Summary
Traumatic brain injury (TBI) is a common phenomenon. Patients who have experienced an injury of this type can develop a range of psychiatric conditions [including depression, bipolar disorder, secondary mania, psychotic states (schizophreniform and paranoid), post-traumatic stress disorder, obsessive-compulsive disorder, phobic disorders, panic disorder and generalised anxiety disorder] and neuropsychiatric syndromes (including apathetic states and disorders of impulse control, ranging from irritability to severe aggression).
Despite the prevalence of these conditions, there have been no adequately controlled studies of epidemiology or pharmacological interventions. Hence, treatment approaches generally follow those seen in psychiatric conditions that occur in non-TBI populations. However, adjustments in these approaches must be made to account for the adverse effect profiles of the drugs used that may worsen cognitive function. Medications with prominent anticholinergic, anti-histaminergic or antidopaminergic effects should therefore not be used as first-line interventions. In addition, traditional antipsychotics may block synaptic plasticity and so should be used with caution in patients with TBI.
The management of apathetic syndromes is based on a paradigm of elevating dopaminergic (with or without noradrenergic) activity. Treatment of impulse control disorders centres on increasing serotonergic activity, along with the use of β-blockers (which may act through serotonin receptors) and anticonvulsants. Stimulant medications can also be useful for apathetic syndromes, and may enhance synaptic plasticity.
While this review predominantly discusses pharmacological interventions, they are only part of the essential multi-disciplinary management of patients with TBI. Cognitive, behavioural and family interventions should also be applied. Environmental management is often paramount, as the environment is frequently easier to alter than the disorders in the individual with TBI are to treat.
Similar content being viewed by others
References
Field JH. Epidemiology of head injuries in England and Wales. London: Department of Health and Social Security, HM Stationery Office, 1976
Moscato BS, Treviso M, Willer BS. The prevalence of traumatic brain injuries and co-occurring disabilities in a national household survey of adults. J Neuropsychiatry Clin Neurosci 1994; 6: 134–42
Kraus JF. Epidemiology of head injury. In: Cooper PR, editor. Head injury. 3rd ed. Baltimore: Williams and Wilkins, 1993: 1–25
Prigitano GP. Disturbances of self awareness of deficit after traumatic brain injury. In: Prigitano GP, Schacter DL, editors. Awareness of deficit after brain injury. New York: Oxford University Press, 1991: 111–26
London PA. Some observations on the course of events after severe injury of the head. J R Coll Surg Eng 1967; 41: 460–79
Frank RG. Families and rehabilitation. Brain Inj 1994; 8: 193–5
Uomoto JM, Esselman PC. Traumatic brain injury and chronic pain: differential types and rates by head injury severity. Arch Phys Med Rehabil 1993; 74: 61–4
Lahz S, Bryant RA. Incidence of chronic pain following traumatic brain injury. Arch Phys Med Rehabil 1996; 77: 889–91
Rutherford WH, Merrett JD, McDonald JR. Sequelae of concussion caused by minor head injuries. Lancet 1977; I: 1–4
Schoenhuber R, Gentilini M. Anxiety and depression after mild head injury: a case control study. J Neurol Neurosurg Psychiatry 1988; 5: 722–4
Mobayed M, Dinan TG. Buspirone/prolactin response in post head injury depression. J Affect Dis 1990; 19(4): 237–41
Brooks DN, Campsie L, Symington C, et al. The five year outcome of severe blunt head injury: a relatives view. J Neurol Neurosurg Psychiatry 1986; 49: 764–70
