Roberts Henrietta, Ford Tamsin J, Karl Anke, Reynolds Shirley, Limond Jenny, Adlam Anna-Lynne R
Psychology, University of Exeter, Exeter, United Kingdom.
Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
Front Hum Neurosci. 2022 Jun 9;16:835897. doi: 10.3389/fnhum.2022.835897. eCollection 2022.
PURPOSE/OBJECTIVE: Young people with paediatric acquired brain injury (pABI) are twice as likely to develop a mood disorder as their peers, frequently have significant unmet socio-emotional needs, and are at over double the risk of going on to use adult mental health services. Recent years have seen significant advances in the development of interventions for young people with mood disorders. However, evidence-based approaches to mood disorders in pABI are lacking and surprisingly little work has evaluated clinical and neuro-developmental models of mood disorders in this population.
We review the literature regarding key mechanisms hypothesised to account for the increased vulnerability to mood disorders in pABI: First, we summarise the direct neurocognitive consequences of pABI, considering the key areas of the brain implicated in vulnerability to mood disorders within a neurodevelopmental framework. Second, we outline five key factors that contribute to the heightened prevalence of mood disorders in young people following ABI. Finally, we synthesise these, integrating neuro-cognitive, developmental and systemic factors to guide clinical formulation.
We present a framework that synthesises the key mechanisms identified in our review, namely the direct effects of pABI, neurocognitive and neuroendocrine factors implicated in mood and anxiety disorders, maladaptive neuroplasticity and trauma, structural and systemic factors, and psychological adjustment and developmental context. This framework is the first attempt to provide integrated guidance on the multiple factors that contribute to elevated life-long risk of mood disorders following pABI.
目的/目标：患有小儿获得性脑损伤（pABI）的年轻人患情绪障碍的可能性是同龄人中的两倍，经常有未得到满足的重大社会情感需求，并且使用成人心理健康服务的风险高出一倍多。近年来，针对患有情绪障碍的年轻人的干预措施有了显著进展。然而，缺乏针对pABI患者情绪障碍的循证方法，令人惊讶的是，很少有研究评估该人群情绪障碍的临床和神经发育模型。
我们回顾了关于假设的导致pABI患者情绪障碍易感性增加的关键机制的文献：首先，我们总结了pABI的直接神经认知后果，在神经发育框架内考虑与情绪障碍易感性相关的关键脑区。其次，我们概述了导致ABI后年轻人情绪障碍患病率升高的五个关键因素。最后，我们将这些因素综合起来，整合神经认知、发育和系统因素以指导临床诊断。
我们提出了一个框架，该框架综合了我们综述中确定的关键机制，即pABI的直接影响、与情绪和焦虑障碍相关的神经认知和神经内分泌因素、适应不良的神经可塑性和创伤、结构和系统因素以及心理调整和发育背景。该框架首次尝试就导致pABI后情绪障碍终身风险升高的多种因素提供综合指导。
