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

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Study identified factors associated with psychotic-type symptoms in patients in a posttraumatic confusional state (PTCS) during early recovery following a moderate or severe traumatic brain injury (TBI) and investigated the prognostic significance of early psychotic-type symptoms for patient productivity outcome. Participants were recruited from the National Institute on Disability and Rehabilitation Research TBI Model Systems program. The Confusion Assessment Protocol was used to determine the diagnosis of PTCS and to assess psychotic-type symptoms, cognitive impairment, and sleep disturbance. Of the 168 individuals with moderate or severe TBI admitted for inpatient rehabilitation, 107 had psychotic-type symptoms on at least 1 examination. Those who were employed or were in an academic program and were making academic progress were coded as productive. One-year productivity outcome was available for 87 of the 107 participants. Results revealed that the 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. These findings suggest that improved sleep in early TBI recovery may decrease the occurrence of psychotic-type symptoms.

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