脑外伤所致精神障碍的影响因素

目的 对脑外伤所致各种精神障碍的发生率、表现形式及影响因素进行相关性研究.方法 以淮南市精神病医院近5年来进行医学鉴定的脑外伤所致各种精神障碍患者共388例为研究对象,在距脑外伤后6个月至1年内由至少3名精神科医师根据"中国精神疾病分类方案与诊断标准(第2版修订本)"(CCMD-2-R)对他们的精神状态进行评估.结果 (1)脑外伤所致精神障碍中智力障碍的发生率为74.2%,以轻度以下的智力障碍为主.(2)颅内血肿、脑干损伤、脑损伤范围、格拉斯哥分度量表评分(GCS)、合并精神障碍及文化程度对智力损伤程度的影响较大.(3)脑干损伤、颅内血肿、GCS、脑损伤范围、昏迷时间与有无智力障碍关系密切;脑损伤范围、脑挫裂伤、额叶损伤、颅内血肿与精神病性症状关系密切;额叶损伤、开颅治疗、颅内血肿与人格改变关系密切.结论 在颅脑创伤所致精神障碍的鉴定中,应结合颅脑创伤的性质,全面评估其精神状态.

Study of mental disorder due to brain damage

Objective To study the incidence rate,pattern and affective factors of mental disorder due to brain damage. Methods According to CCMD-2-R,388 subjects with traumatic brain damage in the Psychiatric Hospital of Huainan city within last 5 years were assessed by three psychiatrists 6 months to 1 year after brain injury. Results (1) 74.2% of the mental disordered due to brain injury have intellectual impairment,most of them is mild; (2)The intracranial hematoma,brain stem injury,brain injury extent,GCS,complicated mental disorder,and education have great effect on intellectual impairment; (3) There is an intimate relationship between the intellectual impairment and the brain stem injury,intracranial hematoma,GCS,brain injury extent,and unconsciousness time. There is an intimate relationship between the mental symptom and the brain injury extent,contusion and laceration of brain,frontal lobe injury,and intracranial hematoma. There is also an intimate relationship between the personality change and the frontal lobe injury,unfolding brain case treatment,and intracranial hematoma. Conclusion To assess over-all mental disorder should rely on the characteristics of craniocerebral injuries.