Neuropsychological diagnosis and treatment after closed-head injury in a patient with a psychiatric history of schizophrenia
Maria Pąchalska, Bożena Grochmal-Bach, Bruce Duncan MacQueen, Magdalena Wilk, Małgorzata Lipowska, Izabela Herman-Sucharska
Med Sci Monit 2008; 14(8): CS76-85
Despite recent interest in the brain/mind problem and possible organic correlates of mental disease, relatively few case studies have examined the problem concretely. The present paper describes a 66-year-old male patient with a long history of schizophrenia, whose psychotic symptoms displayed qualitative and quantitative changes after a closed-head injury.
Material and Method: After a very disturbed childhood and youth, including several jail terms, the patient was diagnosed with schizophrenia in the early 1960s and frequently thereafter hospitalized. Visual hallucinations were the dominant symptom, and art therapy provided some relief, which led to a successful artistic career. In 1989, while actively hallucinating, he suffered a mild TBI in a pedestrian accident. Despite findings of organic dysfunction, he did not receive full neuropsychological diagnosis and treatment until four years later, when he presented with symptoms of perseveration, hemispatial neglect, and disturbances of working memory. The patient then received an individual program of neuropsychological rehabilitation, while his treating psychiatrist gradually withdrew psychotropic medication. After a year of therapy there was marked improvement of both neuropsychological and psychiatric symptoms. At the same time, he began to paint in a completely different style.
Conclusions: The case described here shows that the pathomechanisms of schizophrenia and neurobehavioral disturbances resulting from organic brain damage are not after all unrelated. Microgenetic theory can provide a basis for explaining the course of symptoms in this and similar cases, as we re-think the brain-mind relationship.
Keywords: Tomography, X-Ray Computed, Schizophrenia - complications, Rehabilitation, Neuropsychological Tests, Head Injuries, Closed - therapy