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Relation of TBI to Subsequent Psychosis

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Many studies of brain-injured persons have proceeded since Kraepelin (1919) first proposed that such injury may cause dementia praecox. Together, these studies offer substantial evidence of elevated psychosis incidence among those exposed to TBI, although the reported rates vary greatly and many of these studies have methodological problems, such as the absence of clear diagnostic criteria. In one of the first studies, Kornilov (1980) followed 340 patients with brain injury and found "psychotic symptoms" and a "personality transformation" consistent with negative symptoms in 26.5% of these patients. In Thomsen's (1984) 10- to 15-year follow-up study of 40 patients who incurred severe TBI, 20% of the patients were found to develop posttraumatic psychosis, although the criteria for this determination were not defined. In an earlier study of Finnish veterans that also did not use standardized criteria, Hillbom (1960) found that 7.95% of 415 randomly ascertained Finnish soldiers with a brain injury went on to develop posttraumatic psychosis. About one-third of the posttraumatic psychosis group had a clinical picture resembling schizophrenia, with paranoia and hallucinations, and 40% had sustained temporal lobe injuries.

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