A Case Series Study Of 840 Patients With Mental Disorders After Traumatic Brain Injury

Objective:The aims of the study were to understand the clinical characteristics of patients with mental disorders after traumatic brain injury,their influent factors and the effect of hyperbaric oxygen therapy,to provide the best knowledge of the disease and to explore effective treatment and rehabilitation for this disease.Methods:(1)The clinical data of patients with mental disorders after traumatic brain injury were collected and analyzed retrospectively,of which were admitted to Neurosurgery and Mental Rehabilitation Center of Qingyuan People's Hospital between 2005 and 2014.The epidemiological characteristics and clinical characteristics were analyzed.(2)Twenty-six patients with brain injury and manic disorder were divided into hyperbaric oxygen therapy group(n = 13)and routine treatment group(n = 13).Routine treatment group was treated with conventional treatment methods,while hyperbaric oxygen therapy group using hyperbaric oxygen therapy and conventional treatment methods.The Glasgow Coma Scale(GCS)was used to evaluate the coma of the patients before and after the treatment.The Glasgow Outcome Scale(GOS)was used to evaluate the psychiatric symptoms of the patients.MRI data were used to analyze the patients' Traumatic brain injury.The occurrences of complications and the therapeutic effects were observed.(3)Statistical analysis.SPSS 17.0 software was used for statistical analysis.The counting data is represented by n(%),A x 2 test is used between the groups,Test level alpha is 0.05,When P<0.05,the difference is statistically significant.Results:(1)Age and sex distribution of the patients with mental disorders after traumatic brain injury:a total of 840 cases met the inclusion criteria.The age range of patients were 3-79 years old,with the average age of(41.3 ± 17.9)years.,Male patients accounted for 82.6%(694/840).42.9%(360/840)of the patients was under the age of 25,42.9%(360/840)was in the 25-54 year old group and 14.3%(120/840)in the 55 years old group.(2)Clinical features:Of 840 patients,dementia was found in 95 cases(11.3%),forgotten in 220 cases(26.2%),personality changes in 103 cases(12.3%),manic disorders in 217 cases(25.8%),neurosis 120 cases(14.3%).The proportion of dementia,amnesia,personality changes,manic disorder,affective disorder and neuroses-like syndrome in patients with severe craniocerebral injury was significantly higher than that in patients with moderate craniocerebral injury(P<0.001).The proportion of psychotic disorder,affective disorder and neurosygotic syndrome in patients with moderate craniocerebral injury was significantly higher than that of mild patients(p<0.001).Compared with right frontal lobe injury and right temporal lobe injury,patients with Left frontal lobe lesion,left temporal lobe injury and multi-lobe lesion had higher proportions of dementia,personality changes,manic disorder,affective disorder and neurological-like syndrome(P<0.001).The proportions of dementia,personality change,manic disorder,affective disorder and neurosis-like syndrome were significantly higher than that of the left lobe lesion and left temporal lobe lesion(P<0.001)).The proportion of mental disorders in patients with frontal lobe lesion was significantly higher than that with left frontal lobe lesion,left temporal lobe lesion and right temporal lobe lesion(P<0.001).(3)Efficacy of hyperbaric oxygen treatment:There were 7 male males and 6 female patients in the treatment group,whose aged at 35-67 years;there were 8 males and 5 females in the control group,whose aged at 36-69 years old.There were no significant differences in scores of neurological deficits,edema area,GCS and GOS scores between the two groups before treatment(P>0.05).The death rates of the treatment group and control group were 7.69%and 15.38%,respectively.The recovery rates in the treatment group and the control group were 69.23%and 38.46%,respectively.The Plant survival rates in the two groups were 30.77%and 15.38%,respectively.The scores of neurological deficits and edema area in the hyperbaric oxygen therapy group were significantly lower than those in the conventional therapy group(P<0.05).The GCS and GOS scores of hyperbaric oxygen therapy group was significantly higher than that of routine treatment group(P<0.05).Conclusions:(1)The occurrence of mental disorders after traumatic brain injury is related to the location of craniocerebral injury and the degree of injury.(2)Hyperbaric oxygen therapy can significantly improve the clinical symptoms of patients with brain injury combined with manic psychosis,which have a good safety.This treatment is worth using in clinical practice of treatment and rehabilitation for manic psychosis after traumatic brain injury.