Psychiatric Outcomes Among Patients With Psychosis With or Without Traumatic Brain Injury

OBJECTIVE: The authors compared recorded psychiatric outcomes among patients with psychotic disorders with or without a preceding traumatic brain injury (TBI). METHODS: psychotic disorders (codes F20-F29). The TBI-exposed cohort had a preceding intracranial injury code (S06.xxx), and the comparator cohort had no documented TBI. After 1:1 propensity score matching on age, sex, race, and ethnicity, each cohort included 53,007 patients. New diagnoses of suicide attempt, any substance use disorder, homicidal ideation, and intermittent explosive disorder were assessed for up to 10 years. Relative risks (RRs), risk differences, 95% confidence intervals, and Bonferroni-adjusted significance thresholds were estimated. RESULTS: The TBI-psychosis cohort had significantly (p<0.001) higher risks for suicide attempt (1.6% vs. 0.7%; RR=2.21, 95% CI=1.96-2.50), any substance use disorder (10.5% vs. 9.5%; RR=1.10, 95% CI=1.05-1.15), homicidal ideation (3.0% vs. 2.2%; RR=1.34, 95% CI=1.24-1.44), and intermittent explosive disorder (0.4% vs. 0.2%; RR=1.69, 95% CI=1.33-2.13), compared with the psychosis-only cohort, respectively. CONCLUSIONS: Among patients with psychotic disorders, a documented history of TBI was significantly associated with four adverse psychiatric outcomes. These observational findings do not establish causation and may reflect residual confounding and differential ascertainment.