Berthier M L, Kulisevsky J J, Gironell A, López O L
Department of Medicine and Dermatology, University of Malaga, Spain.
Neuropsychiatry Neuropsychol Behav Neurol. 2001 Jan;14(1):23-31.
The goal of this study was to evaluate behavior and cognition in a consecutive series of patients who developed obsessive-compulsive disorder (OCD) after suffering a traumatic brain injury (TBI).
Because OCD is a rare sequelae of TBI, the phenomenology of obsessions and compulsions, the comorbid psychiatric disorders, the performance on cognitive tests, and the neural correlates have not been well characterized.
Ten adult patients who met DSM-IV diagnostic criteria for OCD after suffering either mild (6 cases), moderate (2 cases), or severe (2 cases) TBI were studied using structured psychiatric rating scales (i.e., Yale-Brown Obsessive Compulsive Scale), cognitive tests, and magnetic resonance imaging (MRI).
Global severity of OCD ranged from moderate to severe, and all patients had multiple obsessions and compulsions. There was a high frequency of aggressive, contamination, need for symmetry/exactness, somatic, and sexual obsessions as well as cleaning/washing, checking, and repeating compulsions. Unusual features such as obsessional slowness (3 cases) and compulsive exercising (3 cases) were also documented. Comorbid psychiatric diagnoses were common and included posttraumatic stress disorder, anxiety with panic attacks, depression, and intermittent explosive disorder. Compared with 10 age-matched normal controls, the OCD group had poor performance on tests of general intelligence, attention, learning, memory, word-retrieval, and executive functions; these cognitive deficits were more pervasive among patients displaying obsessional slowness. All OCD patients with mild TBI had normal MRI scans, whereas focal contusions in the frontotemporal cortices, subcortical structures (caudate nucleus), or both were found in OCD patients with moderate and severe TBI.
Posttraumatic OCD has a relatively specific pattern of symptoms even in patients with mild TBI and is associated with a variety of other psychiatric disorders, particularly non-OCD anxiety. The patterns of cognitive deficits and MRI findings suggest dysfunction of frontal-subcortical circuits.
本研究旨在评估在创伤性脑损伤（TBI）后连续出现强迫症（OCD）的一系列患者的行为和认知情况。
由于强迫症是创伤性脑损伤的一种罕见后遗症，强迫观念和强迫行为的现象学、共病的精神障碍、认知测试表现以及神经关联尚未得到充分描述。
对10例成年患者进行了研究，这些患者在遭受轻度（6例）、中度（2例）或重度（2例）创伤性脑损伤后符合DSM-IV强迫症诊断标准，研究采用结构化精神评定量表（即耶鲁-布朗强迫量表）、认知测试和磁共振成像（MRI）。
强迫症的总体严重程度从中度到重度不等，所有患者都有多种强迫观念和强迫行为。攻击、污染、对称/精确需求、躯体和性方面的强迫观念以及清洁/洗涤、检查和重复强迫行为的出现频率很高。还记录了一些不寻常的特征，如强迫性迟缓（3例）和强迫性锻炼（3例）。共病的精神诊断很常见，包括创伤后应激障碍、伴有惊恐发作的焦虑症、抑郁症和间歇性爆发障碍。与10名年龄匹配的正常对照组相比，强迫症组在一般智力、注意力、学习、记忆、单词检索和执行功能测试中的表现较差；这些认知缺陷在表现出强迫性迟缓的患者中更为普遍。所有轻度创伤性脑损伤的强迫症患者MRI扫描均正常，而中度和重度创伤性脑损伤的强迫症患者在额颞叶皮质、皮质下结构（尾状核）或两者中发现有局灶性挫伤。
即使在轻度创伤性脑损伤患者中，创伤后强迫症也有相对特定的症状模式，并且与多种其他精神障碍有关，尤其是非强迫症性焦虑。认知缺陷模式和MRI结果表明额叶-皮质下回路功能障碍。
