Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 4 2026 10 01 Neurocognitive and psychiatric sequelae following traumatic brain injury in an Iranian forensic cohort: A longitudinal analysis of lesion localization and clinical outcomes 1 14 118634 10.30483/rjm.2026.254740.1497 EN Morteza Talebi Doluee Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Maliheh Dadgar Moghaddam Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Arya Hedjazi Legal Medicine Research center, Legal Medicine Organization, Tehran, Iran. Maryam Moaddab Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mahdi Talebi Department of community and family medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 0000-0002-2328-2536 Journal Article 2026 04 08 Background: Traumatic brain injury (TBI) is a well-established risk factor for neuropsychiatric disorders. However, the relationship between lesion localization and psychiatric phenotypes remains incompletely characterized, particularly in forensic contexts. Objectives: This longitudinal study of an Iranian forensic cohort retrospective analysis of prospectively collected data aimed to investigate the frequency and pattern of psychiatric sequelae following TBI and explore associations between neuroanatomical injury sites and specific psychopathological outcomes. Methods: A total of 113 patients with documented TBI (GCS ≤14, hospitalization ≥24 hours) were consecutively recruited from the Forensic Medicine Organization of Khorasan Razavi, Iran (2020–2022). Patients underwent psychiatric evaluation over a median follow-up of 13 months (IQR: 6–18 months). DSM-5 diagnoses were established using structured clinical interviews. CT scans were reviewed for lesion localization. Multivariate logistic regression and effect sizes (Cramér's V, Cohen's h, risk ratios) were employed. Results: The cohort comprised 92 males (81.4%) and 21 females (18.6%), with a mean age of 36.5 ± 18.4 years. Traffic accidents predominated (84.1%). Notably, 41.6% of patients exhibited no focal parenchymal lesions on initial CT. The most prevalent diagnoses were neurocognitive Disorder (23.0%), major depressive Disorder (19.5%), personality change (13.3%), and post-concussion syndrome (13.3%). In this forensic cohort, 100% of participants received at least one psychiatric diagnosis, which reflects the medicolegal referral context and does not generalize to non-forensic TBI populations. Frontal lobe involvement showed a numerically higher frequency of personality change (29.4% vs. 10.5%; risk ratio = 2.80, 95% CI: 0.98–7.99; p = 0.078). Gender was not an independent predictor (adjusted OR = 1.24, 95% CI: 0.48–3.21, p = 0.66). Conclusion: Neurocognitive Disorder and major depression are the predominant psychiatric sequelae in this Iranian forensic TBI cohort. A substantial proportion of patients developed significant psychopathology despite normal CT imaging—the "normal CT paradox"—underscoring the need for psychiatric surveillance regardless of neuroimaging findings. Findings are limited to forensic medicolegal populations and do not generalize to the general TBI population.

https://journal.razavihospital.ir/article_118634_e827f6de0f97a905af2759e248ac95a4.pdf