Research Reports - Psychotic symptoms as manifestations of the posttraumatic confusional state: Prevalence, risk factors, and association with outcome

J Head Trauma Rehabil. 2013 Mar 26

Sherer M, Yablon SA, Nick TG

OBJECTIVES:: To (1) determine factors associated with psychotic-type symptoms in
persons with moderate or severe traumatic brain injury (TBI) during early
recovery and (2) investigate the prognostic significance of early psychotic-type
symptoms for patient outcome. SETTING:: Acute neurorehabilitation inpatient unit.
PARTICIPANTS:: A total of 168 persons with moderate or severe TBI were admitted
for inpatient rehabilitation. Of these, 107 had psychotic-type symptoms on at
least 1 examination. One-year productivity outcome was available for 87 of the
107 participants. DESIGN:: Prospective, inception cohort, observational study.
MAIN MEASURES:: Confusion Assessment Protocol, productivity outcome at 1 year
postinjury. RESULTS:: Presence of sleep disturbance, a shorter interval from
admission to assessment, and greater cognitive impairment were associated with a
greater incidence of psychotic-type symptoms. Younger age, more years of
education, and lower frequency and severity of psychotic-type symptoms were
associated with a greater likelihood of favorable productivity outcome.
CONCLUSIONS:: We identified risk factors for the occurrence of psychotic-type
symptoms and extended previous findings regarding the significance of these
symptoms for outcome after TBI. These findings suggest that improved sleep in
early TBI recovery may decrease the occurrence of psychotic-type symptoms.

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