Scam Susceptibility in a Young, Schizoaffective Patient with Traumatic Brain Injury: A Case Report with a Review of Financial Exploitation Literature and Possible Therapeutic Interventions Gleaned from Traumatic Brain Injury Rehabilitation Research.

We present here the case of a 27-year-old man with schizoaffective disorder for roughly eight years who, seven years prior to presentation at our institution, suffered a severe traumatic brain injury (TBI) in a car accident. His course since that time has been marked by paranoid and guilty delusions, Cotard delusion (CD), which is the belief he is dead or does not exist, and scam susceptibility leading to the loss of nearly $200,000. He was hospitalized at our institution after his uncle called emergency medical services, concerned about the patient's increasing disorganization and worsening delusions in the setting of medication nonadherence. In our inpatient unit, clozapine was titrated to its highest tolerable dose and, while reality testing appeared and his CD resolved, he remained acutely vulnerable to scams even while hospitalized. We review the existing literature on scam vulnerability, which heretofore has focused primarily on the elderly, and also TBI rehabilitation strategies in an attempt to better understand the underpinnings of this patient's scam susceptibility and to construct a multidisciplinary approach to lessening his susceptibility to financial exploitation in the future.