Iranian Journal of Psychiatry and Clinical Psychology
مجله روانپزشكي و روانشناسي باليني ايران
IJPCP
Medical Sciences
http://ijpcp.iums.ac.ir
18
journal18
1735-4315
2228-7515
10.32598/ijpcp
fa
jalali
1391
4
1
gregorian
2012
7
1
18
1
online
1
fulltext
fa
آسیبشناسی روانی محور یک درچهار ماهۀ اول پس از آسیب مغزی تروماتیک
Axis I Psychopathology during the First Four Mounts After Traumatic Brain Injury
روانپزشکی و روانشناسی
Psychiatry and Psychology
پژوهشي اصيل
Original Research
<p style="LINE-HEIGHT: 15pt MARGIN: 0cm 0cm 0pt mso-line-height-rule: exactly" dir="rtl" class="a"><strong><u><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt" lang="AR-SA">هدف</span></u><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt" lang="AR-SA">:</span></strong><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"> پژوهش حاضر با هدف ارزیابی ابعاد آسیبشناسی روانی محور یک چهارمین دستنامه تشخیصی و آماری اختلالات روانی </span><span dir="ltr"></span><span dir="ltr"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span>(DSM-IV</span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal mso-bidi-language: FA" dir="ltr">)</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span> درچهارماهه نخست پس از آسیب مغزی تروماتیک (</span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr">TBI</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span>) و حالتهای روانی پس از رخداد </span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr">TBI</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span> بود. </span><strong><u><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt" lang="AR-SA">روش</span></u><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt" lang="AR-SA">:</span></strong><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"> در چارچوب یک بررسی توصیفی-</span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal mso-bidi-language: FA" lang="AR-SA"> </span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span style="mso-spacerun: yes"><font size="2"> </font></span>طولی، 238 بیمار دچار </span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr">TBI</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span> (43 زن و 195 مرد) بهشیوه <span style="mso-spacerun: yes"><font size="2"> </font></span>پیاپی نمونهگیری و معاینه شدند. پس از گذشت چهار ماه، 155 نفر (1/65%) از بیماران برای تعیین ماهیت اختلال روانی ناشی از </span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr">TBI</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span> به کمک مصاحبه ساختاریافته بالینی بر پایه معیارهای تشخیصی </span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr">DSM-IV</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span>، به یک روانپزشک مراجعه نمودند. </span><strong><u><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt" lang="AR-SA">یافتهها</span></u><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt" lang="AR-SA">:</span></strong><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"> نتایج نشان دادند که پس از آسیبدیدگی، 117 نفر (5/75%) دارای تشخیص اختلال های روانی ثانوی به </span><span dir="ltr"></span><span dir="ltr"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span><span style="mso-spacerun: yes"><font size="2"> </font></span>TBI</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal"><span dir="rtl"></span><span dir="rtl"></span> <span lang="AR-SA"><font size="2">هستند. از این افراد، 88 بیمار (2/75%) همبودی اختلالهای روانی نشان دادند. با این وجود، شایعترین اختلالهای روانی ناشی از </font></span></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr">TBI</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span> بهترتیب تغییر شخصیت (6/58%)، اختلال خلقی (3/32%)، اختلال اضطرابی (20%)، اختلال خواب (3/19%)، یادزدودگی مزمن (9/12%) و اختلالهای جسمانیشده (3/1%) بودند. اختلالهای دلیریوم، خوردن و روانپریشی ناشی از </span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr">TBI</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span> نیز هر یک به میزان 64/0% تشخیص داده شدند. </span><strong><u><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt" lang="AR-SA">نتیجهگیری</span></u><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt" lang="AR-SA">: </span></strong><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span style="mso-spacerun: yes"><font size="2"> </font></span>فراوانی بالای اختلالهای روانی در مرحله حاد پساز </span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr">TBI</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span> بههمراه بسیاری از موارد جدید تغییر شخصیت و اختلالهای خلقی و اضطرابی، چشمگیر است و بیماران دچار </span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" dir="ltr">TBI</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-STYLE: normal FONT-FAMILY: "Tahoma","sans-serif" LETTER-SPACING: -0.1pt FONT-SIZE: 8pt FONT-WEIGHT: normal" lang="AR-SA"><span dir="rtl"></span><span dir="rtl"></span> دستکم در مقطع زمانی چهارماهه پس از آسیب، باید مورد پایش و ارزیابی قرار گیرند تا خطر بروز اختلالهای روانی کاهش یابد.<p></p></span></p>
