Institute of Psychiatry, University Clinical Center Belgrade, Pasterova 2, Belgrade, Serbia.
J Endocrinol Invest. 2010 Dec;33(11):770-5. doi: 10.1007/BF03350340. Epub 2010 May 17.
Traumatic brain injury (TBI) has been recently recognized as a risk factor for cognitive impairment and hypopituitarism, presented most frequently with GH deficiency (GHD). GHD is associated not only with changes in body composition, but also with impaired quality of life, cognitive dysfunctions and some psychiatric sequelae, usually classified as "depression" or "atypical depression". The impact of GH therapy on mental status in TBI patients is still unknown.
Psychiatric and cognitive functions were tested in 6 GHD patients at baseline (minimum 3 yr after TBI), reassessed after 6 months of GH therapy as well as 12 months after discontinuation of GH therapy. Psychiatric and cognitive examinations included semi-structured interviews and 3 instruments: Symptom-checklist (SCL-90-R), Zung Depression Inventory, and standard composite neuropsychological battery.
Six months of GH therapy in GHD TBI patients improved cognitive abilities (particularly verbal and non-verbal memory) and significantly improved psychiatric functioning. Severity of depression decreased, as well as intensity of interpersonal sensitivity, hostility, paranoid ideation, anxiety, and psychoticism. Somatization, obsessive-compulsive symptoms and phobic anxiety decreased in all except in one patient. In 3 GHD patients who stopped GH therapy for 12 months we registered worsening of the verbal and non-verbal memory, as well symptoms in 3 SCL dimensions: inter-personal sensitivity, anxiety, and paranoid ideation.
GH-deficient TBI patients are depressed and have cognitive impairment. GH therapy induced reduction of depression, social dysfunction, and certain cognitive domains. Our preliminary data support the necessity of conducting randomized placebo-controlled trials on the effects of GH therapy on neuropsychological and psychiatric status in GHD TBI patients.
最近人们认识到创伤性脑损伤（TBI）是认知障碍和垂体功能减退症（GHD）的危险因素，其中 GH 缺乏症最为常见。GHD 不仅与身体成分的变化有关，而且还与生活质量下降、认知功能障碍和一些精神后遗症有关，这些后遗症通常被归类为“抑郁”或“非典型抑郁”。GH 治疗对 TBI 患者精神状态的影响尚不清楚。
在基线时（TBI 后至少 3 年）对 6 名 GHD 患者进行了精神病学和认知功能测试，在 GH 治疗 6 个月后以及停止 GH 治疗 12 个月后再次进行了评估。精神病学和认知检查包括半结构化访谈和 3 种工具：症状清单（SCL-90-R）、Zung 抑郁量表和标准综合神经心理学测试。
6 个月的 GH 治疗可改善 GHD TBI 患者的认知能力（特别是言语和非言语记忆），并显著改善精神功能。抑郁严重程度下降，人际敏感、敌意、偏执观念、焦虑和精神病性也有所改善。除了一名患者外，躯体化、强迫症状和恐怖性焦虑均有所减轻。在 3 名停止 GH 治疗 12 个月的 GHD 患者中，我们发现言语和非言语记忆以及人际敏感、焦虑和偏执观念等 3 个 SCL 维度的症状恶化。
GHD TBI 患者抑郁且认知受损。GH 治疗可降低抑郁、社会功能障碍和某些认知领域的症状。我们的初步数据支持对 GHD TBI 患者进行 GH 治疗对神经心理和精神状态影响的随机安慰剂对照试验的必要性。
