Howlett Jonathon R, Nelson Lindsay D, Stein Murray B
VA San Diego Healthcare System, San Diego, La Jolla, California; Department of Psychiatry, University of California San Diego, La Jolla, California.
Department of Neurosurgery & Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Biol Psychiatry. 2022 Mar 1;91(5):413-420. doi: 10.1016/j.biopsych.2021.09.024. Epub 2021 Oct 2.
Traumatic brain injury (TBI) is associated with a host of psychiatric and neurobehavioral problems. As mortality rates have declined for severe TBI, attention has turned to the cognitive, affective, and behavioral sequelae of injuries across the severity spectrum, which are often more disabling than residual physical effects. Moderate and severe TBI can cause personality changes including impulsivity, severe irritability, affective instability, and apathy. Mild TBI, once considered a largely benign phenomenon, is now known to be associated with a range of affective symptoms, with suicidality, and with worsening or new onset of several psychiatric disorders including posttraumatic stress disorder and major depressive disorder. Repetitive head impacts, often in athletic contexts, are now believed to be associated with a number of emotional and behavioral sequelae. The nature and etiology of mental health manifestations of TBI (including a combination of brain dysfunction and psychological trauma and interrelationships between cognitive, affective, and physical symptoms) are complex and have been a focus of recent epidemiological and mechanistic studies. This paper will review the epidemiology of psychiatric and neurobehavioral problems after TBI in military, civilian, and athletic contexts.
创伤性脑损伤（TBI）与一系列精神和神经行为问题相关。随着重度TBI死亡率的下降，人们的注意力已转向不同严重程度损伤的认知、情感和行为后遗症，这些后遗症往往比残留的身体影响更具致残性。中度和重度TBI可导致人格改变，包括冲动、严重易怒、情感不稳定和冷漠。轻度TBI曾被认为在很大程度上是一种良性现象，现在已知与一系列情感症状、自杀倾向以及包括创伤后应激障碍和重度抑郁症在内的多种精神障碍的恶化或新发有关。现在认为，经常在运动环境中发生的重复性头部撞击与许多情感和行为后遗症有关。TBI心理健康表现的性质和病因（包括脑功能障碍与心理创伤的结合以及认知、情感和身体症状之间的相互关系）很复杂，一直是近期流行病学和机制研究的重点。本文将综述军事、民用和运动环境中TBI后精神和神经行为问题的流行病学。
