大脑左右半球损伤后情绪障碍差异的观察

Mood disorders differ after left and right cerebral hemisphere injury

目的探讨大脑左右半球损伤后情绪情感异常的不同表现、可能机制，以期能为临床上大脑损伤患者的心理及肢体功能障碍等康复治疗方案的设计、预后评价提供依据。方法选取康复中心脑损伤患者51例，分为左侧脑半球损伤组（左脑损伤组）26例和右侧脑半球损伤组（右脑损伤组）25例，均进行汉密尔顿抑郁量表（HAMD）测试，最终对HAMD总分、各分项得分及选项差异进行归纳、分析及总结。结果左脑损伤组患者在抑郁总分及抑郁情绪、有罪感、自杀等15个分项目方面较右脑损伤组患者得分高，差异有统计学意义（P〈0．05，P〈0．01）。右脑损伤组患者在日夜变化、人格解体或现实解体、偏执症状等3个方面较左脑损伤组患者得分高，差异有统计学意义（P〈0．05）。结论大脑半球的偏侧化效应也表现在情绪情感方面，左右两侧大脑损伤后的抑郁表现不同，因此在临床上左右大脑半球损伤患者的康复治疗方案、预后评价、心理干预需要区别对待。

Objective To explore mood disorders after left and right cerebral hemisphere injury, to search for possible mechanisms and to provide the basis for designing rehabilitation protocols and assessing prognosis. Methods Fifty-one cases with brain injury were recruited from a rehabilitation center and divided into left and right hemisphere injury groups with 26 and 25 cases, respectively. Hamilton rating scale for depression （HRSD） scores were analyzed. Results The left hemisphere patients had significantly higher HRSD total scores and higher scores indicating 15 kinds of mood disorders （ depression, feelings of guilt, suicidal thoughts etc. ）. Right hemisphere injury patients had significantly higher diurnal variation, depersonalization or derealization and paranoid symptoms. Con- clusions The lateralization of the cerebral tlemispheres may display itself in mood and emotion. After left or right hemisphere injury, the depression presentation is different, so treatment, prognosis assessment and psychological intervention should be different for left and right hemisphere injuries.