Parker Rolland S
Department of Neurology, New York University School of Medicine, New York, NY 10016, USA.
NeuroRehabilitation. 2002;17(2):131-43.
The definitions in the Diagnostic and Statistical Manual-4th Ed.-TR [5] relating to posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) after mechanical accidents do not reflect the range of dysfunctions, the significance of patient differences, and fluctuating intensity, direction, and symptoms with increasing time since an injury. The considerable overlapping of symptoms is not considered at all, nor is concussion given a diagnosis. Some anatomical and physiological considerations for these frequently comorbid conditions are specified to increase diagnostic precision, or call attention to unavoidable ambiguities. The current definitions lead to diagnostic error since there are many that are based upon symptoms that are not trauma related although they resemble those of TBI. A Taxonomy of Neurobehavioral Disorders draws attention to a wide range of physiological and behavioral functions, with implications for more accurate recognition of symptoms, diagnosis, and treatment. Persistent posttraumatic disorders, more complex than PTSD, exist, due to the effects of unhealed tissues, impairment, and the social consequences of impairment and rejection. There are recommendations for the improvement of the definitions of PTSD and traumatic brain injury when both may be co-morbid after a mechanical injury.
《精神疾病诊断与统计手册（第4版，修订版）》[5]中关于机械事故后创伤后应激障碍（PTSD）和创伤性脑损伤（TBI）的定义，并未反映出功能障碍的范围、患者个体差异的重要性，以及自受伤后随着时间推移症状强度、方向和症状的波动情况。症状的大量重叠根本未被考虑，脑震荡也未被诊断。针对这些经常合并出现的情况，明确了一些解剖学和生理学方面的考量因素，以提高诊断的准确性，或引起对不可避免的模糊性的关注。当前的定义会导致诊断错误，因为有许多定义是基于与创伤无关但类似于TBI症状的症状。《神经行为障碍分类学》关注了广泛的生理和行为功能，对更准确地识别症状、诊断和治疗具有启示意义。由于未愈合组织的影响、损伤以及损伤和排斥的社会后果，存在比PTSD更复杂的持续性创伤后障碍。对于机械损伤后PTSD和创伤性脑损伤可能合并出现的情况，有改进其定义的建议。
