家庭提供心理服务至关重要。
