Risk Factors in Psychosis Secondary to Traumatic Brain Injury

Abstract

Psychosis is a rare but devastating sequela of traumatic brain injury (TBI). This study examined risk factors for developing a psychosis secondary to TBI (PSTBI). Demographics of 25 inpatients with PSTBI were statistically analyzed for risk factors. Data from the PSTBI group were also compared with data from a control group of TBI patients without psychosis. Results indicate the PSTBI group was more likely to have had a previous congenital neurological disorder or to have sustained a head injury prior to adolescence. The PSTBI also had a higher proportion of males. Discussion focuses on potential models for developing PSTBI.

Psychosis following traumatic brain injury

“…However, the role of TBI in the genesis of psychosis is a complex matter about which there is considerable scientific uncertainty and disagreement. Although the frequency of psychosis following TBI exceeds that of the general population (Davison & Bagley, 1969;Achte et al, 1969;Achte et al, 1991), there is often a considerable delay between TBI and the onset of psychotic symptoms (Fujii & Ahmed, 1996;Fujii & Ahmed, 2001;Sachdev et al, 2001). Once psychosis develops, the constellation of post-traumatic psychotic symptoms may be difficult to distinguish from those of schizophrenia , complicating the determination of the relationship, where such exists, between an often remote TBI and a recent-onset psychosis.…”

“…The post-traumatic psychoses are often 'atypical' with regard to age of onset (Fujii & Ahmed, 2001;Sachdev et al, 2001;Fujii & Ahmed, 2002), symptom types (Goethe & Levin, 1984), neuroimaging findings (Fujii & Ahmed, 2002), and the presence of comorbid conditions such as epilepsy (Hillbom, 1960;Fujii & Ahmed, 1996) and/or associated cognitive impairment (Fujii & Ahmed, 2002) when compared to the primary psychotic disorders. These differences between psychosis due to TBI and the primary psychotic disorders suggest that TBI may be more than a risk factor for the development of the primary psychotic disorders; it may in some cases be an etiology of psychosis in its own right.…”

Treating Thought Disorders

“…11 Persons with risk factors for developing a psychosis secondary to TBI are more likely to have had a previous congenital neurological disorder or to have sustained a head injury prior to adolescence. 12 Lifetime incidence rates of TBI survivors who later demonstrate psychotic symptoms vary across studies, varying from 3.4% to 8.9%. 13,14 The onset of psychosis after TBI is highly variable but is generally delayed.…”

“…In their study of World War II veterans, Achte et al 15 reported that the occurrence of psychotic symptoms ranged from 2 days to 48 years after injury, with 42% experiencing their first psychotic episode 10 or more years after sustaining a missile wound to the head. Fujii and Ahmed 16 reported a range from 3 months to 19 years, with a mean onset of 5.9 years after closed head trauma. Feinstein and Ron 17 reported a mean latency of 11.7 years, with a range of 0 to 52 years.…”

“…106 In the premedication recordings an excess current source density in the beta frequencies in the cingulate gyrus was revealed by LORETA. The beta frequencies (beta 2 [16][17][18][19][20], beta 3 [20-24 Hz] and beta 4 [24-28 Hz]) involved were located primarily in the middle cingulate gyrus as well as adjacent frontal and parieto-occipital regions. Other studies have found that individuals with OCD symptoms have excess beta activity in the cingulate gyrus compared to a non-OCD control group.…”