Radhakrishnan Rajiv, Garakani Amir, Gross Lawrence S, Goin Marcia K, Pine Janet, Slaby Andrew E, Sumner Calvin R, Baron David A
Yale University School of Medicine, New Haven, CT, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA.
Yale University School of Medicine, New Haven, CT, USA; Silver Hill Hospital, New Canaan, CT, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA.
Lancet Psychiatry. 2016 Dec;3(12):1166-1175. doi: 10.1016/S2215-0366(16)30266-8.
Over the past decade, concussion has become the most widely discussed injury in contact sports. However, concussions also occur in several other settings, such as non-contact sports, elderly individuals, young children, military personnel, and victims of domestic violence. Concussion is frequently undiagnosed as a cause of psychiatric morbidity, especially when the patient has no history of loss of consciousness or direct head trauma. Almost all of the extant literature focuses on traumatic brain injury and assumes that concussion is merely a mild form of traumatic brain injury, which has resulted in a lack of understanding about what concussion is, and how to diagnose, monitor, and treat its varied neuropsychiatric symptoms. In this Review, we address key issues so that the psychiatric clinician can better understand and treat patients with a clinical phenotype that might be the direct result of, or be exacerbated by, concussion. Future research needs to focus on prospective clinical trials in all affected patient populations (ie, those affected by concussion and those affected by various degrees of traumatic brain injury), the identification of reliable biomarkers that can be used to assist with diagnosis and treatment response, and the development of effective treatment interventions. Clearly differentiating concussion from traumatic brain injury is essential to achieve reliable and clinically relevant outcomes.
在过去十年中，脑震荡已成为接触性运动中讨论最为广泛的损伤。然而，脑震荡也会在其他几种情况下发生，比如非接触性运动、老年人、幼儿、军事人员以及家庭暴力受害者。脑震荡作为精神疾病的一个病因常常未被诊断出来，尤其是当患者没有意识丧失或直接头部外伤史时。几乎所有现存文献都聚焦于创伤性脑损伤，并认为脑震荡仅仅是创伤性脑损伤的一种轻度形式，这导致人们对脑震荡是什么以及如何诊断、监测和治疗其各种神经精神症状缺乏了解。在本综述中，我们阐述关键问题，以便精神科临床医生能够更好地理解和治疗具有可能是脑震荡直接导致或因脑震荡而加重的临床表型的患者。未来的研究需要集中在对所有受影响患者群体（即那些受脑震荡影响的患者以及那些受不同程度创伤性脑损伤影响的患者）进行前瞻性临床试验，识别可用于辅助诊断和治疗反应的可靠生物标志物，以及开发有效的治疗干预措施。明确区分脑震荡和创伤性脑损伤对于获得可靠且与临床相关的结果至关重要。
