Delirium Resulting From Traumatic Brain Injury as an Acute Risk Factor for Suicide: A Case Report and Review of the Literature

Rocca, Gabriele; Caputo, Fiorella; Frigiolini, Francesca; Verde, Alfredo; Ventura, Francesco

doi:10.1176/appi.neuropsych.18080172

Cited by 4 publications

(2 citation statements)

References 19 publications

(18 reference statements)

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“…Lower GCS scores on admission have long been associated with increased mortality, worse neurocognitive outcomes. Patients with post-traumatic delirium are also at risk for severe acute and long-term psychiatric consequences [ 14 - 16 ]. Delirium often remains unnoticed if not actively screened for in the ICU [ 17 ]; therefore, prevention, early identification, and effective management of delirium are critical aspects of ICU care.…”

Section: Introductionmentioning

confidence: 99%

Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice

Roberson¹,

Patel²,

Dąbrowski

et al. 2021

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: Traumatic brain injury (TBI) can initiate a very complex disease of the central nervous system (CNS) starting with the primary pathology of the inciting trauma and subsequent inflammatory and CNS tissue response. Delirium has long been regarded as an almost inevitable consequence of moderate to severe TBI, but more recently has been recognized as an organ dysfunction syndrome with potentially mitigating interventions. The diagnosis of delirium is independently associated with prolonged hospitalization, increased mortality and worse cognitive outcome across critically ill populations. Investigation of the unique problems and management challenges of TBI patients is needed to reduce the burden of delirium in this population. In this narrative review, possible etiologic mechanisms behind post-traumatic delirium are discussed, including primary injury to structures mediating arousal and attention and secondary injury due to progressive inflammatory destruction ofthe brain parenchyma. Other potential etiologic contributors include dysregulation of neurotransmission due to intravenous sedatives, seizures, organ failure, sleep cycle disruption or other delirium risk factors. Delirium screening canbe accomplished in TBI patients and presence of delirium portends worse outcomes. There is evidence that multicomponent care bundles including an analgesia-prioritized sedation algorithm, regular spontaneous awakening and breathing trials, protocolized delirium assessment, early mobility and family engagement can reduce the burden of ICU delirium. The aim of this review is to summarize the approach to delirium in TBI patients with an emphasis on pathogenesis and management. Emerging CNS-active drug therapies that show promise in preclinicalstudies are highlighted.

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Section: Introductionmentioning

confidence: 99%

Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice

Roberson¹,

Patel²,

Dąbrowski

et al. 2021

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“…23,24 Behavioral disorders are even more common in the neuro-ICU where patients may already have pre-existing neurological conditions (including acute brain injuries and neurodegenerative diseases such as dementia). [25][26][27] Psychiatric and behavioral adverse events of antiseizure medications (ASMs) 28,29 could make it even more challenging to manage critically ill patients as they are often compounded by underlying medical and neurologic conditions and effects of medications.…”

Section: Incidence and Management Of Seizures In Hospital And The Cri...mentioning

confidence: 99%

Intravenous Brivaracetam in the Management of Acute Seizures in the Hospital Setting: A Scoping Review

Lee

Klein

Dongre

et al. 2022

J Intensive Care Med

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Background Clinical considerations for drug treatment of acute seizures involve variables such as safety, tolerability, drug-drug interactions, dosage, route of administration, and alterations in pharmacokinetics because of critical illness. Therapy options that are easily and quickly administered without dilution, well tolerated, and effective are needed for the treatment of acute seizures. The objective of this review is to focus on the clinical considerations relating to the use of intravenous brivaracetam (IV BRV) for the treatment of acute seizures in the hospital, focusing on critically ill patients. Methods This was a scoping literature review of PubMed from inception to April 13, 2021, and search of the American Academy of Neurology (AAN) 2021 Annual Meeting website for English language publications/conference abstracts reporting the results of IV BRV use in hospitalized patients, particularly in the critical care setting. Outcomes of interest relating to the clinical pharmacology, safety, tolerability, efficacy, and effectiveness of IV BRV were reviewed and are discussed. Results Twelve studies were included for analysis. One study showed that plasma concentrations of IV BRV 15 min after the first dose were similar between patients receiving IV BRV as bolus or infusion. IV BRV was generally well tolerated in patients with acute seizures in the hospital setting, with a low incidence of individual TEAEs classified as behavioral disorders. IV BRV demonstrated efficacy and effectiveness and had a rapid onset, with clinical and electrophysiological improvement in seizures observed within minutes. Although outside of the approved label, findings from several studies suggest that IV BRV reduces seizures and is generally well tolerated in patients with status epilepticus. Conclusions IV BRV shows effectiveness, and is generally well tolerated in the management of acute seizures in hospitalized patients where rapid administration is needed, representing a clinically relevant antiseizure medication for potential use in the critical care setting.

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Neuropsychiatry and Traumatic Brain Injury

Scicutella

2019

Acquired Brain Injury

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Delirium Resulting From Traumatic Brain Injury as an Acute Risk Factor for Suicide: A Case Report and Review of the Literature

Cited by 4 publications

References 19 publications

Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice

Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice

Intravenous Brivaracetam in the Management of Acute Seizures in the Hospital Setting: A Scoping Review

Neuropsychiatry and Traumatic Brain Injury

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