Traumatic Brain Injury and Delusional Disorder: A Narrative Synthesis with Psychopharmacologic Implications

Traumatic brain injury (TBI) is associated with a range of neuropsychiatric sequelae, including secondary psychotic disorders. Delusional syndromes are a prominent and clinically significant manifestation, often classified as Psychotic Disorder Due to Another Medical Condition.^1,2.

This narrative synthesis reviews case series, cohort studies, retrospective analyses, and conceptual literature published between 1998 and 2025, focusing on epidemiology, clinical features, pathophysiology, diagnosis, and psychopharmacologic management of post-TBI delusional syndromes.

Delusions-commonly persecutory or misidentification types-frequently emerge after a latency of months to years and are more prevalent than schizophrenia-like presentations.^1,2,6 Risk factors include moderate-to-severe injury, frontal or temporal lesions (particularly right-sided), post-traumatic epilepsy, and genetic vulnerability.^3-6 Compared to primary psychotic disorders, negative symptoms are typically less prominent, though cognitive impairment is nearly universal.^6,7,12 Low-dose atypical antipsychotics demonstrate favorable response rates, but tolerability concerns-including sedation, extrapyramidal symptoms, and seizure risk-necessitate cautious use.^8,9 Adjunctive anticonvulsants may be beneficial, particularly in patients with comorbid epilepsy.^10,15.

Post-TBI delusional syndromes highlight the role of structural brain injury in the development of psychosis. Careful diagnostic evaluation and individualized, low-dose psychopharmacologic strategies are essential. Further research is needed to guide evidence-based treatment in this population.