Federoff JP, Starkstein SE, Forrester AW, et al. Depression in patients with acute traumatic brain injury. Am J Psychiatry 1992; 149: 918–23
Kinsella G, Moran X, Ford B, et al. Emotional disorder and its assessment within the severe head-injured population. Psychol Med 1988; 18: 57–63
Levin HS, Grossman RG. Behavioural sequelae of closed head injury: a quantitative study. Arch Neurol 1978; 35: 720–7
Oddy M, Coughlan T, Tyerman A, et al. Social adjustment after closed head injury: a further follow-up seven years after injury. J Neurol Neurosurg Psychiatry 1985; 48: 564–8
Tyerman A, Humphrey M. Changes in self concept following severe head injury. Int J Rehabil Res 1984; 7: 11–23
van Zomeran A, van den Burg W Residual complaints of patients two years after severe head injury. J Neurol Neurosurg Psychiatry 1985: 14: 21–8
Varney NR, Hartzke JS, Roberts RJ. Major depression in patients with closed head injury. Neuropsychology 1987; 1: 7–9
Weddell R, Oddy M, Jenkins D. Social adjustment after rehabilitation: a two-year follow up of patients with severe head injury. Psychosom Med 1980; 10: 257–63
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. rev. Washington, DC: American Psychiatric Association, 1987
Robinson RG, Jorge R. Mood disorders. In: Silver JM, Yudofsky SC, Hales RE, editors. Neuropsychiatry of traumatic brain injury. Washington, DC: American Psychiatric Press, 1994: 219–50
Jorge RE, Robinson RG, Arndt SV. Are depressive symptoms specific for depressed mood in traumatic brain injury? J Nerv Ment Dis 1993; 181: 91–9
Jorge RE, Robinson RG, Arndt SV, et al. Depression and traumatic brain injury: a longitudinal study. J Affect Dis 1993; 27: 233–43
Jorge RE, Robinson RG, Arndt SV, et al. Comparison between acute and delayed onset depression following traumatic brain injury. J Neuropsychiatry Clin Neurosci 1993; 5: 43–9
Jorge RE, Robinson RG, Starkstein SE, et al. Depression and anxiety following traumatic brain injury. J Neuropsychiatry Clin Neurosci 1993; 5: 369–74
Lishman WA. Physiogenesis and psychogenesis in the ‘post-concussional’ syndrome. Br J Psychiatry 1988; 153: 460–9
van Zomeran AH, Saan RJ. Psychological and social sequelae of severe head injury. In: Braakman R, editor. Handbook of clinical neurology. Vol. 13. Head injury. Amsterdam: Elsevier, 1990: 397–420
Prigitano GP. Psychiatric aspects of head injury: problem areas and suggested guidelines for research. In: Levin HS, Eisenberg HM, editors. Neurobehavioural recovery from head injury. Oxford: Oxford University Press, 1987: 215–32
Grafman J, Vance SC, Swingartner H, et al. The effects of lateralised frontal lesions on mood regulation. Brain 1986; 109: 1127–48
Lishman WA. Brain damage in relation to psychiatric disability after head injury. Br J Psychiatry 1968; 114: 373–410
Tomarken AJ, Davidson RJ. Frontal brain activation in repressors and nonrepressors. J Abnorm Psychol 1994; 103: 339–49
Ross ED. Non verbal aspects of language. Neurol Clin 1993; 11(1): 9–23
Saran AS. Depression after minor closed head injury: role of dexamathasone depression test and antidepressants. J Clin Psychiatry 1985; 46(8): 335–8
Silver JM, Hales RE, Yudofsky SC. Neuropsychiatric aspects of traumatic brain injury. In: Yudofsky SC, Hales RE, editors. The American psychiatric press textbook of neuropsychiatry. Washington, DC: American Psychiatry Pres, 1992: 363–95
Dinan TG, Mobayed M. Treatment resistance of depression after head injury: a preliminary study of amitriptyline response. Acta Psychiatr Scand 1992; 85: 292–4
Cassidy JW. Fluoxetine: a serotonergically active antidepressant. J Head Trauma Rehabil 1989; 4: 67–9
