Executive dysfunction in psychosis following traumatic brain injury (PFTBI)

Rachel Batty, Andrew Francis, Neil Thomas, Malcolm Hopwood, Jennie Ponsford, Lisa Johnston, Susan Rossell
Journal of Clinical and Experimental Neuropsychology 2015, 37 (9): 917-30

INTRODUCTION: Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent, and often do not reflect the deficits demonstrated in patients with traumatic brain injury (TBI) or SCZ. We sought to determine the extent of executive dysfunction in PFTBI relative to three comparison cohorts.

METHOD: Measures of executive function were administered to dually diagnosed patients with PFTBI (n = 10) including tests of mental inhibition and switching, processing speed, and attention: the Stroop Task, Trail Making Test (TMT), and the Attention subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Demographically comparable patients with TBI (n = 10), SCZ (n = 23), and healthy controls (n = 23) underwent an identical battery.

RESULTS: Significant executive dysfunction was evident in patients with PFTBI on all measures. Relative to all three comparison cohorts patients with PFTBI performed most poorly.

CONCLUSIONS: These data present novel evidence of substantially impaired executive function across four task types in PFTBI and suggest that TBI and psychosis have an additive influence on executive function deficits. Treatment programs requiring substantial executive engagement are not suitable for patients dually diagnosed with PFTBI.

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