Razavi Journal of Medicine

Razavi Journal of Medicine

Neurocognitive and psychiatric sequelae following traumatic brain injury in an Iranian forensic cohort: A longitudinal analysis of lesion localization and clinical outcomes

Articles in Press

Document Type : Original Article

Authors
Morteza Talebi Doluee 1
Maliheh Dadgar Moghaddam 2
Arya Hedjazi 3
Maryam Moaddab 4
Mahdi Talebi 5
1 Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Legal Medicine Research center, Legal Medicine Organization, Tehran, Iran.
4 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
5 Department of community and family medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
10.30483/rjm.2026.254740.1497
Abstract
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.
Keywords
Traumatic Brain Injury
Neurocognitive Disorders
Major Depressive Disorder
Forensic Psychiatry
Subjects

Acknowledgements: The authors wish to express their sincere gratitude to the staff of the Legal Medicine Organization of Khorasan Razavi for their invaluable assistance with patient recruitment and data collection. We also extend our appreciation to the patients and their families for their participation in this study.


Data Availability Statement: The data supporting the findings of this study are available from the Legal Medicine Organization of Khorasan Razavi. However, access is restricted and used under ethical approval for the current study. De-identified data are available from the corresponding author upon reasonable request and with permission of the Legal Medicine Organization.


Conflicts of interests: The authors declare that they have no conflicts of interest to disclose.


Funding Statement: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.


Ethical Approval: This study was approved by the Medical Ethics Committee of Mashhad University of Medical Sciences (Approval Code: IR.MUMS.REC.P941366). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments, or with comparable ethical standards. Written informed consent was obtained from all individual participants included in the study.


Consent for publication: Not applicable


Author contributions: Conceptualization: Mahdi Talebi (MT); Methodology and Formal analysis: Morteza Talebi Doluee (MTD), Malihe Dadgar Moghadam (MDM); Investigation and Data curation: Arya Hedjazi (AH); Writing – Original draft: Maryam Moaddab (MM);. All authors have read and approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi Journal of Medicine

Articles in Press, Accepted Manuscript
Available Online from 17 June 2026