Hostname: page-component-77c89778f8-vsgnj Total loading time: 0 Render date: 2024-07-17T22:28:07.688Z Has data issue: false hasContentIssue false

Increased risk of schizophrenia following traumatic brain injury: a 5-year follow-up study in Taiwan

Published online by Cambridge University Press:  22 September 2010

Yi-Hua Chen
Affiliation:
School of Public Health, Taipei Medical University, Taipei, Taiwan
Wen-Ta Chiu*
Affiliation:
Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
Shu-Fen Chu
Affiliation:
Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
Herng-Ching Lin*
Affiliation:
School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
*
(Email: wtchiu@tmu.edu.tw) [W.-T. Chiu]
*Address for correspondence: H.-C. Lin, Ph.D., School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan. (Email: henry@tmu.edu.tw) [H.-C. Lin]

Abstract

Background

Whether traumatic brain injury (TBI) is an independent risk factor for the subsequent development of schizophrenia has evoked considerable controversy. No evidence has been previously reported from Asia. This study estimated the risk of schizophrenia during a 5-year period following hospital admission for TBI relative to a comparison group of non-TBI patients during the same period in Taiwan.

Method

Two datasets were linked: the Traumatic Brain Injury Registry and the Taiwan National Health Insurance Research Dataset. A total of 3495 patients hospitalized with a diagnosis of TBI from 2001 to 2002 were included, together with 17 475 non-TBI patients as the comparison group, matched on sex, age, and year of TBI hospitalization. Each individual was followed for 5 years to identify any later diagnosis of schizophrenia. Cox proportional hazard regressions were performed for analysis.

Results

During the 5-year follow-up period, patients who had suffered TBI were independently associated with a 1.99-fold (95% confidence interval 1.28–3.08) increased risk of subsequent schizophrenia, after adjusting for monthly income and residential geographical location. The severity and type of TBI was not associated with the subsequent development of schizophrenia.

Conclusions

Our findings add important evidence from Asia and suggest a potential link between TBI and schizophrenia. Our study suggests that clinicians and family members should be alert to possible neuropsychiatric conditions following TBI.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

