Major depression following traumatic brain injury
Major depression following traumatic brain injury
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DOI：
10.1001/archpsyc.61.1.42
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发表时间：
2004-01-01
影响因子：
--
通讯作者：
Arndt, S
中科院分区：
文献类型：
--
作者：
Jorge, RE;Robinson, RG;Arndt, S
背景：重性抑郁是创伤性脑损伤（TBI）患者常见的精神并发症。然而，据我们所知，重性抑郁症的临床相关性还没有得到广泛的研究。目的：确定创伤性脑损伤后发生的重性抑郁症的临床、神经心理学和结构神经影像学相关性。设计：前瞻性、病例对照、监测研究，在创伤事件发生后的第一年进行。设置：大学医院一级创伤中心和一个专门的康复单位。方法：研究组包括91例TBI患者。另外，27例多发伤但无中枢神经系统损伤证据的患者构成对照组。在基线和创伤事件后3、6和12个月对患者的状况进行评估。精神病诊断是使用结构化的临床访谈和DSM-IV标准。神经心理测试和定量磁共振成像进行了3个月的随访visit.Results：在持续TBI后的第一年中，观察到30（33%）的91例患者的重度抑郁症。TBI患者中重度抑郁症的发生率明显高于对照组。患有重度抑郁症的TBI患者比没有重度抑郁症的患者更有可能有情绪和焦虑障碍的个人病史。抑郁症患者共病焦虑（76.7%）和攻击行为（56.7%）。与非抑郁症患者相比，抑郁症患者的执行功能有更大的损害。重度抑郁症也与较差的社会功能在6个月和12个月的后续行动，以及显着减少左前额叶灰质体积，特别是在腹外侧和背外侧regions.Conclusions：重度抑郁症是一种常见的并发症TBI，阻碍了病人的恢复。它与执行功能障碍、消极情绪和突出的焦虑症状有关。TBI引起的神经病理学改变可能导致外侧和背侧前额叶皮质失活，腹侧边缘系统和包括杏仁核在内的边缘系统结构激活增加。
Backgroud: Major depression is a frequent psychiatric complication among patients with traumatic brain injury (TBI). To our knowledge, however, the clinical correlates of major depression have not been extensively studied.Objective: To determine the clinical, neuropsychological, and structural neuroimaging correlates of major depression occurring after TBI.Design: Prospective, case-controlled, surveillance study conducted during the first year after the traumatic episode occurred.Settings: University hospital level I trauma center and a specialized rehabilitation unit.Methods: The study group consisted of 91 patients with TBI. In addition, 27 patients with multiple traumas but without evidence of central nervous system injury constituted the control group. The patients' conditions were evaluated at baseline and at 3, 6, and 12 months after the traumatic episode. Psychiatric diagnosis was made using a structured clinical interview and DSM-IV criteria. Neuropsychological testing and quantitative magnetic resonance imaging were performed at the 3-month follow-up visit.Results: Major depressive disorder was observed in 30 (33%) of 91 patients during the first year after sustaining a TBI. Major depressive disorder was significantly more frequent among patients with TBI than among the controls. Patients with TBI who had major depression were more likely to have a personal history of mood and anxiety disorders than patients who did not have major depression. Patients with major depression exhibited comorbid anxiety (76.7%) and aggressive behavior (56.7%). Patients with major depression had significantly greater impairment in executive functions than their nondepressed counterparts. Major depression was also associated with poorer social functioning at the 6-and 12-month follow-up, as well as significantly reduced left prefrontal gray matter volumes, particularly in the ventrolateral and dorsolateral regions.Conclusions: Major depression is a frequent complication of TBI that hinders a patient's recovery. It is associated with executive dysfunction, negative affect, and prominent anxiety symptoms. The neuropathological changes produced by TBI may lead to deactivation of lateral and dorsal prefrontal cortices and increased activation of ventral limbic and paralimbic structures including the amygdala.