Management Challenges of Psychosis and Aggression Secondary to Traumatic Brain Injury: A Report of Two Cases

Millions of people in the United States suffer from traumatic brain injury (TBI) yearly. Individuals recovering from moderate to severe TBI are at risk of developing medical and psychiatric comorbidities. Psychosis due to TBI appears to be an infrequent yet serious complication. Psychosis secondary to TBI is debilitating, and its management remains challenging. Individuals may have complex clinical presentations, such as behavioral disturbances (impulsivity or aggression) or other comorbid conditions (anxiety, depression, PTSD (post-traumatic stress disorder), substance use disorders, and seizure disorders). Atypical antipsychotics are the first line of treatment, along with psychotherapy. Mood stabilizers or antidepressants should be considered for mood disturbance. Other comorbid conditions must be addressed promptly to improve outcomes and stabilize the patient in the community. In this article, we discuss two cases that developed psychosis secondary to TBI along with comorbid conditions and their management.