Max Jeffrey E, Friedman Keren, Wilde Elisabeth A, Bigler Erin D, Hanten Gerri, Schachar Russell J, Saunders Ann E, Dennis Maureen, Ewing-Cobbs Linda, Chapman Sandra B, Yang Tony T, Levin Harvey S
From the Dept. of Psychiatry, UC San Diego, San Diego, CA, and Rady Children's Hospital, San Diego, CA (JEM); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (KF); Baylor College of Medicine, Houston, TX (EAW); Brigham Young University, Provo, UT (EDB); University of Toronto, Toronto, Canada (RJS); University of Texas Health Science Center, Houston, TX (AS); University of Toronto, Toronto, Canada (MD [deceased]; University of Texas Health Science Center, Houston, TX (LE-C); University of Texas, Dallas, TX (SBC); University of California, San Francisco, CA (TTY); Baylor College of Medicine, Houston, TX (HSL).
J Neuropsychiatry Clin Neurosci. 2015;27(2):112-20. doi: 10.1176/appi.neuropsych.13080190.
This study aimed to better understand the occurrence of novel psychiatric disorders (NPDs) in children with mild traumatic brain injury (mTBI) in relation to preinjury variables, injury-related variables, and concurrent neurocognitive outcome. Eighty-seven children aged 5-14 years who had experienced mTBI were studied from consecutive hospital admissions with semistructured psychiatric interviews soon after injury (baseline). Fifty-four children were reassessed 24 months postinjury. Standardized instruments were used to evaluate injury severity, lesion characteristics, preinjury variables (lifetime psychiatric disorder, family psychiatric history, family function, socioeconomic status, psychosocial adversity, adaptive function, and academic function), and finally, postinjury neurocognitive and adaptive function. At 24 months postinjury, NPDs had occurred in 17 of 54 (31%) participants. NPD at 24 months was related to frontal white matter lesions and was associated with estimated preinjury reading, preinjury adaptive function, and concurrent deficits in reading, processing speed, and adaptive function. These findings extend earlier reports that the psychiatric morbidity after mTBI in children is more common than previously thought, and moreover, it is linked to preinjury individual variables and injury characteristics and is associated with postinjury adaptive and neurocognitive functioning.
本研究旨在更深入地了解轻度创伤性脑损伤（mTBI）儿童中新发精神障碍（NPDs）的发生情况，及其与伤前变量、损伤相关变量和并发神经认知结果的关系。对87名年龄在5至14岁之间经历过mTBI的儿童进行了研究，这些儿童来自连续的医院入院病例，在受伤后不久（基线）接受了半结构化精神科访谈。54名儿童在受伤后24个月进行了重新评估。使用标准化工具评估损伤严重程度、病变特征、伤前变量（终生精神障碍、家族精神病史、家庭功能、社会经济地位、心理社会逆境、适应功能和学业功能），最后评估伤后神经认知和适应功能。在受伤后24个月时，54名参与者中有17名（31%）出现了NPDs。受伤后24个月时的NPDs与额叶白质病变有关，并且与伤前估计的阅读能力、伤前适应功能以及同时存在的阅读、处理速度和适应功能缺陷有关。这些发现扩展了早期的报告，即儿童mTBI后的精神疾病发病率比以前认为的更常见，而且，它与伤前个体变量和损伤特征有关，并与伤后适应和神经认知功能相关。
