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J Head Trauma Rehabil. 2014 Mar-Apr;29(2):E11-8. doi: 10.1097/HTR.0b013e318287f894.

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

Author information

  • 1TIRR 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).



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.


Acute neurorehabilitation inpatient unit.


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.


Prospective, inception cohort, observational study.


Confusion Assessment Protocol, productivity outcome at 1 year postinjury.


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.


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.

[PubMed - indexed for MEDLINE]
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