Fugate L P, Spacek L A, Kresty L A, Levy C E, Johnson J C, Mysiw W J
Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus 43210, USA.
Arch Phys Med Rehabil. 1997 Sep;78(9):917-23. doi: 10.1016/s0003-9993(97)90050-2.
To determine national patterns of defining agitation after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors.
A random sample of 70% of the members of the Brain Injury Special Interest Group (SIG) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) were surveyed by telephone.
The 129 members who responded yielded an 82% response rate. Respondents rated 18 characteristics from established rating scales on a 5-point scale according to each characteristic's relation to its clinical definition of agitation. Physical aggression, explosive anger, increased psychomotor activity, impulsivity, verbal aggression, disorganized thinking, perceptual disturbances, and reduced ability to maintain or appropriately shift attention were rated by at least 50% of the sample as very important or essential to agitation. Delirium, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), has been proposed as a standard definition of agitation. The degree to which all characteristics from the 3rd revised edition of the DSM (DSM-IIIR), considered together, were perceived to relate to agitation predicted 24% of the degree to which the term "delirium" was perceived to relate to agitation (Canonical correlation r = .48, p = .0002). Physicians' ratings of individual delirium characteristics from the DSM-IIIR were examined to determine if a sufficient number were similarly ranked to fulfill the diagnostic criteria for delirium. A significant number of physicians rated diagnostic criteria for delirium in one direction, yet did not rank the term "delirium" accordingly (McNemar's p = .04).
There is considerable variation among physiatrists in their rating of characteristics that define agitation. Many define agitation during the acute recovery phase as posttraumatic amnesia plus an excess of behavior such as aggression, disinhibition, and/or emotional lability. Less support was given to defining agitation by the DSM-IIIR or DSM-IV diagnostic criteria for delirium. Delirium appears related to, but is not sufficient for, a diagnosis of agitation.
确定对治疗创伤性脑损伤（TBI）幸存者有明确兴趣的物理治疗师对TBI后激越的定义模式。
通过电话对美国物理医学与康复学会（AAPM&R）脑损伤特别兴趣小组（SIG）70%的成员进行随机抽样调查。
129名回复者的回复率为82%。根据既定评定量表中的18项特征与激越临床定义的关系，回复者以5分制对其进行评分。至少50%的样本将身体攻击、爆发性愤怒、精神运动活动增加、冲动、言语攻击、思维紊乱、感知障碍以及维持或适当转移注意力能力下降评为对激越非常重要或必不可少。《精神疾病诊断与统计手册》（DSM）中定义的谵妄已被提议作为激越的标准定义。DSM第三版修订本（DSM-IIIR）中所有特征综合起来被认为与激越相关的程度，预测了“谵妄”一词被认为与激越相关程度的24%（典型相关系数r = 0.48，p = 0.0002）。对医生对DSM-IIIR中个别谵妄特征的评分进行检查，以确定是否有足够数量的特征被类似排序以满足谵妄的诊断标准。相当数量的医生在一个方向上对谵妄的诊断标准进行了评分，但并未相应地对“谵妄”一词进行排序（麦克内玛检验p = 0.04）。
物理治疗师在对定义激越的特征评分方面存在相当大的差异。许多人将急性恢复期的激越定义为创伤后遗忘症加上过度的行为，如攻击、去抑制和/或情绪不稳定。DSM-IIIR或DSM-IV谵妄诊断标准对激越定义的支持较少。谵妄似乎与激越诊断相关，但不足以作为激越的诊断依据。
