Mind the Gap: Missing Links in the Understanding of Traumatic Brain Injury and Mental Health.
Mind the Gap: Missing Links in the Understanding of Traumatic Brain Injury and Mental Health.
复制标题
DOI：
10.1016/j.biopsych.2021.12.001
复制
发表时间：
2022-03-01
影响因子：
10.6
通讯作者：
Stein MB
中科院分区：
文献类型：
--
作者：
Nelson LD;Stein MB
颅脑损伤是世界范围内导致残疾的主要原因，发病率不断上升，估计有5500万人患有与颅脑损伤相关的残疾(1)。颅脑损伤后的残疾似乎主要是由损伤的不同神经行为或心理健康相关的后果驱动的(2，3)。本期《生物精神病学》的综述讨论了脑外伤和心理健康的知识现状，但我们不能不承认脑外伤和心理健康的定义在不断演变。尽管通常作为单一的诊断进行讨论，但脑外伤是由无数的病理生理特征和临床后遗症组成的混合体。虽然毫无疑问，导致坦率的意识丧失和急性神经影像表现的损伤反映了脑外伤，但在过去的25年中，损伤谱的“底线”下降了(4)。特别是，脑损伤的明显外在迹象，如意识丧失，现在不仅被认为是不必要的诊断，而且在轻度脑损伤(MTBI)后也很少见。在常规评估中，TBI并不总是很容易被临床体征识别，这给识别、治疗和研究这种疾病带来了挑战。在通过非侵入性(如血液和神经成像)生物标志物检测脑损伤方面取得的令人振奋的进展带来了希望，即目前关于什么是脑损伤以及如何识别脑损伤的不确定性在可预见的未来将得到改善(5)。正如TBI的定义引起了激烈的争论，心理健康和相关的精神疾病的定义也缺乏一个普遍认可的定义。心理健康的定义可以强调心理健康量表、个人特征(例如，积极情绪、主观幸福感、韧性)和不同的最终目标(例如，个人与社会)的标准界限，并需要适合应用这些定义的背景和文化(6)。最近，一项雄心勃勃的国际混合方法研究试图确定
TBI is a leading cause of disability worldwide, with an increasing incidence and an estimated 55 million people living with traumatic brain injury-(TBI-) related disability (1). Disability after TBI appears to be driven largely by the diverse neurobehavioral—or mental health-related—consequences of the injury (2, 3). The reviews in this special issue of Biological Psychiatry discuss the current state of knowledge on TBI and mental health, but we cannot introduce them without acknowledging that definitions of TBI and mental health are continually evolving.Though commonly discussed as a single diagnosis, TBI is an amalgam of conditions comprising myriad pathophysiological features and clinical sequelae. While there is no doubt that injuries resulting in frank unconsciousness and acute neuroimaging findings reflect TBI, the “floor” of the injury spectrum has sunk lower in the past 25 years (4). In particular, clear outward signs of brain injury like unconsciousness are now recognized as not only unnecessary for diagnosis but uncommon after mild TBI (mTBI). The fact that TBI is not always readily identified by clinical signs during routine assessments presents challenges for identifying, treating, and studying this disorder. Exciting advances in detecting TBI through noninvasive (eg, blood-based and neuroimaging) biomarkers bring hope that the current state of uncertainty about what TBI is and how to identify it will improve in the foreseeable future (5). Just as definitions of TBI are hotly debated, the construct of mental health and, relatedly, psychiatric disease, lacks a universally agreed-upon definition. Definitions of mental health can emphasize normative cutoffs on psychological health scales, personal characteristics (eg, positive affect, subjective wellbeing, resilience), and differing end goals (eg, individual versus societal) and need to be appropriate to the contexts and cultures in which they are to be applied (6). An ambitious international mixed-methods study recently sought to identify the core
登录
查看更多内容
影响因子：
10.6
作者：
Howlett JR;Nelson LD;Stein MB
通讯作者：
Stein MB
影响因子：
11
作者：
Wilson, Lindsay;Horton, Lindsay;Menon, David
通讯作者：
Menon, David
影响因子：
10.6
作者：
Mayer AR;Quinn DK
通讯作者：
Quinn DK
影响因子：
10.6
作者：
Meier TB;Savitz J
通讯作者：
Savitz J
影响因子：
10.6
作者：
Olsen CM;Corrigan JD
通讯作者：
Corrigan JD