Schizophrenias and dementias are relatively rare. A history of closed head injury, sustained for example in a motor vehicle accident or an assault, is relatively more common. This requires neuropsychological evaluation and expertise with pharmacotherapy utilized for organically based mood and behavior disorders. Exposure to toxic substances in the workplace can be another important factor impinging on the clinical presentation of the patient. Examples of such exposure include industrial solvents used in painting and fiberglass fabrication, farm chemicals, and the petrochemical industry.
Neuropsychological testing is valuable for confirmation of the nature and extent of the impairment.
Clinically such patients often display unpredictable mood swings coupled with extreme impulsivity. This can be quite dangerous, as they may attempt suicide by violent means, or assault other acquaintances or family members. One should look for an absence of any similar behavior prior to the injury to increase the index of suspicion of traumatic or toxic injury. It is important that a thorough developmental history be obtained. A history of neglect, abuse, and educational failure negatively impacts the prognosis and demands more sophisticated treatment.