McAllister TW
Dartmouth Hitchcock Medical Center, Lebanon, NH
Semin Clin Neuropsychiatry. 1998 Jul;3(3):211-223.
Psychotic syndromes occur more frequently in individuals who have had a traumatic brain injury (TBI) than in the general population. Psychotic syndromes following a TBI can present in the period of post-traumatic anmesia, in association with post-traumatic epilepsy, in association with TBI-related mood disorders, and as a chronic, schizophrenia-like syndrome. Individuals with schizophrenia (a chronic psychotic disorder) have a higher frequency of prior TBI than individuals with other psychiatric disorders. These observations suggest an intriguing link between psychosis and TBI. The study of the neuroanatomical and neuropathological substrate of schizophrenia, and of the core symptoms of the disorder ("negative" symptoms, hallucinations, delusions), suggests that abnormalities in the structure and function of certain brain regions play a role in the genesis and maintenance of these core symptoms. The key brain regions include the dorsolateral prefrontal cortex, temporal lobe structures, basal ganglia, thalamus, and cingulate gyrus. These brain regions are commonly injured in many patients with TBI, suggesting a possible mechanism underlying the observed link between TBI and psychosis. This article reviews the literature on TBI and psychosis, and suggests an approach to the evaluation and treatment of individuals with TBI and psychosis.
与普通人群相比，创伤性脑损伤（TBI）患者中精神病性综合征的发生率更高。TBI后的精神病性综合征可出现在创伤后遗忘期，与创伤后癫痫相关，与TBI相关的情绪障碍相关，以及作为一种慢性的、类似精神分裂症的综合征出现。与患有其他精神疾病的个体相比，患有精神分裂症（一种慢性精神病性障碍）的个体既往TBI的发生率更高。这些观察结果表明精神病与TBI之间存在着有趣的联系。对精神分裂症的神经解剖学和神经病理学基础以及该疾病的核心症状（“阴性”症状、幻觉、妄想）的研究表明，某些脑区的结构和功能异常在这些核心症状的发生和维持中起作用。关键脑区包括背外侧前额叶皮层、颞叶结构、基底神经节、丘脑和扣带回。这些脑区在许多TBI患者中常受到损伤，这提示了TBI与精神病之间观察到的联系背后可能的机制。本文回顾了关于TBI和精神病的文献，并提出了一种评估和治疗TBI和精神病患者的方法。
