儿童和青少年创伤性脑损伤后 6 个月的新型精神障碍。
Novel Psychiatric Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents.
机构信息
Department of Psychiatry (Max), Division of Biostatistics & Bioinformatics, Herbert Wertheim School of Public Health (Vaida), and Department of Radiology (Hesselink), University of California, San Diego; Rady Children's Hospital, San Diego (Max); Taconic Hills High School, Craryville, New York (Drake); University of Texas Health Science Center at Houston (Ewing-Cobbs, Saunders); The Hospital for Sick Children, University of Toronto(Schachar); Center for BrainHealth, The University of Texas at Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences (Yang) and Department of Radiology and Biomedical Imaging (Tymofiyeva), University of California, San Francisco; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde, Levin).
出版信息
J Neuropsychiatry Clin Neurosci. 2023 Spring;35(2):141-150. doi: 10.1176/appi.neuropsych.21120301. Epub 2022 Aug 22.
OBJECTIVE
To investigate the factors predictive of novel psychiatric disorders in the interval 0-6 months following traumatic brain injury (TBI).
METHODS
Children ages 5-14 years consecutively hospitalized for mild to severe TBI at five hospitals were recruited. Participants were evaluated at baseline (soon after injury) for pre-injury characteristics including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, family function, family psychiatric history, and adaptive function. In addition to the psychosocial variables, injury severity and lesion location detected with acquisition of a research MRI were measured to develop a biopsychosocial predictive model for development of novel psychiatric disorders. Psychiatric outcome, including occurrence of a novel psychiatric disorder, was assessed 6 months after the injury.
RESULTS
The recruited sample numbered 177 children, and 141 children (80%) returned for the six-month assessment. Of the 141 children, 58 (41%) developed a novel psychiatric disorder. In univariable analyses, novel psychiatric disorder was significantly associated with lower SES, higher psychosocial adversity, and lesions in frontal lobe locations, such as frontal white matter, superior frontal gyrus, inferior frontal gyrus, and orbital gyrus. Multivariable analyses found that novel psychiatric disorder was independently and significantly associated with frontal-lobe white matter, superior frontal gyrus, and orbital gyrus lesions.
CONCLUSION
The results demonstrate that occurrence of novel psychiatric disorders following pediatric TBI requiring hospitalization is common and has identifiable psychosocial and specific biological predictors. However, only the lesion predictors were independently related to this adverse psychiatric outcome.
目的
探讨创伤性脑损伤（TBI）后 0-6 个月新发生精神障碍的预测因素。
方法
连续纳入五家医院因轻度至重度 TBI 住院的 5-14 岁儿童。在基线（受伤后不久）评估参与者的损伤前特征，包括精神障碍、社会经济状况（SES）、心理社会逆境、家庭功能、家庭精神病史和适应功能。除了社会心理变量外，还测量了使用研究性 MRI 检测到的损伤严重程度和病变位置，以制定一个生物心理社会预测模型，预测新发生的精神障碍。在损伤后 6 个月评估精神障碍结局，包括发生新的精神障碍。
结果
共纳入 177 名儿童，141 名儿童（80%）返回进行 6 个月评估。在这 141 名儿童中，有 58 名（41%）发生了新的精神障碍。在单变量分析中，新的精神障碍与 SES 较低、心理社会逆境较高以及额叶部位病变（如额叶白质、额上回、额下回和眶回）显著相关。多变量分析发现，新的精神障碍与额叶白质、额上回和眶回病变独立相关。
结论
研究结果表明，需要住院治疗的儿童 TBI 后发生新的精神障碍很常见，且有可识别的社会心理和特定生物学预测因素。然而，只有病变预测因素与这种不良精神结局独立相关。
Zotero 插件