Pharmacological management for agitation and aggression in people with acquired brain injury

Fleminger, Simon; Greenwood, R; Oliver, Donna L.

doi:10.1002/14651858.cd003299.pub2

Cited by 135 publications

(96 citation statements)

References 81 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In fact, these patients receive antiepileptic therapy to treat behavioural disturbances and post-traumatic seizures [15] or beta-blockers, namely propranolol, which is the only effective drug in psychomotor agitation, according to Cochrane Analysis [16], which is also used for post-traumatic dysautonomic syndrome, all drugs that may affect pain perception. Anticonvulsants or GABAergic drugs such as gabapentin, pregabalin or clonazepam, which are given to reduce central or peripheral pain or indomethacin to prevent para-articular ossification [17], may well be responsible for attenuation of head pain, if present.…”

Section: Post-traumatic Headache After Moderate/severe and Very Severmentioning

confidence: 99%

Post-traumatic headache: facts and doubts

et al. 2009

View full text Add to dashboard Cite

The International Classification of Headache Disorders does not separate the moderate from severe/very severe traumatic brain injury (TBI), since they are all defined by Glasgow coma scale (GCS) < 13. The distinction between the severe and very severe TBI (GCS < 8) should be made upon coma duration that in the latter may be longer than 15 days up to months in the case of vegetative state. Post-traumatic amnesia duration may double the coma duration itself. Therefore, the 3-month parameter proposed to define the occurrence or resolution of post-traumatic headache (PTH) appears inadequate. Following TBI, neuropathic pain, central pain, thalamic pain, combined pain are all possible and they call for proper pharmacological approaches. One more reason for having difficulties in obtaining information about headache in the early phase after regaining consciousness is the presence of concomitant medications that may affect pain perception. Post-traumatic stress disorder (PTSD) develops days or weeks after stress and tends to improve or disappear within 3 months after exposure; interestingly, this spontaneous timing resembles that of PTH. In our experience the number of TBI patients with PTH at 1-year follow-up is lower in those with longer coma duration and more severe TBI. Cognitive functioning evaluated after at least 12 months from TBI, showed mild or no impairment in these patients with severe TBI and PTH, whereas they have psychopathological changes, namely anxiety and depression. The majority of patients with PTH after severe/very severe TBI had skull fractures or dural lacerations and paroxystic EEG abnormalities. The combination of psychological changes (depression and anxiety) and organic features (skull fractures, dural lacerations, epileptic EEG abnormalities) in PTH may be inversely correlated with the severity of TBI, with prevalence of psychological disturbances in mild TBI and of organic lesions in severe TBI. On the other hand, only in severe TBI patients with good cognitive recovery the influence of the psychopathological disorders may play a role. In fact, the affective pain perception is probably related to the integrity of cognitive functions as in mild TBI and in severe TBI with good cognitive outcome.

show abstract

Section: Post-traumatic Headache After Moderate/severe and Very Severmentioning

confidence: 99%

Post-traumatic headache: facts and doubts

et al. 2009

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Few survey respondents use propranolol, despite its wide use in other neuropsychiatric settings such as traumatic brain injury [19]. A Cochrane review of pharmacologic treatment of agitation in acquired brain injury concluded that Beta-blockers had best efficacy [20]. Only a few survey respondents use, or were familiar with, buspirone for HD irritability despite early positive research reports [21] [22].…”

Section: Discussionmentioning

confidence: 99%

An International Survey-based Algorithm for the Pharmacologic Treatment of Irritability in Huntington's Disease

Groves¹,

Duijn²,

Anderson³

et al. 2011

PLoS Curr

View full text Add to dashboard Cite

It is generally believed that treatments are available to manage irritability in Huntington’s disease (HD). However, lack of an evidence base prevents the establishment of treatment guidelines for this symptom. The research literature fails to address behavioral intervention strategies, drug selection, drug dosing, management of inadequate response to a single drug, or preferred drugs when additional behavioral symptoms comorbid to irritability are present. In an effort to inform clinical decision-making we surveyed an international group of experts to address these points. The experts consistently endorsed an antipsychotic drug (APD) as first choice for treatment of urgent and aggressive irritability behaviors. However, there was variation in practice patterns for treating less severe symptoms. Serotonin reuptake inhibitors (SSRIs) were first choice drug treatments by most respondents across all geographic regions. However, APDs were also endorsed as first choice for mild or moderate irritability, more frequently in Europe than in North America and Australia. Antiepileptic mood stabilizers (AEDs) were used by fewer respondents as first choice drug. Perceived efficacy for control of mild or moderate irritability was judged somewhat higher for APDs than SSRIs or AEDs. Benzodiazepines were not used as monotherapy, but frequently as an adjunctive drug in the setting of comorbid anxiety. Though many cited lack of experience with mirtazapine, others familiar with its use in HD chose it as an alternative monotherapy, or as adjunctive therapy if insomnia was a comorbid factor. This report presents survey results, reviews available irritability studies, and lastly proposes an algorithm for the treatment of irritability in HD derived from expert preferences obtained through this survey.

show abstract

“…12 However, there is still insufficient evidence to support a standard pharmacologic approach to anger following TBI, and several commonly used agents may impede cognitive recovery. 13 …”

Section: Introductionmentioning

confidence: 99%

Anger Self-Management Training for Chronic Moderate to Severe Traumatic Brain Injury: Results of a Randomized Controlled Trial

Hart

Brockway

Maiuro

et al. 2017

Journal of Head Trauma Rehabilitation

View full text Add to dashboard Cite

Objective Test efficacy of 8-session, 1:1 treatment, Anger Self-Management Training (ASMT), for chronic moderate to severe traumatic brain injury (TBI). Setting Three US outpatient treatment facilities. Participants 90 people with TBI and elevated self-reported anger; 76 significant others (SOs) provided collateral data. Design Multi-center randomized controlled trial with 2:1 randomization to ASMT or structurally equivalent comparison treatment, Personal Readjustment and Education (PRE). Primary outcome assessment 1 week post treatment; 8-week follow-up. Primary outcome: Response to treatment defined as ≥1 standard deviation change in self-reported anger. Secondary outcomes: SO-rated anger, emotional and behavioral status, satisfaction with life, timing of treatment response, participant and SO-rated global change and treatment satisfaction. Main Measures State-Trait Anger Expression Inventory-Revised Trait Anger (TA) and Anger Expression-Out (AX-O) subscales; Brief Anger-Aggression Questionnaire (BAAQ); Likert-type ratings of treatment satisfaction, global changes in anger and well-being. Results After treatment, ASMT response rate (68%) exceeded that of PRE (47%) on TA but not AX-O or BAAQ; this finding persisted at 8 week follow-up. No significant between-group differences in SO-reported response rates, emotional/ehavioral status, or life satisfaction. ASMT participants were more satisfied with treatment and rated global change in anger as significantly better; SO ratings of global change in both anger and well-being were superior for ASMT. Conclusion Anger self-management training was efficacious and persistent for some aspects of problematic anger. More research is needed to determine optimal dose and essential ingredients of behavioral treatment for anger following TBI.

show abstract

Pharmacological management for agitation and aggression in people with acquired brain injury

Cited by 135 publications

References 81 publications

Post-traumatic headache: facts and doubts

Post-traumatic headache: facts and doubts

An International Survey-based Algorithm for the Pharmacologic Treatment of Irritability in Huntington's Disease

Anger Self-Management Training for Chronic Moderate to Severe Traumatic Brain Injury: Results of a Randomized Controlled Trial

Contact Info

Product

Resources

About