AbdelMalik, P, Husted, J, Chow, EW, Bassett, AS (2003). Childhood head injury and expression of schizophrenia in multiply affected families. Archives of General Psychiatry 60, 231236.CrossRefGoogle ScholarPubMed
Achté, KA, Hillbom, E, Aalberg, V (1969). Psychoses following war brain injuries. Acta Psychiatrica Scandinavica 45, 118.CrossRefGoogle ScholarPubMed
Buckley, P, Stack, JP, Madigan, C, O'Callaghan, E, Larkin, C, Redmond, O, Ennis, JT, Waddington, JL (1993). Magnetic resonance imaging of schizophrenia-like psychoses associated with cerebral trauma: clinicopathological correlates. American Journal of Psychiatry 150, 146148.Google ScholarPubMed
David, AS, Prince, M (2005). Psychosis following head injury: a critical review. Journal of Neurology Neurosurgery and Psychiatry 76 (Suppl. 1), i53i60.CrossRefGoogle ScholarPubMed
Davidson, K, Bagley, CR (1969). Schizophrenia-like psychoses associated with organic disorders of the central nervous system: a review of the literature. In Current Problems in Neuropsychiatry: Schizophrenia, Epilepsy, the Temporal Lobe. Special Publication no. 4(ed. Herrington, R.), pp. 189. British Psychiatric Association: London.Google Scholar
Deb, S, Lyons, I, Koutzoukis, C, Ali, I, McCarthy, G (1999). Rate of psychiatric illness 1 year after traumatic brain injury. American Journal of Psychiatry 156, 374378.CrossRefGoogle ScholarPubMed
Fann, JR, Burington, B, Leonetti, A, Jaffe, K, Katon, WJ, Thompson, RS (2004). Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Archives of General Psychiatry 61, 5361.CrossRefGoogle Scholar
Fleminger, S (2008). Long-term psychiatric disorders after traumatic brain injury. European Journal of Anaesthesiology Supplement 42, 123130.CrossRefGoogle ScholarPubMed
Fujii, D, Ahmed, I (2002). Characteristics of psychotic disorder due to traumatic brain injury: an analysis of case studies in the literature. Journal of Neuropsychiatry and Clinical Neurosciences 14, 130140.CrossRefGoogle ScholarPubMed
Gualtieri, T, Cox, DR (1991). The delayed neurobehavioural sequelae of traumatic brain injury. Brain Injury 5, 219232.CrossRefGoogle ScholarPubMed
Haas, GL, Sweeney, JA (1992). Premorbid and onset features of first-episode schizophrenia. Schizophrenia Bulletin 18, 373386.CrossRefGoogle ScholarPubMed
Harrison, G, Whitley, E, Rasmussen, F, Lewis, G, Dalman, C, Gunnell, D (2006). Risk of schizophrenia and other non-affective psychosis among individuals exposed to head injury: case control study. Schizophrenia Research 88, 119126.CrossRefGoogle ScholarPubMed
Keith, SJ, Regier, DA, Rae, DS (1991). Schizophrenic disorders. In Psychiatric Disorders in America. The Epidemiologic Catchment Area Study (ed. Robins, L. N. and Regier, D. A.), pp. 3352. The Free Press, a Division of Macmillan, Inc.: New York.Google Scholar
Keshavan, MS, Tandon, R, Boutros, NN, Nasrallah, HA (2008). Schizophrenia, ‘just the facts’: what we know in 2008. Part 3: neurobiology. Schizophrenia Research 106, 89–107.CrossRefGoogle ScholarPubMed
Larsen, TK, McGlashan, TH, Johannessen, JO, Vibe-Hansen, L (1996). First-episode schizophrenia: II. Premorbid patterns by gender. Schizophrenia Bulletin 22, 257269.CrossRefGoogle ScholarPubMed
Lishman, WA (1968). Brain damage in relation to psychiatric disability after head injury. British Journal of Psychiatry 114, 373410.CrossRefGoogle ScholarPubMed
Malaspina, D, Goetz, RR, Friedman, JH, Kaufmann, CA, Faraone, SV, Tsuang, M, Cloninger, CR, Nurnberger, JI Jr, Blehar, MC (2001). Traumatic brain injury and schizophrenia in members of schizophrenia and bipolar disorder pedigrees. American Journal of Psychiatry 158, 440446.CrossRefGoogle ScholarPubMed
Nielsen, AS, Mortensen, PB, O'Callaghan, E, Mors, O, Ewald, H (2002). Is head injury a risk factor for schizophrenia? Schizophrenia Research 55, 9398.CrossRefGoogle ScholarPubMed
O'Callaghan, E, Larkin, C, Redmond, O, Stack, J, Ennis, JT, Waddington, JL (1988). ‘Early-onset schizophrenia’ after teenage head injury. A case report with magnetic resonance imaging. British Journal of Psychiatry 153, 394396.CrossRefGoogle ScholarPubMed
Sachdev, P, Smith, JS, Cathcart, S (2001). Schizophrenia-like psychosis following traumatic brain injury: a chart-based descriptive and case-control study. Psychological Medicine 31, 231239.CrossRefGoogle ScholarPubMed
Silver, JM, Kramer, R, Greenwald, S, Weissman, M (2001). The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Injury 15, 935945.CrossRefGoogle ScholarPubMed
Tandon, R, Keshavan, MS, Nasrallah, HA (2008). Schizophrenia, ‘just the facts’: what we know in 2008. 2. Epidemiology and etiology. Schizophrenia Research 102, 118.CrossRefGoogle ScholarPubMed
Tienari, P, Wynne, LC, Sorri, A, Lahti, I, Laksy, K, Moring, J, Naarala, M, Nieminen, P, Wahlberg, KE (2004). Genotype–environment interaction in schizophrenia-spectrum disorder. Long-term follow-up study of Finnish adoptees. British Journal of Psychiatry 184, 216222.CrossRefGoogle ScholarPubMed
Tzeng, DS, Lian, LC, Chang, CU, Yang, CY, Lee, GT, Pan, P, Lung, FW (2007). Healthcare in schizophrenia: effectiveness and progress of a redesigned care network. BMC Health Service Research 7, 129.CrossRefGoogle ScholarPubMed
Wilcox, JA, Nasrallah, HA (1987). Childhood head trauma and psychosis. Psychiatry Research 21, 303306.CrossRefGoogle ScholarPubMed
Yang, LH (2007). Application of mental illness stigma theory to Chinese societies: synthesis and new directions. Singapore Medical Journal 48, 977985.Google ScholarPubMed
Yung, AR, McGorry, PD (1996). The initial prodrome in psychosis: descriptive and qualitative aspects. Australian and New Zealand Journal of Psychiatry 30, 587599.CrossRefGoogle ScholarPubMed