Fann J R, Katon W J, Uomoto J M, Esselman P C
Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, USA.
Am J Psychiatry. 1995 Oct;152(10):1493-9. doi: 10.1176/ajp.152.10.1493.
This study examined psychiatric sequelae of traumatic brain injuries in outpatients and their relation to functional disability.
Fifty consecutive outpatients with traumatic brain injuries who came to a brain injury rehabilitation clinic for initial evaluation were examined for DSM-III-R diagnoses with the use of the National Institute of Mental Health Diagnostic Interview Schedule. The patients completed the Medical Outcomes Study Health Survey to assess functional disability and a questionnaire to assess postconcussion symptoms and self-perceptions of the severity of their brain injuries and cognitive functioning.
Thirteen (26%) of the patients had current major depression, and an additional 14 (28%) reported a first-onset major depressive episode after the injury that had resolved. Twelve (24%) had current generalized anxiety disorder, and four (8%) reported current substance abuse. The group with depression and/or anxiety was significantly more impaired than the nondepressed/nonanxious patients according to the Medical Outcomes Study Health Survey measures of emotional role functioning, mental health, and general health perceptions. The depressed/anxious group also rated their injuries as significantly more severe and their cognitive functioning as significantly worse, despite the lack of significant differences in objective measures of severity of injury and Mini-Mental State examination scores. The depressed patients reported significantly more postconcussion symptoms that were increasing in severity over time.
Depression and anxiety are common in outpatients with traumatic brain injuries. Patients with depression or anxiety are more functionally disabled and perceive their injury and cognitive impairment as more severe. Depressed patients report more increasingly severe postconcussion symptoms.
本研究调查了门诊创伤性脑损伤患者的精神后遗症及其与功能残疾的关系。
连续五十名到脑损伤康复门诊进行初始评估的创伤性脑损伤门诊患者，使用美国国立精神卫生研究所诊断访谈表进行DSM-III-R诊断检查。患者完成医疗结局研究健康调查以评估功能残疾情况，并填写一份问卷以评估脑震荡后症状以及他们对自身脑损伤严重程度和认知功能的自我认知。
13名（26%）患者目前患有重度抑郁症，另有14名（28%）报告在受伤后首次出现已缓解的重度抑郁发作。12名（24%）患者目前患有广泛性焦虑症，4名（8%）报告目前存在药物滥用问题。根据医疗结局研究健康调查中关于情感角色功能、心理健康和总体健康认知的测量，患有抑郁症和/或焦虑症的患者组比未患抑郁症/焦虑症的患者受损程度明显更严重。尽管在客观损伤严重程度测量和简易精神状态检查得分方面没有显著差异，但抑郁/焦虑组患者仍将自己的损伤评定为明显更严重，认知功能也明显更差。抑郁患者报告的脑震荡后症状明显更多，且症状严重程度随时间增加。
抑郁症和焦虑症在创伤性脑损伤门诊患者中很常见。患有抑郁症或焦虑症的患者功能残疾程度更高，并且认为自己的损伤和认知障碍更严重。抑郁患者报告的脑震荡后症状越来越严重。
