Psychosis following traumatic brain injury

Abstract

Psychosis is a relatively infrequent but potentially serious and debilitating consequence of traumatic brain injury (TBI), and one about which there is considerable scientific uncertainty and disagreement. There are several substantial clinical, epidemiological, and neurobiological differences between the post-traumatic psychoses and the primary psychotic disorders. The recognition of these differences may facilitate identification and treatment of patients whose psychosis is most appropriately regarded as post-traumatic. In the service of assisting psychiatrists and other mental health clinicians in the diagnosis and treatment of persons with post-traumatic psychoses, this article will review post-traumatic psychosis, including definitions relevant to describing the clinical syndrome, as well as epidemiologic, neurobiological, and neurogenetic factors attendant to it. An approach to evaluation and treatment will then be offered, emphasizing identification of the syndrome of post-traumatic psychosis, consideration of the differential diagnosis of this condition, and careful selection and administration of treatment interventions.

Neuropsychiatric consequences of traumatic brain injury: a review of recent findings

“…Preliminary studies suggest that psychotic disorders following TBI are characterized by paranoid delusions and auditory hallucinations, with other hallucinatory experiences and negative symptoms being a less frequent component of the symptom profile [54,55]. In line with the current hypothesis on the physiopathology of psychotic disorders, post-traumatic psychosis has been associated with the presence of cognitive disturbance and neuropathological changes in the frontal and temporal lobes.…”

Psychiatric disorders and traumatic brain injury

“…Therefore, atypical antipsychotics seem to be more appropriate. The initial doses must be prescribed from one third to half of the usual ones, increasing them gradually and carefully, since these individuals are particularly susceptible to side effects (Arciniegas et al 2003). Well succeeded treatments using risperidone (Schreiber et al 1998) and olanzapine (Arciniegas et al 2003;Warden et al 2006) were reported, as well as the association between risperidone with galantamine (Bennouna et al 2005).…”

Treating Thought Disorders

“…Case studies (varying between one and nine patients) of atypical antipsychotic agents such as clozapine, risperidone and olanzapine given to TBI patients showed mixed results. [115][116][117] It is evident that more effective treatment modalities are needed in treatment-resistant schizophrenia, or any form of thought disorder, to address the needs of patients who remain substantially symptomatic and disabled even with the use of currently available antipsychotic agents.…”