Stéfan Angélique, Mathé Jean-François
Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Saint-Jacques, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex, France.
Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Saint-Jacques, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex, France.
Ann Phys Rehabil Med. 2016 Feb;59(1):5-17. doi: 10.1016/j.rehab.2015.11.002. Epub 2016 Jan 4.
Behavioral disorders are major sequelae of severe traumatic brain injury. Before considering care management of these disorders, and in the absence of a precise definition for TBI-related behavioral disorder, it is essential to refine, according to the data from the literature, incidence, prevalence, predictive factors of commonly admitted disruptive symptoms.
Systematic review of the literature targeting epidemiological data related to behavioral disorders after traumatic brain injury in order to elaborate good practice recommendations according to the methodology established by the French High Authority for Health.
Two hundred and ninety-nine articles were identified. The responsibility of traumatic brain injury (TBI) in the onset of behavioral disorders is unequivocal. Globally, behavioral disorders are twice more frequent after TBI than orthopedic trauma without TBI (Masson et al., 1996). These disorders are classified into disruptive primary behaviors by excess (agitation 11-70%, aggression 25-39%, irritability 29-71%, alcohol abuse 7-26% drug abuse 2-20%), disruptive primary behaviors by default (apathy 20-71%), affective disorders - anxiety - psychosis (depression 12-76%, anxiety 0.8-24,5%, posttraumatic stress 11-18%, obsessive-compulsive disorders 1.2-30%, psychosis 0.7%), suicide attempts and suicide 1%.
The improvement of care management for behavioral disorders goes through a first step of defining a common terminology. Four categories of posttraumatic behavioral clinical symptoms are defined: disruptive primary behaviors by excess, by default, affective disorders-psychosis-anxiety, suicide attempts and suicide. All these symptoms yield a higher prevalence than in the general population. They impact all of life's domains and are sustainable over time.
行为障碍是重度创伤性脑损伤的主要后遗症。在考虑对这些障碍进行护理管理之前，且在缺乏与创伤性脑损伤相关行为障碍的精确界定的情况下，根据文献数据细化常见的破坏性行为症状的发病率、患病率及预测因素至关重要。
针对与创伤性脑损伤后行为障碍相关的流行病学数据进行文献系统综述，以便根据法国卫生高级管理局制定的方法阐述良好实践建议。
共识别出299篇文章。创伤性脑损伤（TBI）在行为障碍发病中的作用是明确的。总体而言，创伤性脑损伤后行为障碍的发生率是无创伤性脑损伤的骨科创伤后的两倍（马森等人，1996年）。这些障碍可分为以下几类：过度的破坏性行为（躁动11%-70%，攻击行为25%-39%，易怒29%-71%，酒精滥用7%-26%，药物滥用2%-20%）、缺失的破坏性行为（冷漠20%-71%）、情感障碍-焦虑-精神病（抑郁12%-76%，焦虑0.8%-24.5%，创伤后应激11%-18%，强迫症1.2%-30%，精神病0.7%）、自杀未遂和自杀1%。
行为障碍护理管理的改善首先要定义一个通用术语。定义了四类创伤后行为临床症状：过度的破坏性行为、缺失的破坏性行为、情感障碍-精神病-焦虑、自杀未遂和自杀。所有这些症状的患病率均高于一般人群。它们影响生活的所有领域，且会持续存在。
