儿童和青少年创伤性脑损伤后 6 个月出现新型对立违抗性障碍。
Novel Oppositional Defiant Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents.
机构信息
Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max).
出版信息
J Neuropsychiatry Clin Neurosci. 2022 Winter;34(1):68-76. doi: 10.1176/appi.neuropsych.21020052. Epub 2021 Nov 12.
OBJECTIVE
The investigators aimed to assess predictive factors of novel oppositional defiant disorder (ODD) among children and adolescents in the first 6 months following traumatic brain injury (TBI).
METHODS
Children ages 5-14 years who experienced a TBI were recruited from consecutive admissions to five hospitals. Testing of a biopsychosocial model that may elucidate the development of novel ODD included assessment soon after injury (baseline) of preinjury characteristics, including psychiatric disorders, adaptive function, family function, psychosocial adversity, family psychiatric history, socioeconomic status, injury severity, and postinjury processing speed (which may be a proxy for brain injury). MRI analyses were also conducted to examine potential brain lesions. Psychiatric outcome, including that of novel ODD, was assessed 6 months after the injury.
RESULTS
A total of 177 children and adolescents were recruited for the study, and 134 who were without preinjury ODD, conduct disorder, or disruptive behavior disorder not otherwise specified (DBD NOS) returned for the 6-month assessment. Of those who returned 6 months postinjury, 11 (8.2%) developed novel ODD, and none developed novel conduct disorder or DBD NOS. Novel ODD was significantly associated with socioeconomic status, preinjury family functioning, psychosocial adversity, and processing speed.
CONCLUSIONS
These findings show that an important minority of children with TBI developed ODD. Psychosocial and injury-related variables, including socioeconomic status, lower family function, psychosocial adversity, and processing speed, significantly increase risk for this outcome.
目的
研究人员旨在评估创伤性脑损伤（TBI）后 6 个月内儿童和青少年新发对立违抗性障碍（ODD）的预测因素。
方法
从五家医院连续收治的患儿中招募年龄在 5-14 岁之间、患有 TBI 的患儿。通过对可能阐明新发 ODD 发展的生物心理社会模型进行测试，包括在受伤后不久（基线）评估受伤前的特征，包括精神疾病、适应功能、家庭功能、心理社会逆境、家庭精神病史、社会经济地位、损伤严重程度和受伤后处理速度（可能是脑损伤的替代指标）。还进行了 MRI 分析以检查潜在的脑损伤。在受伤后 6 个月评估精神疾病结局，包括新发 ODD。
结果
共有 177 名儿童和青少年被招募参加研究，其中 134 名在受伤前没有 ODD、品行障碍或未特指的破坏性行为障碍（DBD NOS），并在 6 个月时进行了评估。在受伤后 6 个月返回的患儿中，有 11 名（8.2%）新发 ODD，无一例新发品行障碍或 DBD NOS。新发 ODD 与社会经济地位、受伤前家庭功能、心理社会逆境和处理速度显著相关。
结论
这些发现表明，TBI 患儿中有相当一部分发生了 ODD。社会心理和损伤相关的变量，包括社会经济地位、较低的家庭功能、心理社会逆境和处理速度，显著增加了发生这种结局的风险。
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