Agressive behavior after traumatic brain injury

Abstract

Aggressive behavior can unveil organic brain injuries, depressive syndrome as well as iatrogenic nature of the environment. This clinical case is based on the fact that antipsychotic drugs, aside from their sedative effect, are not the proper treatment for agitation following traumatic brain injury. This case also highlights how management of behavioral disorders following TBI should not be based on pharmacological treatments only but instead should focus on multidisciplinary strategies of care.

Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit

“…This could be explained by the fact that patients with severe TBI might have different lesions which may influence the behavioral or cognitive function. [23] In contrast, a prospective study reported agitation and restlessness in only 11% of the closed severe head injury patients (GCS < 8). [24] In our study, the lesions (except SAH) and severity of head injuries did not differ significantly in cases with or without agitation.…”

“…There are several factors that could be associated with the development of agitation in ICU which vary depending upon the severity of illness, oxygenation status, metabolic disorders, medications and sepsis-associated encephalopathy. [4,19] Saoût et al [23] suggested agitation or aggressive behavior to be observed in 11% to 34% of patients who sustained TBI. In our study, two-third of patients who sustained TBI developed agitations with lower GCS on the initial presentation to the emergency department.…”

Combining the Antipsychotic Drug Haloperidol and Environmental Enrichment after Traumatic Brain Injury Is a Double-Edged Sword

“…The platform was a clear Plexiglas stand (10 cm diameter, 26 cm high) that was positioned 26 cm from the maze wall in the southwest quadrant and held constant for each rat. Spatial learning began on post-operative day 14 and consisted of providing a block of four daily trials (4-min inter-trial interval) for five consecutive days (14)(15)(16)(17)(18) to locate the platform when it was submerged 2 cm below the water surface. On day 19 the platform was made visible to the rats by raising it 2 cm above the water surface as a control procedure to determine the contributions of non-spatial factors (e.g., sensory-motor performance, motivation, and visual acuity) on cognitive performance.…”

“…8,14 A traditionally administered APD is the first-generation drug haloperidol (HAL). HAL, a D 2 -receptor antagonist, acts diffusely and indiscriminately throughout the brain affecting postsynaptic D 2 receptors.…”

Maintaining community living with post brain injury agitation: A role for sodium valproate

“…Non-pharmacological interventions to treat neurobehavioural symptoms should also be employed in conjunction with pharmacological agents, as drug intervention alone will not resolve behaviour in the majority of cases [12,13]. Meticulous multi-disciplinary historical, clinical and neuropsychological assessments of complex neurobehavioural presentations post-ABI are required to devise appropriate intervention strategies.…”