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He sustained a left-sided subdural haematoma requiring decompressive craniotomy. Post-surgery, he demonstrated resolution of longstanding hallucinations and self-harming behaviours, enhanced affective regulation and successful tapering of antipsychotic medications, alongside improvement in social and functional abilities. Although such improvement is uncommon, this case highlights the need for reassessment of psychiatric diagnoses, functional status and pharmacological regimens following neurological injury, particularly in individuals with overlapping psychiatric conditions. The findings also suggest that environmental stability, structured rehabilitation and reduction of complex polypharmacy may have contributed to clinical improvement. This case contributes to the limited literature on psychiatric outcomes following TBI and underscores the importance of an integrated, multidisciplinary approach to post-injury management.<\/jats:p>","DOI":"10.1136\/bcr-2025-266529","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T15:45:20Z","timestamp":1775576720000},"page":"e266529","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Improvement in psychiatric symptoms after subdural haematoma and decompressive craniotomy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1938-537X","authenticated-orcid":false,"given":"Ozlem","family":"Erol Durgun","sequence":"first","affiliation":[{"name":"Rehabilitation Medicine, Nottingham University Hospitals, NHS Trust, Nottingham, UK"},{"name":"Rehabilitation Medicine, National Rehabilitation Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Sivan","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine, Nottingham University Hospitals, NHS Trust, Nottingham, UK"},{"name":"Rehabilitation Medicine, National Rehabilitation Centre, Nottingham, UK"},{"name":"Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Sapsford","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine, Nottingham University Hospitals, NHS Trust, Nottingham, UK"},{"name":"Rehabilitation Medicine, National Rehabilitation Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javvad","family":"Haider","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine, Nottingham University Hospitals, NHS Trust, Nottingham, UK"},{"name":"Rehabilitation Medicine, National Rehabilitation Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"2026062608153692000_19.4.e266529.1","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1080\/02699052.2020.1805125","article-title":"Paradoxical complete and spontaneous resolution of depression, psychosis, and suicidal ideation following a traumatic brain injury","volume":"34","author":"Yeung","year":"2020","journal-title":"Brain Inj"},{"key":"2026062608153692000_19.4.e266529.2","first-page":"27237","article-title":"Resolution of positive symptoms of schizophrenia after traumatic brain injury","volume":"16","author":"Brieler","year":"2014","journal-title":"Prim Care Companion CNS Disord"},{"key":"2026062608153692000_19.4.e266529.3","first-page":"797","article-title":"Psychiatric disorders and traumatic brain injury","volume":"4","author":"Schwarzbold","year":"2008","journal-title":"Neuropsychiatr Dis Treat"},{"key":"2026062608153692000_19.4.e266529.4","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/S2215-0366(19)30289-5","article-title":"Prevalence of co-occurring mental health diagnoses in the autism population","volume":"6","author":"Lai","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"2026062608153692000_19.4.e266529.5","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.neubiorev.2011.08.005","article-title":"Anatomical insights into the interaction of emotion and cognition in the prefrontal cortex","volume":"36","author":"Ray","year":"2012","journal-title":"Neuroscience & Biobehavioral Reviews"},{"key":"2026062608153692000_19.4.e266529.6","doi-asserted-by":"crossref","DOI":"10.3390\/ijms21020588","article-title":"Approaches to Monitor Circuit Disruption after Traumatic Brain Injury: Frontiers in Preclinical Research","volume":"21","author":"Krishna","year":"2020","journal-title":"Int J Mol Sci"},{"key":"2026062608153692000_19.4.e266529.7","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.tics.2017.03.003","article-title":"Injured Brains and Adaptive Networks: The Benefits and Costs of Hyperconnectivity","volume":"21","author":"Hillary","year":"2017","journal-title":"Trends Cogn Sci (Regul Ed)"},{"key":"2026062608153692000_19.4.e266529.8","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00252"},{"key":"2026062608153692000_19.4.e266529.9","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-018-06350-7","article-title":"Cerebello-thalamo-cortical hyperconnectivity and psychosis","volume":"9","author":"Cao","year":"2018","journal-title":"Nat Commun"},{"key":"2026062608153692000_19.4.e266529.10","doi-asserted-by":"crossref","unstructured":"Filley CM . 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