腦震盪後症候群：臨床神經心理學觀點

Post-Concussion Syndrome From a Perspective of Clinical Neuropsychology

楊啟正(Chi-Cheng Yang)

《臨床心理學刊》 14卷1/2期 (2020/12) Pp. 18-32

https://doi.org/10.6550/ACP.202012_14(1_2).0002

摘要

目的：腦震盪後症候群（post-concussion syndrome, PCS）為輕度頭部外傷（mild traumatic brain injury, MTBI）後常見的困擾。PCS通常於受傷後三個月內可明顯改善，但仍有許多患者會有持續性之PCS長達一年以上。過去研究已試圖從神經病理與心理社會等多面向來分析此症候群的成因與影響因素，並且找出適當之處遇方法。然而，國內對於MTBI與PCS的瞭解仍較為侷限。有鑑於此，本研究整理國內外對於MTBI與PCS的相關研究，期能提供PCS更加完整的評估與治療。方法：本研究主要從三個不同角度來呈現MTBI與PCS。在臨床特性部分，主要說明PCS的病程與回復狀況。在PCS的可能成因與影響因素方面，分別說明神經病理、心理與整合式成因之看法。在治療方面，則討論PCS的藥物與非藥物治療。最後，則提供關於PCS的三個未來研究方向，包括「PCS的縱貫式呈現」、「個別PCS之影響」與「行動科技對於PCS的治療」。結果：PCS的成因複雜且影響因素眾多，即使過去已有許多不同角度之治療方法，臨床上仍需要謹慎評估每位患者的PCS表現型態。結論：綜合「生理—心理—社會」等面向與特定症狀之分析後，才得以對PCS提供最精準之治療。

關鍵字

輕度頭部外傷 ； 腦震盪後症候群 ； 生理—心理—社會 ； 精準治療

並列摘要

Objectives: Post-concussion syndrome (PCS) is not uncommon after mild traumatic brain injury (MTBI). Although PCS improves in three months after injury, a few patients still experience persistent PCS for more than one year. Many researchers have explored the PCS from multiple aspects, including its etiology and influencing factors, but the understanding of PCS and MTBI is still misted in Taiwan. This review thus aims to organize the results of past studies and provide a more comprehensive evaluation and treatment directions for PCS. Methods: This review mainly depicts MTBI and PCS from three perspectives. In terms of clinical features of PCS, the disease course and recovery process are presented. In terms of etiology and associating factors, the neuropathological, psychological and holistic views are illustrated. In addition, the non-pharmacological and pharmacological treatments for PCS are discussed. Lastly, the three future issues of PCS, which includes ＂the evaluation of longitudinal PCS,＂ ＂influence from individual PCS,＂ and ＂mobilized technology for PCS treatment,＂ are presented. Results: A variety of etiologies and factors may contribute to the presence of PCS. Conclusions: Although different evaluations and interventions have been developed, a case formulation focusing on the individual symptom endorsement from ＂bio-psychosocial＂ perspectives is merited.

並列關鍵字

mild traumatic brain injury ； post-concussion syndrome ； bio-psycho-social ； precision treatment

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