Psychopharmacological management of a patient with traumatic encephalopathy syndrome and Parkinsonism following attempted suicide

An estimated 1.6 to 3.8 million cases of athletics-related traumatic brain injury (TBI) occur each year in the United States. While several studies have shown that antipsychotics or antidepressants may improve psychiatric symptoms after TBI, the impact on suicidality has not been investigated directly. This case report describes the psychopharmacological management of a former NFL player who met diagnostic criteria for Traumatic Encephalopathy Syndrome (TES), and who presented following a suicide attempt with cognitive impairment, paranoia, hallucinations, and mild parkinsonism. We discuss the patient's course and management, from stabilization during their initial hospitalization, subsequent decompensation as an outpatient, readmission, and improvement in outpatient assisted living with stable psychiatric symptoms. Management included the addition of clozapine to their regimen and marijuana cessation. As new diagnostic criteria are implemented to identify patients with TES without postmortem neuropathological confirmation, this example of the clinical course and treatment of TES may help guide future studies and clinical care. The atypical antipsychotic clozapine may be especially useful in patients presenting with psychosis and suicidality, and pimavanserin may be useful in patients with motor symptoms.