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Title: Les troubles psychotiques post-traumatiques : un modèle physiopathologique de la schizophrénie
Keywords: Modèle neurodéveloppemental
Psychose post-traumatique
Schizophrénie post-traumatique
Symptômes psychotiques
Traumatisme crânien
Neurodevelopmental Model
Psychotic Symptoms
Posttraumatic Psychosis
Posttraumatic Schizophrenia
Traumatic Brain Injury
Issue Date: 8-Apr-2011
Publisher: Elsevier
Abstract: Résumé La schizophrénie et le traumatisme crânien sont deux problèmes majeurs de santé publique. Parmi les complications neuropsychologiques et psychiatriques secondaires au traumatisme crânien, les psychoses post-traumatiques interrogent plusieurs cadres nosographiques. Le trouble psychotique secondaire à une affection médicale générale nécessite d’affirmer une étiologie physiologique directe entre l’affection médicale traumatique et les symptômes psychotiques. La Schizophrenia-like psychosis est un syndrome schizophrénique secondaire au traumatisme crânien et qui traduit une atteinte cérébrale diffuse. Cette entité clinique est différenciée de la schizophrénie post-traumatique qui désigne une schizophrénie primaire décompensée dans les suites d’un traumatisme crânien.Ces différents diagnostics catégoriels peuvent être réunis au sein d’une approche dimensionnelle des symptômes psychotiques post-traumatiques. Un tel continuum clinique interroge les théories physiopathologiques de la schizophrénie dans une approche étiologique. Les modèles neurodégénératif, de dysrégulation dopaminergique et neurodéveloppemental sont utiles pour expliciter les troubles psychotiques post-traumatiques. Dans le même temps, la physiopathologie de la schizophrénie primaire apporte des éléments de compréhension étiologique pour les troubles psychotiques post-traumatiques. Dans les deux cas, une vulnérabilité génétique éprouvée par le facteur traumatique prend une expression clinique psychotique. Certains troubles psychotiques post-traumatiques sont à considérer comme des formes phénotypiques particulières du spectre de la schizophrénie. L’interaction entre le patrimoine génétique du sujet et l’environnement extérieur met en jeu les mécanismes de neuroplasticité cérébrale. Les avancées techniques de neuroimagerie (calculs volumétriques, calculs de densité cellulaire) offrent des perspectives d’études pour la compréhension neurophysiologique des troubles psychotiques post-traumatiques en lien avec la schizophrénie primaire.
Abstract Traumatic Brain Injury (TBI) and later serious psychopathology have long been associated in the literature. Psychotic disorder following traumatic head injury is reported to occur in 0,7 to 8,9% of patients who sustain a head injury. This paper summarizes the recent literature about psychotic symptoms following traumatic brain injury (TBI) and try to articulate these psychotic disorders to a pathophysiological model of primary schizophrenia. Psychotic disorder due to a general medical condition (TBI) indicates that the hallucinations or delusions are the direct physical consequences of the medical condition. A contrario, schizophrenia-like psychosis is a secondary schizophreniform syndrom that must be differentiated from post-traumatic schizophrenia where the head trauma is an external factor furthering the onset of a primary psychosis. A dimensional approach could although take place for understanding pathophysiology. Head injury has been reported to increase the likelihood of the development of psychosis disorder due to TBI, schizophrenia-like psychosis and posttraumatic schizophrenia. While TBI is a major public health issue, schizophrenia following TBI is relatively rare and poorly studied. The onset of schizophrenia occurs most commonly from late adolescence to midadulthood, in a age group where head injury is more frequent. Even if early illness features of schizophrenia might increase exposure to TBI, posttraumatic schizophrenia could be the result of a gene-environment interaction. The pathophysiology research in psychotic disorders following traumatic brain injury don’t must distinguish schizophrenia from other psychotic syndromes but have to consider a dimensional approach of these psychotic phenomena. Family history of schizophrenia and frontal or parietal lobe deficits were more common in patients with posttraumatic psychotic symptoms. Susceptibility to schizophrenia is believed to be due to multiple genetic and interacting factors and mild childhood head injury may play a role in the development and onset of schizophrenia in families with a strong genetic predisposition. The authors suggest hypotheses aimed at furthering the understanding of the physiologic mechanisms relating traumatic brain injuries to psychotic symptoms. Psychotic disorder following TBI, schizophrenia like psychosis and posttraumatic schizophrenia are a potential interest to clinicians and neuroscientists, as it may provide clues to understanding primary psychotic disorders such as schizophrenia. Schizophrenia is a psychotic disorder commonly attributed to the interaction of genetic vulnerability and environmental events which implies that environmental factors modulate the effects of the genotype. Schizophrenia related to TBI could also be the result of a gene-environment interaction. Schizophrenia genes may increase exposure to head trauma (through agitation or cognitive impairment), with head trauma further increasing the risk for schizophrenia. Further studies are needed to articulate the links between secondary psychotic symptoms and primary schizophrenia in a structure/function paradigm. The new imaging techniques of magnetic resonance imaging, position emission tomography and single-photon emission computed tomography could aid in this sense.
ISSN: 00034487 (ISSN)
DOI: 10.1016/j.amp.2009.12.020
Rights: 2010
Affiliation: Service de psychiatrie et de psychologie clinique, Hôpital d’Instruction des Armées Legouest - 27 Avenue de Plantières--> , BP 90001--> , Metz cedex 3--> - FRANCE (Auxéméry, Y.)
FRANCE (Auxéméry, Y.)
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