Newburn GM, Edwards RA, Thomas H, et al. A comparison of the efficacy and tolerability of moclobemide given as a single daily dose or as three divided doses per day for the treatment of patients with a major depressive episode (DSM-3-R). J Clin Psychopharmacol 1995; 15 Suppl. 2: 10–5
Williams R, Edwards RA, Newburn GM, et al. A double-blind comparison of moclobemide and fluoxetine in the treatment of depressive disorders. Int Clin Psychopharmacol 1993; 7: 155–8
Newburn GM, Fraser AR, Menkes DB, et al. A double-blind trial of moclobemide versus amitriptyline in the treatment of depressive disorders. Aust NZ J Psychiatry 1990; 24: 475–9
Silverman M. Organic stupor subsequent to a severe head injury treated with ECT. Br J Psychiatry 1964; 110: 645–50
Ruedrich I, Chu CC, Moore SI. ECT for major depression in a patient with acute brain trauma. Am J Psychiatry 1983; 140: 928–9
Devane CL. Comparative safety and tolerability of selective serotonin reuptake inhibitors. Hum Psychopharmacol 1995; 10 Suppl.: S185–193
Andersen BS, Mikkelsen W, Vesteragen A, et al. No influence of the antidepressant paroxetine on carbamazepine, valproate and phenytoin. Epilepsy Res 1991; 10: 201–4
Remeron — scientific information. Oss, The Netherlands
Hoffman-La Roche Safety database. Basel, 1998
Hoheisel HP, Walch R. Uber manisch-depressive und uerwandte verstimmungszus tande nach Hirnverletzung. Arch Psychiatr Nervenkrankheiten 1952; 188: 1–25
Lishman WA. Organic psychiatry: the psychological consequences of cerebral disorder. 2nd ed. Oxford: Blackwell Scientific Publications, 1987
Jorge RE, Robinson RG, Starkstein SE, et al. Manic syndromes following traumatic brain injury. Am J Psychiatry 1993; 155: 916–21
Shukla S, Cook BL, Mukherjee S, et al. Mania following head trauma. Am J Psychiatry 1987; 144: 93–6
Starkstein SE, Pearlson GD, Boston JD, et al. Mania following head trauma: a controlled study of causative factors. Arch Neurol 1988; 44: 1069–73
Starkstein SE, Boston JD, Robinson RG. Mechanisms of mania after brain injury: 12 case reports and review of the literature. J Nerv Ment Dis 1988; 176: 87–100
Starkstein SE, Mayberg HS, Berthier ML, et al. Secondary mania: neuroradiological and metabolic findings. Am Neurol 1990; 27: 652–9
Stewart JT, Nemsath RN. Bipolar illness following traumatic brain injury: treatment with lithium and carbamazepine. J Clin Psychiatry 1988; 49: 74–5
Bouvy PF, van de Wetering BJM, Mearwaldt JD, et al. A case of organic brain syndrome following head injury successfully treated with carbamazepine. Acta Psychiatr Scand 1988; 77: 361–3
Pope HG, McElroy SL, Satlin A, et al. Head injury, bipolar disorder and response to valproate. Compr Psychiatry 1988; 29: 34–8
Bakchine S, Lacomblez C, Benoit N, et al. Manic-like states after orbitofrontal and right temporoparietal injury: efficacy of clonidine. Neurology 1989; 39: 777–81
Pleak RR, Birmaher B, Gavrileseu A, et al. Mania and neuropsychiatric excitement following carbamazepine. J Am Acad Child Adolesc Psychiatry 1988; 27: 500–3
Schiff HB, Sabrin TB, Geller A, et al. Lithium in aggressive behaviour. Am J Psychiatry 1982; 139: 1346–8
Hornstein A, Seliger G. Cognitive side effects of lithium in closed head injury. J Neuropsychiatry Clin Neurosci 1989; 1: 446–7
Parmelee DX, O’Shannick FJ. Carbamazepine-lithium toxicity in brain damaged adolescents. Brain Inj 1988; 2: 305–8
Calabrese JR, Bowden C, Woyshville MJ. Lithium and the anticonvulsants in the treatment of bipolar disorder. In: Bloom FE, Kupfer DJ, editors. Psychopharmacology: the fourth generation of progress. New York: Raven Press, 1995: 1099–111
Feeney D, Gonzales A, Law W. Amphetamine, haloperidol and experience interact to affect rate of recovery after motor cortex injury. Science 1982; 217: 855–7
Bernstein JG. Drug therapy in psychiatry. 3rd ed. St Louis: Mosby-Year Book, 1995