<p style="TEXT-ALIGN: justify LINE-HEIGHT: 12pt MARGIN: 0cm 0cm 0pt unicode-bidi: embed DIRECTION: ltr mso-line-height-rule: exactly" class="MsoNormal"><a name="OLE_LINK4"></a><a name="OLE_LINK3"><span style="mso-bookmark: OLE_LINK4"><b><u><span style="FONT-SIZE: 9pt mso-bidi-font-family: 'Times New Roman'"><font face="Times New Roman">Objectives</font></span></u></b></span></a><font face="Times New Roman"><span style="mso-bookmark: OLE_LINK3"><span style="mso-bookmark: OLE_LINK4"><b><span style="FONT-SIZE: 9pt mso-bidi-font-family: 'Times New Roman'">:</span></b></span></span><span style="mso-bookmark: OLE_LINK3"><span style="mso-bookmark: OLE_LINK4"><span style="FONT-SIZE: 9pt mso-bidi-font-family: 'Times New Roman'"> </span></span></span><span style="mso-bookmark: OLE_LINK4"></span><span style="mso-bookmark: OLE_LINK3"></span><span style="FONT-SIZE: 9pt mso-fareast-font-family: Calibri mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">The aim of this research was to examine <span lang="FA"></span>the dimensions of axis I disorders during the first four months after <span lang="FA"></span>Traumatic Brain Injury (TBI) and mental states after TBI. <b><u>Method</u></b>: Overall, 238 patients (43 females and 195 males) with TBI, in a descriptive-<span style="LETTER-SPACING: -0.2pt">longitudinal study, were selected by consecutive sampling</span> procedure and each of them undergone medical <span lang="FA"></span>examinations. After 4 months of follow-up, 65.1% (155 cases) of the patients referred <span lang="FA"></span>to a psychiatrist to determine the nature of their mental disorder due to <span lang="FA"></span>TBI, using a structured clinical interview, <span style="LETTER-SPACING: -0.2pt">based on the </span><span style="LETTER-SPACING: -0.3pt">Diagnostic and Statistical Manual of Mental Disorders, 4th ed.</span><span style="LETTER-SPACING: -0.2pt"> (DSM-IV) <span lang="FA"><span dir="rtl"></span><span dir="rtl"></span><span dir="rtl"><span dir="rtl"></span><span dir="rtl"></span>.</span><span dir="ltr"></span><span dir="ltr"></span><span dir="ltr"></span><span dir="ltr"></span> </span><b><u>Results</u></b>: The results</span> showed that 75.5% (117 cases) of the patients had post-injury mental disorders <span lang="FA"></span>secondary to TBI<span lang="FA"></span></span><span style="FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">.</span><span style="FONT-SIZE: 9pt mso-bidi-font-family: 'Times New Roman'"> </span><span style="FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">Of these, 88 patients (75.2%) showed the comorbidity of mental disorders. However, the most <span style="LETTER-SPACING: -0.2pt">common</span></span><span style="LETTER-SPACING: -0.2pt FONT-SIZE: 9pt mso-fareast-font-family: Calibri mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'"> mental disorders due to TBI </span><span style="LETTER-SPACING: -0.2pt FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">included personality</span><span style="FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'"> change (58.6%),</span><span style="FONT-SIZE: 9pt mso-fareast-font-family: Calibri mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'"> </span><span style="FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">mood <span style="LETTER-SPACING: -0.2pt">disorders (32.3%),</span></span><span style="LETTER-SPACING: -0.2pt FONT-SIZE: 9pt mso-fareast-font-family: Calibri mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'"> </span><span style="LETTER-SPACING: -0.2pt FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">anxiety disorders (20%),</span><span style="LETTER-SPACING: -0.2pt FONT-SIZE: 9pt mso-fareast-font-family: Calibri mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'"> </span><span style="LETTER-SPACING: -0.2pt FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">sleep disorders</span><span style="FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'"> (19.3%),</span><span style="FONT-SIZE: 9pt mso-fareast-font-family: Calibri mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'"> </span><span style="FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">chronic amnesia (12.9%) and somatoform <span style="LETTER-SPACING: -0.2pt">disorders (1.3%).</span></span><span style="LETTER-SPACING: -0.2pt FONT-SIZE: 9pt mso-fareast-font-family: Calibri mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'"> </span><span style="LETTER-SPACING: -0.2pt FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">Delirium, eating and psychotic disorders</span><span style="FONT-SIZE: 9pt mso-bidi-font-family: 'Times New Roman'"> </span><span style="FONT-SIZE: 9pt mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">due to TBI, <span lang="FA"></span>each <span lang="FA"></span>up to 0.64%, were also diagnosed<span lang="FA"></span>. </span><b><u><span style="FONT-SIZE: 9pt mso-fareast-font-family: Calibri mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">Conclusion</span></u></b><span style="FONT-SIZE: 9pt mso-fareast-font-family: Calibri mso-bidi-language: FA mso-bidi-font-family: 'Times New Roman'">: The high frequency of mental disorders is evident in the acute phase after TBI, along with many novel cases of personality changes, mood and <span style="LETTER-SPACING: -0.2pt">anxiety disorders. Therefore <span lang="FA"></span>TBI patients must be monitored</span> and evaluated at least in a 4-<span lang="FA"></span>month period after the trauma to reduce the risk of mental <span lang="FA"></span>disorders incident.<p></p></span></font></p>
آسیب مغزی تروماتیک، اختلال روانی، همبودی، پیامدهای عصبی- رفتاری
traumatic brain injury, mental disorder, comorbidity, neurobehavioral sequelae
13
28
http://ijpcp.iums.ac.ir/browse.php?a_code=A-10-1-457&slc_lang=fa&sid=1
Sajad
Rezaei
سجاد
رضائی
rezaei_psy@hotmail.com
180031947532846006428
180031947532846006428
Yes
Guilan University
دانشگاه گیلان
Iraj
Salehi
ایرج
صالحی
180031947532846006429
180031947532846006429
No
Guilan University
دانشگاه گیلان
Heshmatollah
Moosavi
حشمتا...
موسوی
180031947532846006430
180031947532846006430
No
Guilan University of Medical Sciences
دانشگاه علوم پزشکی گیلان
Shahrokh
Yousefzaeh
شاهرخ
یوسفزاده
180031947532846006431
180031947532846006431
No
Guilan University of Medical Sciences
دانشگاه علوم پزشکی گیلان