Improvement in psychiatric symptoms after subdural haematoma and decompressive craniotomy

This case study reports unexpected improvement in psychiatric symptoms following traumatic brain injury (TBI) in a man in his mid-30s with a complex psychiatric history, including autism spectrum disorder, paranoid schizophrenia and a personality disorder. He sustained a left-sided subdural haematoma requiring decompressive craniotomy. Post-surgery, he demonstrated resolution of longstanding hallucinations and self-harming behaviours, enhanced affective regulation and successful tapering of antipsychotic medications, alongside improvement in social and functional abilities. Although such improvement is uncommon, this case highlights the need for reassessment of psychiatric diagnoses, functional status and pharmacological regimens following neurological injury, particularly in individuals with overlapping psychiatric conditions. The findings also suggest that environmental stability, structured rehabilitation and reduction of complex polypharmacy may have contributed to clinical improvement. This case contributes to the limited literature on psychiatric outcomes following TBI and underscores the importance of an integrated, multidisciplinary approach to post-injury management.