Schizophrenic patients, perhaps because of clumsiness, distractibility, poor coordination, or poor judgment, are subject to various forms of traumatic insult, but there may be other connections. The impact of traumatic brain injury (TBI) on a person's functioning is, of course, related to the extent and type of injury sustained, yet TBI can mimic the features of schizophrenia, making exact diagnosis difficult. Schizophrenia following TBI could be a phenocopy of schizophrenia or the consequence of gene-environment interaction, or the association of a TBI event and schizophrenia could be spurious if those predisposed to schizophrenia have greater trauma for other reasons. Malaspina et al. (2001) investigated the relationship between traumatic brain injury and psychiatric diagnoses in a large group of subjects from families with at least two biologically related first-degree relatives with schizophrenia, schizoaffective disorder, or bipolar disorder. Rates of TBI were significantly higher for those with schizophrenia (19.6% in the schizophrenia pedigree, 4.5% in the bipolar pedigree) than for those with no mental illness. Multivariate analysis of within-pedigree data showed that mental illness was related to traumatic brain injury only in the schizophrenia pedigrees. Members of schizophrenia pedigrees also failed to show the typical greater likelihood of TBI in males compared with females—a gender difference that was present among schizophrenia subjects from the bipolar pedigrees.
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