Morikawa M, Iida J, Tokuyama A, Tatsuda H, Matsumoto H, Kishimoto T
Department of Psychiatry, Nara Medical University, Shijo-cho 840, Kashihara, 634-8522 Japan.
Nihon Shinkei Seishin Yakurigaku Zasshi. 2000 Oct;20(4):149-53.
A 19-year-old male had a traffic accident while driving his motorbike and suffered an injury to the left frontotemporal part of the head. He remained conscious, had no focal neurological signs, and brain-computed tomography was unremarkable at the prefectural hospital, department of neurosurgery. Six months later he demonstrated a personality change, which was marked by irritability, aggression, labile moods, childishness, irresponsibility, and a lack of motivation. He sometimes made trouble for those around him, and he consulted our hospital 2 years and 9 months after the accident. He was diagnosed as having posttraumatic personality disorder and was treated with clonazepam, a dosage of up to 1.5 mg/day. Although his symptoms were moderately improved, he complained of sleepiness as an adverse effect. Carbamazepine (100 mg/day) was added in expectation of further improvement. Within a few days he improved to his preaccident personality. After the administration of clonazepam was discontinued, he maintained his good mental status. Now about two years after the initiation of therapy, he works in social welfare facilities and has no relapses. Even if a head injury is mild without definite organic signs in brain, it may have a possibility of causing personality change, which may be treatable.
一名19岁男性骑摩托车时发生交通事故，头部左额颞部受伤。他仍有意识，无局灶性神经体征，在县医院神经外科进行的脑部计算机断层扫描无异常。六个月后，他出现了人格改变，表现为易怒、攻击性、情绪不稳定、幼稚、不负责任和缺乏动力。他有时给周围的人带来麻烦，事故发生两年零九个月后他到我院就诊。他被诊断为创伤后人格障碍，接受了氯硝西泮治疗，剂量高达1.5毫克/天。虽然他的症状有中度改善，但他抱怨嗜睡是一种不良反应。加用卡马西平（100毫克/天）以期进一步改善。几天内他就恢复到事故前的人格状态。停用氯硝西泮后，他保持了良好的精神状态。现在治疗开始约两年后，他在社会福利机构工作，没有复发。即使头部损伤较轻，脑部无明确器质性体征，也可能导致人格改变，而这种改变可能是可治疗的。