Hillbom E. After effects of brain injury. Acta Psychiatr Neurol Scand 1960; 142 Suppl.: 1–195
Achte KA, Hillbom E, Aalberg V. Post-traumatic psychoses following war brain injuries: reports from the Rehabilitation Institute for Brain Injured Veterans in Finland. Vol 1. Helsinki, 1967
Achte KA, Hillbom E, Aalberg V Psychoses following war brain injuries. Acta Psychiatr Scand 1969; 45: 1–18
Ota Y Psychiatric studies on civilian head injuries. In: Walker AE, Caveness WF, Critchly M, editors. The late effects of head injury. Springfield (IL): Thomas, 1969
Lal S, Merbitz CP, Grip JC. Modification of function in head-injured patients with Sinemet. Brain Inj 1988; 2: 225–33
Leonard B. Fundamentals of psychopharmacology. Chichester: John Wiley and Sons, 1992
Stanislav SW Cognitive effects of antipsychotic agents in persons with traumatic brain injury. Brain Inj 1997; 11(5): 335–41
Kane J, Honigfeld G, Singer J, et al. Clozapine for the treatment of resistant schizophrenia: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789–96
Wolf B, Grohmann R, Schmidt LG, et al. Psychiatric admissions due to adverse drug reactions. Compr Psychiatry 1989; 30: 534–45
Roebush P, Stewart T. A prospective analysis of 24 episodes of neuroleptic malignant syndrome. Am J Psychiatry 1989; 146: 717–25
Vincent FM, Zimmerman JF, van Hären J. Neuroleptic malignant syndrome complicating closed head injury. Neurosurg 1986; 18: 190–3
Yassa R, Nair V, Schwartz G. Tardive dyskinesia and the primary psychiatric diagnosis. Psychosomatics 1984; 25: 135–8
Yassa R, Nair V, Schwartz G. Tardive dyskinesia: a two-year follow up study. Psychosomatics 1984; 25: 852–5
Meltzer HY. Atypical antipsychotic drugs. In: Bloom FE, Kupfer DJ, editors. Psychopharmacology: the fourth generation of progress. New York: Raven Press, 1995: 1277–86
Marin MS, Fogel BS, Hawkins J, et al. Apathy: a treatable syndrome. J Neuropsychiatry Clin Neurosci 1995; 7(1): 23–30
Chandler MC, Barnhill JL, Gualtieri CT. Case studies: amantadine for the agitated head injury patient. Brain Inj 1988; 2: 309–11
Gualtieri CT, Chandler M, Coons TB, et al. Amantadine: a new clinical profile for traumatic brain injury. Clin Neuropharmacol 1989; 12: 258–70
Olanzapine product monograph. Eli Lilly and Company (NZ) Ltd., 1997
Warden DL, Labbate LA, Salazar AM, et al. Post-traumatic stress disorder in patients with traumatic brain injury and amnesia forthe event? J Neuropsychiatry Clin Neurosci 1997; 9: 18–22
Epstein RS, Ursano RJ. Anxiety disorders. In: Silver JM, Yudofsky SC, Hales RE, editors. Neuropsychiatry of traumatic brain injury. Washington, DC: American Psychiatric Press, 1994: 285–311
Adler A. Mental symptoms following head injury: a statistical analysis of two hundred cases. Arch Neurol Psychiatry 1945; 53: 34–43
Fallon S, Ryan C, Chamberlain K, et al. Tricyclics: possible treatment for post-traumatic stress disorder. J Clin Psychiatry 1985; 46: 385–9
Silver JM, Sandberg DP, Hales RE. New approaches in the pharmacotherapy of post-traumatic stress disorder. J Clin Psychiatry 1990; 51(10 Suppl.): 33–8
Hollander E, Cohen LJ.The assessment and treatment of refractory anxiety. J Clin Psychiatry 1994; 55(2 Suppl.): 27–31
Zald DH, Kim SW. Anatomy and function of the orbital frontal cortex. I. Anatomy, neurocircuitry and obsessive compulsive disorder. J Neuropsychiatry Clin Neurosci 1996; 8(2): 125–38
Zald DH, Kim SW. Anatomy and function of the orbital frontal cortex. II. Function and relevance to obsessive compulsive disorder. J Neuropsychiatry Clin Neurosci 1996; 8(3): 249–61
Kant R, Smith-Semiller L, Duffy JD. Obsessive-compulsive disorder after closed head injury: a review of literature and report of four cases. Brain Inj 1996; 10(1): 55–63
