Fann J R, Leonetti A, Jaffe K, Katon W J, Cummings P, Thompson R S
Department of Psychiatry, University of Washington, Seattle, Washington, USA.
J Neurol Neurosurg Psychiatry. 2002 May;72(5):615-20. doi: 10.1136/jnnp.72.5.615.
To determine whether psychiatric illness is a risk factor for subsequent traumatic brain injury (TBI).
Case control study in a large staff model health maintenance organisation in western Washington State. Patients with TBI, determined by International classification of diseases, 9th revision, clinical modification (ICD-9-CM) diagnoses, were 1440 health plan members who had TBI diagnosed in 1993 and who had been enrolled in the previous year, during which no TBI was ascertained. Three health plan members were randomly selected as control subjects, matched by age, sex, and reference date. Psychiatric illness in the year before the TBI reference date was determined by using computerised records of ICD-9-CM diagnoses, psychiatric medication prescriptions, and utilisation of a psychiatric service.
For those with a psychiatric diagnosis in the year before the reference date, the adjusted relative risk for TBI was 1.7 (95% confidence interval (CI) 1.4 to 2.0) compared with those without a psychiatric diagnosis. Patients who had filled a psychiatric medication prescription had an adjusted relative risk for TBI of 1.6 (95% CI 1.2 to 2.1) compared with those who had not filled a psychiatric medication prescription. Patients who had utilised psychiatric services had an adjusted relative risk for TBI of 1.3 (95% CI 1.0 to 1.6) compared with those who had not utilised psychiatric services. The adjusted relative risk for TBI for patients with psychiatric illness determined by any of the three psychiatric indicators was 1.6 (95% CI 1.4 to 1.9) compared with those without any psychiatric indicator.
Psychiatric illness appears to be associated with an increased risk for TBI.
确定精神疾病是否为后续创伤性脑损伤（TBI）的危险因素。
在华盛顿州西部一个大型员工模式健康维护组织中进行病例对照研究。根据国际疾病分类第九版临床修订本（ICD - 9 - CM）诊断确定为TBI的患者，是1440名健康计划成员，他们于1993年被诊断为TBI，且上一年已参保，在此期间未确诊TBI。随机选择三名健康计划成员作为对照对象，按年龄、性别和参考日期进行匹配。通过使用ICD - 9 - CM诊断的计算机记录、精神科药物处方以及精神科服务的使用情况来确定TBI参考日期前一年的精神疾病。
与无精神疾病诊断者相比，参考日期前一年有精神疾病诊断者的TBI调整相对风险为1.7（95%置信区间（CI）1.4至2.0）。与未开具精神科药物处方者相比，开具了精神科药物处方的患者TBI调整相对风险为1.6（95%CI 1.2至2.1）。与未使用精神科服务者相比，使用了精神科服务的患者TBI调整相对风险为1.3（95%CI 1.0至1.6）。由这三项精神科指标中的任何一项确定患有精神疾病的患者与无任何精神科指标者相比，TBI调整相对风险为1.6（95%CI 1.4至1.9）。
精神疾病似乎与TBI风险增加相关。
