Posttraumatic Psychosis

There are about three million cases of traumatic brain injury in the US each year. These patients have between two to five times greater risk of developing psychosis than the general population. In this report, we explore the limited number studies examining the incidence of psychosis in different populations. These studies were primarily retrospective and involved both veterans and civilians suffering from different types of injuries, penetrating or open and closed head injuries. Posttraumatic psychosis can occur several years after the head injury and the relationship between the injury and the psychosis is not always clear. In this report, we explore this relationship from the standpoint of risk factors for the development of psychosis. These may be lesion-specific such as the extent of the injury, laterality of lesion, as well as others such as genetic vulnerability and comorbid epilepsy, which actually may be an intervening variable between the brain injury and the onset of late-onset psychosis. Treatment is based on limited data and consists of both pharmacologic and nonpharmacologic approaches. Pharmacologic treatment of posttraumatic psychosis consists of symptomatic, functional, and hypothetical approaches. Specific pharmacologic treatment consists of antipsychotics, or antikindling anticonvulsants, or a combination thereof. Nonpharmacologic approaches such as cognitive retraining and behavioral treatment are oriented towards improving functioning and teaching adaptive coping strategies.