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Psychotic Symptoms as Manifestations of the Posttraumatic Confusional State: Prevalence, Risk Factors, and Association With Outcome

Sherer, Mark PhD; Yablon, Stuart A. MD; Nick, Todd G. PhD

The Journal of Head Trauma Rehabilitation: March/April 2014 - Volume 29 - Issue 2 - p E11–E18
doi: 10.1097/HTR.0b013e318287f894
Original Articles

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.

TIRR Memorial Hermann, Baylor College of Medicine, University of Houston Medical School, Houston, Texas (Dr Sherer); Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada (Dr Yablon); and Department of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock (Dr Nick).

Corresponding Author: Mark Sherer, PhD, TIRR Memorial Hermann, 1333 Moursund, Houston, TX 77030 (

This research was supported by US Department of Education National Institute on Disability and Rehabilitation Research Grants H133A070043 and H133A020514.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins