Prospective Review of Early Psychosis Following Traumatic Brain Injury in a Tertiary Hospital in Suburban Community of South Western Nigeria

Abstract

Background: The onset of psychotic symptoms after traumatic brain injury varies significantly in the literature with early onset psychosis most likely to present to neurosurgeons. Aim: To document our experience with early posttraumatic brain injury psychosis Methodology: Prospective review of patients who presented to our neurosurgical unit with psychotic symptoms following traumatic brain injury over a period of eighteen months from July 2018 to December 2019. Clinical and radiological profiles of the patients were documented prospectively. Results: Five patients out of 145 patients (3.4%) with traumatic brain injury had posttraumatic brain injury psychosis using the Diagnostic and Statistical Manual for Mental Disorders 5th Edition. The onset of symptoms ranges between 7 to 17 days. There were three maleretired primary school teachers and two female students. Age ranges between 10 to 67 years. One patient had bilateral frontal burrhole drainage of the subdural hygroma under local anesthesia and sedation with propofol. There was complete resolution of the psychotic symptoms in the immediate postoperative period but these re-emerged about two hours post operatively. Conclusions: Early onset psychosis following traumatic brain injury most likely will present to neurosurgeon and it responds to antipsychotic medications. Propofol may have a promising role in the management of post traumatic brain injury psychosis. There is need for long term follow up to evaluate the risk of recurrent psychosis.