Stein DJ, Hollander E, Leibowitz MR. Neurobiology of impulsivity and the impulse control disorders. J Neuropsychiatry Clin Neurosci 1993; 5: 9–17
Jenike M. Pharmacologic treatment of obsessive-compulsive disorders. Psychiatr Clin North Am 1992; 15(4): 895–919
Cahill L, Prins B, Weber M, et al. Beta adrenergic activation and memory for emotional events. Nature 1994; 371: 702–4
Versiani M, Mundim FD, Nardi AE, et al. Phenelzine in social phobia. J Clin Psychopharmacol 1988; 8: 279–83
Leibowitz MR, Schneier F, Campeas R, et al. Phenelzine vs antenolol in social phobia: a placebo-controlled comparison. Arch Gen Psychiatry 1992; 480: 290–300
Versiani M, Nardi AE, Mundim FD, et al. Pharmacotherapy of social phobia: a controlled study with moclobemide and phenelzine. Br J Psychiatry 1992; 161: 353–60
Trott GE, Friese HJ, Menzel M, et al. Use of moclobemide in children with attention deficit hyperactivity disorder. Psychopharmacology 1992; 106: 5134–6
Goldstein K. After effects of brain injuries in war. New York: Grune and Stratton, 1942
Willer B, Corrigan JD. Whatever it takes: a model for community based services. Brain Inj 1994; 8(7): 647–59
Clark DM. Anxiety states: panic and generalised states. In: Hawton K, Salkouskis PM, Kirk J, et al. editors. Cognitive behavioural therapy for psychiatric problems: a practical guide. Oxford: Oxford University Press, 1989: 52–96
Solyom L, Solyom C, Ledwidge B. Fluoxetine in panic disorder. Can J Psychiatry 1991; 36: 378–80
Black DW, Wesner R, Bowers W, et al. A comparison of fluoxetine, cognitive therapy and placebo in the treatment of panic disorder. Arch Gen Psychiatry 1993; 50: 44–50
Newburn GM. Psychological problems after disability: recognition and management. Patient Manage NZ 1996; 25(9): 17–24
Gualtieri CT, Evans RW. Stimulant treatment for neuro-behavioural sequelae of traumatic brain injury. Brain Inj 1988; 2: 273–90
Lipper S, Tuchman MM. Treatment of chronic post-traumatic organic brain syndrome with dextroamphetamine: first reported case. J Nerv Ment Dis 1976; 162: 266–71
Evans RW, Gualtiera CT, Patterson D. Treatment of chronic closed head injury with psychostimulant drugs: a controlled case study and an appropriate evaluation procedure. J Nerv Ment Dis 1987; 187: 106–10
Pannelee DX, O’Shannick GJ. Neuropsychiatric interventions with head-injured children and adolescents. Brain Inj 1987; 1: 41–7
Gualtieri CT. Buspirone: neuropsychiatric effects. J Head Trauma Rehabil 1991; 6(1): 90–2
Shader RD, Greenblatt DJ. The pharmacotherapy of acute anxiety: a mini update. In: Bloom FE, Kupter DJ, editors. Psychopharmacology: the fourth generation of progress. New York: Raven Press, 1995: 1341–8
Nickels JA, Schneider WH, Dombouy ML, et al. Clinical use of amantadine in brain injury rehabilitation. Brain Inj 1994; 8(8): 709–18
van Reekum R, Bayley M, Garner S, et al. N of 1 study: amantadine for the amotivational syndrome in a patient with traumatic brain injury. Brain Inj 1995; 9(1): 49–53
Crimson ML, Childs A, Wilcox RE, et al. The effect of bromocriptine on speech dysfunction in patients with diffuse brain injury (akinetic mutism). Clin Neuropharmacol 1988; 11: 462–6
Eames P. The use of Sinemet and bromocriptine. Brain Inj 1989; 3: 319–20
Gupta SR, Mlcoch AG. Bromocriptine treatment of non-fluent aphasia. Arch Phys Med Rehabil 1992; 73: 373–6
Parks RW, Crocker DJ, Manje HK, et al. Assessment of bromocriptine interventions for the treatment of frontal lobe syndrome: a case study. J Neuropsychiatry Clin Neurosci 1992; 4: 109–10
Wolf AP, Gleckman AD. Sinemet and brain injury: function versus statistical change and suggestions for future research design. Brain Inj 1995; 9(5): 487–93
Bleiberg J, Garmoe W, Cedarquist J, et al. Effects of Dexedrine on performance consistency following brain injury. Neuropsychiatry Neuropsychol Behav Neurol 1993; 6: 245–8
