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Brain injury and aggression

For the clinician who has had any depth of experience working with a brain-injured population, there is little doubt that behavioral problems following traumatic brain injury (TBI) can present significant management challenges. Common in TBI, behavioral disinhibition and associated problems may increase over the first year following injury,1 and are often associated with damage to the prefrontal regions of the brain.2,–,4 Estimates of the occurrence of agitation or aggression range from 35% to 96% of patients with TBI during the acute period and from 31% to 71% of these patients in the chronic phase.5

With respect to the treatment of post-TBI aggression, several agents may be efficacious, including β-blockers, antipsychotics, antiseizure drugs, stimulants, and mood stabilizers.2,5,6 Regardless of the presumed cause or etiology of aggressive behavior in a particular patient with TBI, behavioral management approaches, including psychotherapeutic intervention, are also commonly used, often in conjunction with pharmacologic treatment. However, it would be erroneous to assume that there is a universally established evidence-based protocol for the management or treatment of …