Schizophrenia and head injuries

Ian Ford, of Oamaru, asked:

If a schizophrenic has an accident and is headinjured, because of multiple personalities would they take longer to heal mentally?

Richard Linscott, a clinical psychologist at the University of Otago, responded:

This is a great question with no straightforward answer. In thinking about this, we need to look at a myth and then several facts about head injury and schizophrenia.

People with schizophrenia do not have multiple personalities. The multiplepersonality myth is a misinterpretation of the origin of the word schizophrenia, which Eugen Bleuler coined in the early 1900s by combining schizo, meaning split, and phren, meaning mind. Bleuler, a Swiss psychiatrist, coined the term to describe what he saw in his patients, namely marked disconnections in emotion and thinking.

Head injuries disrupt the functions of the brain. These often cause problems with thinking, reasoning, remembering, attending, perception, and planning. Most head injuries are mild and, with the right treatment, recovery will occur over weeks or months. When injuries are severe, cognitive problems can be more extensive. They will persist for months and years after the injury and affect employment, social life, and friendships.

It turns out that cognitive abilities are also affected in schizophrenia. Four of every five people with schizophrenia have marked difficulty with these same cognitive abilities, especially those involving concentration, memory, and planning. Ironically, before Bleuler coined the term schizophrenia, the disorder was referred to as dementia praecox,

or premature dementia.

Let’s ramp up the complexity! Head injuries can cause psychiatric disorders. In many circumstances, these psychiatric disorders can be thought of as reactions to the consequences of the head injury, such as the loss of employment or friends. In these cases, the more severe the injury, the more likely the disorder. The situation with schizophrenia may be different: Those with a head injury are more likely to develop schizophrenia, but the odds of developing schizophrenia are not related to the injury severity.

So, if a person with schizophrenia were to have a head injury, would they take longer to recover from the head injury than someone who does not have schizophrenia?

Possibly; possibly not. I’d not bet one way or the other without knowing a hundred different things about the person, including how severe the injury was, how much they have lost because of the injury, and how they cope with schizophrenia! Even then, it would be superdifficult, if not impossible, to separate the cognitive effects of schizophrenia and head injury on the person.