Аффективные расстройства в посткоматозном периоде после тяжелой травмы мозга

The currency of the study is caused by high frequency of emotional disorders after severe traumatic brain injuries and their impact on rehabilitation process and life quality of the patients.The aim of the study was to investigate different variants of affective pathology in the process of rehabilitation of psychic activity after severe traumatic brain injury.Materials and methods. Affective impairments in 153 patients with severe TBI admitted to hospital in comatose state (with the value 3-7 scores on Glasgow come scale in the first day after injury) were assessed in dynamics by using the clinical method. The study included patients, who survived in the first 6 months after the injury and resuscitated.Results. The following set probability of occurrence of different emotional disorders was found in studied group: apathy (46%), euphoria (33%), dysphoria (26%), depression (48%), anxiety (38%), and hyperthymia (6%). Preferred sequence of their onset after coma in the range of apathy-euphoria-dysphoria-depression-anxiety was found. Interconnection of localization of posttraumatic focal brain changes and possibility of appearance of separate variants of emotional impairments were revealed as a trend: apathy in a case of lesion of left frontal lobe, euphoria in a case of lesion of right frontal lobe, depression in a case of lesion of posterior parts of right hemisphere, anxiety in a case of lesion of posterior parts of the left hemisphere. Unfavorable prognostic value was found for clinical outcomes of severe TBI symptoms for apathy and dysphoria and relatively favorable for symptoms of depression and hyperthymia. The necessity of individualization of psychopharmacotherapy was confirmed, as well as the necessity of exclusion of tricyclic antidepressive drugs and benzodiazepines in the treatment of emotional pathology in postcomatose patients.

тяжелая черепно-мозговая травма, аффективные расстройства, апатия, эйфория, дисфория, депрессия, тревога, психофармакотерапия, severe traumatic brain injury, affective disorders, apathy, euphoria, dysphoria, depression, anxiety, psychopharmacotherapy

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