Cognitive Neuroscience Laboratory, Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine, 1709 Dryden Rd., Ste. 725, Houston, TX 77030, USA.
J Clin Exp Neuropsychol. 2008 Apr;30(3):360-79. doi: 10.1080/13803390701416635. Epub 2007 Jul 25.
Controversy surrounding the causation of symptom complaints after mild traumatic brain injury (MTBI) is reflected by the existence of alternative diagnostic criteria for postconcussional syndrome (PCS) in the International Classification of Diseases (ICD) and postconcussional disorder (PCD) in the Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV). Previous studies of persisting symptoms have employed various symptom checklists rather than uniform criteria-based diagnoses. This is the first prospective study of persisting symptom complaints using the formal diagnostic criteria for PCD and PCS and comparing these criteria sets in terms of prevalence, relationship to potential compensation, and emotional/functional status. In this prospective study, an unselected series of adults with uncomplicated MTBI (N = 139) was assessed at 6 months postinjury with a brief neuropsychological battery and measures of psychiatric symptoms/disorders, social support/community integration, health-related quality of life, and global outcome. In parallel analyses, participants with PCD/PCS were compared to those without the disorder. Potential compensation was an equally significant factor in both criteria sets. Persistent PCS criteria were met 3.1 times more frequently than persistent PCD criteria. Significant racial differences in fulfilling PCD/PCS criteria were found. No differences in emotional/functional status patterns or global outcome were found between the criteria sets except for minor dissimilarities in the social/community integration domain. The results demonstrate that despite large differences in the frequency of patients meeting the two diagnostic criteria sets, a clear basis for preferring either the PCD or PCS criteria remains to be determined.
轻度创伤性脑损伤 (MTBI) 后症状投诉的病因存在争议，这反映在《国际疾病分类》 (ICD) 中存在用于创伤后综合征 (PCS) 的替代诊断标准和《精神障碍诊断与统计手册-第 4 版》 (DSM-IV) 中用于创伤后障碍 (PCD) 的替代诊断标准。以前对持续症状的研究采用了各种症状检查表，而不是基于统一标准的诊断。这是第一项使用创伤后障碍和创伤后综合征的正式诊断标准来研究持续症状投诉的前瞻性研究，并比较了这些标准集在患病率、与潜在补偿的关系以及情绪/功能状态方面的差异。在这项前瞻性研究中，对未经选择的、患有单纯 MTBI 的成年人（N=139）进行了评估，在损伤后 6 个月时使用简短的神经心理学测试和精神症状/障碍、社会支持/社区融入、健康相关生活质量和总体结果的测量。在平行分析中，将患有 PCD/PCS 的参与者与没有该障碍的参与者进行了比较。潜在的补偿在两个标准集中都是一个同等重要的因素。持续的 PCS 标准比持续的 PCD 标准的满足率高 3.1 倍。在满足 PCD/PCS 标准方面存在显著的种族差异。除了在社会/社区融入领域存在一些细微差异外，两个标准集之间在情绪/功能状态模式或总体结果方面没有差异。结果表明，尽管满足这两个诊断标准集的患者频率存在很大差异，但仍需要确定更倾向于使用 PCD 还是 PCS 标准的明确依据。
