Schizophrenia-like psychosis following traumatic brain injury: a chart-based descriptive and case-control study

School of Psychiatry, University of New South Wales and Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia.
Psychological Medicine (Impact Factor: 5.43). 03/2001; 31(2):231-9. DOI: 10.1017/S0033291701003336
Source: PubMed

ABSTRACT Head injury has been reported to increase the likelihood of the development of schizophrenia-like psychosis (SLP), but its features and risk factors have been insufficiently investigated.
Between 1987 and 1997, we examined 45 referred patients with SLP following brain trauma. These subjects were matched with 45 head-injured subjects without SLP on age (current and at injury) and gender, and their case records reviewed systematically. The groups were compared and logistic regression analyses performed.
The psychoses had a mean age of onset of 26.3 years, a mean latency of 54.7 months after head injury, usually a gradual onset and a subacute or chronic course. Prodromal symptoms were common and depression often present at onset. Paranoid delusions and auditory hallucinations were the predominant features, with formal thought disorder, catatonic features and negative symptoms being uncommon. The SLP group had more widespread brain damage on neuroimaging, especially in the left temporal and right parietal regions, and were more impaired cognitively. Fewer (non-significantly) SLP subjects had epilepsy which was more likely to be well-controlled in this group. On regression analysis, a positive family history of psychosis and duration of loss of consciousness were the best predictors of SLP.
Head injury-related psychosis is usually paranoid-hallucinatory and subacute or chronic in its presentation. A genetic predisposition to schizophrenia and severity of injury with significant brain damage and cognitive impairment may be vulnerability factors.

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    ABSTRACT: Background: Organic brain pathology usually may be followed by mental disorders. This research was aimed at constructing a predictive model and investigating the risk factors in the incidence of mental disorders after traumatic brain injury (TBI). Materials and Methods: Two hundred and thirty eight patients (195 males and 43 females) were entered the study in a descriptive-longitudinal design by non-probable and consecutive sampling method. They were undergone neurosurgical examinations and psychological evaluations. After a 4-month follow-up, 65.1% of the patients (N=155) referred to a psychiatrist in order to determine the nature of mental disorder following TBI, using a structured clinical interview based on DSM-IV diagnostic criteria. Results: 75.48% (117 cases) of patients had a form of mental disorder secondary to TBI. The Results of binary logistic regression analyses for calculating odds ratio (OR) model with 95% confidence interval (CI) indicating the severity of TBI (OR = 3.497, 95% CI =1.259-9.712), presence of subcranial injury (OR = 2.834, 95% CI =1.022-7.857) and falling level of general compatibility, as measured by modified version of GHQ-28 (OR = 1.072, 95% CI =1.035-1.111) indicated an increasing risk in the incidence of mental disorder7 T . Conclusion: Findings revealed that in the development of post-TBI mental disorders, first there was a close relationship with organic brain pathology (TBI severity and subcranial injury), although the role of effective psychological factors such as level of general compatibility after trauma should not be neglected. Also in order to predict the people at risk of mental disorders after TBI, the proposed predictive model in this study can be used.
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