Halbauer Joshua D, Ashford J Wesson, Zeitzer Jamie M, Adamson Maheen M, Lew Henry L, Yesavage Jerome A
Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA 94304, USA.
J Rehabil Res Dev. 2009;46(6):757-96. doi: 10.1682/jrrd.2008.08.0119.
Soldiers with a traumatic brain injury (TBI) present with an array of neuropsychiatric symptoms that can be grouped into nosological clusters: (1) cognitive dysfunctions: difficulties in memory, attention, language, visuospatial cognition, sensory-motor integration, affect recognition, and/or executive function typically associated with neocortical damage; (2) neurobehavioral disorders: mood, affect, anxiety, posttraumatic stress, and psychosis, as well as agitation, sleep problems, and libido loss, that may have been caused by damage to the cortex, limbic system, and/or brain stem monoaminergic projection systems; (3) somatosensory disruptions: impaired smell, vision, hearing, equilibrium, taste, and somatosensory perception frequently caused by trauma to the sensory organs or their projections through the brain stem to central processing systems; (4) somatic symptoms: headache and chronic pain; and (5) substance dependence. TBI-related cognitive impairment is common in veterans who have served in recent conflicts in the Middle East and is often related to blasts from improvised explosive devices. Although neurobehavioral disorders such as depression and posttraumatic stress disorder commonly occur after combat, the presentation of such disorders in those with head injury may pass undetected with use of current diagnostic criteria and neuropsychological instruments. With a multidimensional approach (such as the biopsychosocial model) applied to each symptom cluster, psychological, occupational, and social dysfunction can be delineated and managed.
患有创伤性脑损伤（TBI）的士兵会出现一系列神经精神症状，这些症状可分为不同的病症集群：（1）认知功能障碍：记忆、注意力、语言、视觉空间认知、感觉运动整合、情感识别和/或执行功能方面的困难，通常与新皮质损伤有关；（2）神经行为障碍：情绪、情感、焦虑、创伤后应激障碍和精神病，以及激动、睡眠问题和性欲丧失，这些可能是由皮质、边缘系统和/或脑干单胺能投射系统受损引起的；（3）躯体感觉障碍：嗅觉、视觉、听觉、平衡、味觉和躯体感觉受损，常由感觉器官或其通过脑干向中央处理系统的投射受到创伤所致；（4）躯体症状：头痛和慢性疼痛；以及（5）物质依赖。与TBI相关的认知障碍在曾参与中东近期冲突的退伍军人中很常见，且常与简易爆炸装置爆炸有关。尽管诸如抑郁症和创伤后应激障碍等神经行为障碍在战斗后很常见，但使用当前的诊断标准和神经心理学工具可能无法检测出头部受伤者中这些障碍的表现。采用多维方法（如生物心理社会模型）来处理每个症状集群，可以明确并管理心理、职业和社会功能障碍。
