Traumatic Brain Injury and Delusional Disorder: A Narrative Synthesis with Psychopharmacologic Implications

Background

Traumatic brain injury (TBI) is associated with a range of neuropsychiatric sequelae, including secondary psychotic disorders. Delusional syndromes are a prominent and clinically significant manifestation, often classified as Psychotic Disorder Due to Another Medical Condition.1,2

Methods

This narrative synthesis reviews case series, cohort studies, retrospective analyses, and conceptual literature published between 1998 and 2025, focusing on epidemiology, clinical features, pathophysiology, diagnosis, and psychopharmacologic management of post-TBI delusional syndromes.

Results

Delusions—commonly persecutory or misidentification types—frequently emerge after a latency of months to years and are more prevalent than schizophrenia-like presentations.1,2,6 Risk factors include moderate-to-severe injury, frontal or temporal lesions (particularly right-sided), post-traumatic epilepsy, and genetic vulnerability.3–6 Compared to primary psychotic disorders, negative symptoms are typically less prominent, though cognitive impairment is nearly universal.6,7,12 Low-dose atypical antipsychotics demonstrate favorable response rates, but tolerability concerns—including sedation, extrapyramidal symptoms, and seizure risk—necessitate cautious use.8,9 Adjunctive anticonvulsants may be beneficial, particularly in patients with comorbid epilepsy.10,15

Conclusions

Post-TBI delusional syndromes highlight the role of structural brain injury in the development of psychosis. Careful diagnostic evaluation and individualized, low-dose psychopharmacologic strategies are essential. Further research is needed to guide evidence-based treatment in this population.