Stubbs Jacob L, Green Katherine E, Silverberg Noah D, Howard Andrew, Dhariwal Amrit K, Brubacher Jeffrey R, Garraway Naisan, Heran Manraj K S, Sekhon Mypinder S, Aquino Angela, Purcell Victoria, Hutchison James S, Torres Ivan J, Panenka William J
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, BC, Canada.
Front Neurol. 2020 Feb 4;11:43. doi: 10.3389/fneur.2020.00043. eCollection 2020.
Somatization may contribute to persistent symptoms after mild traumatic brain injury (mTBI). In two independently-recruited study samples, we characterized the extent to which symptoms atypical of mTBI but typical for patients suffering from somatization (e.g., gastrointestinal upset, musculoskeletal, and cardiorespiratory complaints) were present in adult patients with prolonged recovery following mTBI. The first sample was cross-sectional and consisted of mTBI patients recruited from the community who reported ongoing symptoms attributable to a previous mTBI ( = 16) along with a healthy control group ( = 15). The second sample consisted of patients with mTBI prospectively recruited from a Level 1 trauma center who had either good recovery (GOSE = 8; = 32) or poor recovery (GOSE < 8; = 29). In all participants, we evaluated atypical somatic symptoms using the Patient Health Questionnaire-15 and typical post-concussion symptoms with the Rivermead Post-Concussion Symptom Questionnaire. Participants with poor recovery from mTBI had significantly higher "atypical" somatic symptoms as compared to the healthy control group in Sample 1 ( = 4.308, < 0.001) and to mTBI patients with good recovery in Sample 2 ( = 3.169, < 0.001). As would be expected, participants with poor outcome in Sample 2 had a higher burden of typical rather than atypical symptoms [ = 4.750, < 0.001, = 0.88]. However, participants with poor recovery still reported atypical somatic symptoms that were significantly higher (1.4 standard deviations, on average) than those with good recovery. Our results suggest that although "typical" post-concussion symptoms predominate after mTBI, a broad range of somatic symptoms also frequently accompanies mTBI, and that somatization may represent an important, modifiable factor in mTBI recovery.
躯体化可能导致轻度创伤性脑损伤（mTBI）后症状持续存在。在两个独立招募的研究样本中，我们描述了在mTBI后恢复时间延长的成年患者中，出现mTBI不典型但躯体化患者典型的症状（如胃肠道不适、肌肉骨骼和心肺方面的主诉）的程度。第一个样本是横断面样本，由从社区招募的报告有先前mTBI所致持续症状的mTBI患者（n = 16）以及一个健康对照组（n = 15）组成。第二个样本由从一级创伤中心前瞻性招募的mTBI患者组成，这些患者要么恢复良好（格拉斯哥结局量表[GOSE]=8；n = 32），要么恢复不佳（GOSE<8；n = 29）。在所有参与者中，我们使用患者健康问卷-15评估不典型躯体症状，并用里弗米德脑震荡后症状问卷评估典型的脑震荡后症状。与样本1中的健康对照组相比（t = 4.308，P<0.001）以及与样本2中恢复良好的mTBI患者相比（t = 3.169，P<0.001），mTBI恢复不佳的参与者有显著更多的“不典型”躯体症状。正如预期的那样，样本2中结局不佳的参与者典型症状的负担更高，而非不典型症状[ t = 4.750，P<0.001，效应量=0.88]。然而，恢复不佳的参与者仍报告不典型躯体症状显著高于恢复良好的参与者（平均高1.4个标准差）。我们的结果表明，尽管mTBI后“典型的”脑震荡后症状占主导，但广泛的躯体症状也经常伴随mTBI出现，并且躯体化可能是mTBI恢复中的一个重要的、可改变的因素。
