Department of Psychiatry at University of California, San Diego, Children's Hospital and Health Center, San Diego, CA 92123, USA.
J Neuropsychiatry Clin Neurosci. 2011 Winter;23(1):29-39. doi: 10.1176/jnp.23.1.jnp29.
The study's objective was to assess the nature, rate, predictive factors, and neuroimaging correlates of novel (new-onset) definite anxiety disorders and novel definite/subclinical anxiety disorders (in a broader group of children with at least subclinical anxiety disorders) after traumatic brain injury (TBI). Children with TBI from consecutive admissions to five trauma centers were enrolled and studied with psychiatric interviews soon after injury (baseline) and again 6 months post-injury. Novel definite anxiety disorder and novel definite/subclinical anxiety disorders were heterogeneous and occurred in 8.5% (N=12) and 17% (N=24) of participants, respectively, in the first 6 months after injury. Novel definite anxiety disorder was significantly associated with younger age at injury and tended to be associated with novel depressive disorder, as well as lesions of the superior frontal gyrus. Novel definite/subclinical anxiety disorder was significantly associated with concurrent psychiatric problems of personality change due to TBI and novel definite/subclinical depressive disorder, as well as with lesions of the superior frontal gyrus and a trend-association with frontal lobe white-matter lesions. These findings suggest that anxiety after childhood TBI may be part of a broader problem of affective dysregulation related to damaged dorsal frontal lobe and frontal white-matter systems, with younger children being at greatest risk for developing novel anxiety disorder after TBI.
本研究旨在评估创伤性脑损伤（TBI）后新发（新发病）明确焦虑障碍和新发明确/亚临床焦虑障碍（在至少存在亚临床焦虑障碍的儿童更广泛的群体中）的性质、发生率、预测因素和神经影像学相关性。连续纳入来自五个创伤中心的 TBI 患儿，并在损伤后不久（基线）和损伤后 6 个月进行精神科访谈进行研究。在损伤后的前 6 个月，分别有 8.5%（N=12）和 17%（N=24）的参与者出现新发明确焦虑障碍和新发明确/亚临床焦虑障碍，这些障碍具有异质性。新发明确焦虑障碍与损伤时年龄较小显著相关，且往往与新发抑郁障碍以及额上回病变相关。新发明确/亚临床焦虑障碍与 TBI 引起的人格改变和新发明确/亚临床抑郁障碍的同时存在的精神问题显著相关，也与额上回病变以及额叶白质病变相关。这些发现表明，儿童 TBI 后的焦虑可能是与背侧额叶和额叶白质系统损伤相关的广泛情感调节障碍的一部分，年龄较小的儿童在 TBI 后发生新发焦虑障碍的风险最高。