Speech TJ, Rao SM, Osmon DC, et al. A double-blind controlled study of methylphenidate treatment in closed head injury. Brain Inj 1993; 7: 333–8
Kraus MF. Neuropsychiatric sequelae of stroke and traumatic brain injury: the role of psychostimulants. Int J Psychiatry Med 1995; 25: 39–51
Hornstein A, Lennihan L, Seliger G, et al. Amphetamine in recovery from brain injury. Brain Inj 1996; 10(2): 145–8
Feeney DM, Sutton RL. Pharmacotherapy for recovery of function after brain injury. CRC Crit Rev Clin Neurobiol 1997; 3: 135–97
Evans RW, Gualtieri CT, Amara I. Methylphenidate and memory: dissociated effects in hyperactive children. Psychopharmacology 1986; 90: 211–6
Hovda DA, Feeney DM. Amphetamine with experience promotes recovery of locomotor function after unilateral frontal cortex injury in the cat. Brain Res 1984; 298: 358–91
Gold PE, Delanoy RL, Merrin J. Modulation of long term potentiation by peripherally administered amphetamine and epinephrine. Brain Res 1984; 305: 103–7
Uranova NA, Klinzova AJ, Istomin VV, et al. The effects of amphetamine on synaptic plasticity in rat’s medial prefrontal cortex. J Hirnforschung 1989; 30: 45–50
Sutton RL, Hovda DA, Feeney DM. Amphetamine accelerates recovery of locomotor function following bilateral frontal cortex ablation in cats. Behav Neurosci 1989; 103: 837–41
Dietrich WD, Alonso O, Busto R, et al. Influence of amphetamine treatment on somatosensory function of the normal and infarcted rat brain. Stroke 1990; 21 Suppl. 111: 147–50
Wroblewski B, Leary J, Whelan A, et al. Methylphenidate and seizure frequency in brain-injured patients. J Clin Psychiatry 1992; 53: 86–9
Wood RL. Towards a model of cognitive rehabilitation. In: Wood RL, Fussey I, editors. Cognitive rehabilitation in perspective. London: Taylor and Francis, 1990: 3–25
McKinlay WW, Brooks DN, Bond MR, et al. The short term outcomes of severe blunt head injury as reported by the relatives of the injured person. J Neurol Neurosurg Psychiatry 1981; 44: 527–33
Dikmen S, Machamer J, Temkin N. Psychosocial outcome in patients with moderate to severe head injury: 2 year follow-up. Brain Inj 1993; 7(2): 113–24
Lewis DD, Pincus JF, Bard D, et al. Neuropsychiatric, psychoeducational and family characteristics of 14 juveniles condemned to death in the United States. Am J Psychiatry 1988; 145: 584–9
Rosenbaum A, Hose SR. Head injury and marital aggression. Am J Psychiatry 1989; 146(8): 1048–51
Elliott FA. Neurological findings in adult minimal brain dysfunction and the dyscontrol syndrome. J Nerv Ment Dis 1982; 170: 680–7
Wills RG, Young JPR, Thomas DJ. Kleine-Levin syndrome: report of two cases with onset of symptoms precipitated by head trauma. Br J Psychiatry 1988; 152: 410–2
Stewart JT. Akathisia following traumatic brain injury: treatment with bromocriptine. J Neurol Neurosurg Psychiatry 1989; 52: 1200–1
Fornazzari L, Farlnik K, Smith I, et al. Violent visual hallucinations and aggression in frontal lobe dysfunction: clinical manifestations of deep orbitofrontal foci. J Neuropsychiatry Clin Neurosci 1992; 4: 42–4
Eichelman B. Aggressive behaviour: from laboratory to clinic. Arch Gen Psychiatry 1992; 49: 488–99
Devinsky O, Kernan J, Bear DM. Aggressive behaviour following exposure to cholinesterase inhibitors. J Neuropsychiatry Clin Neurosci 1992; 4: 189–94
Siegel A. Neuroanatomical and neurochemical mechanisms that underlie defensive rage and aggression in the cat: role of the amygdala. Neuropsychopharmacology 1994; 10(35): 375
Pletnikov MV. The participation of the octapeptide cholecystokinin and beta-endorphin in the neurochemical support of the interspecific and intraspecific aggressivity of rats. Zh Vyssh Nerv Deiat Im I P Pavlova 1989; 39: 770–3
Depaulis A, Keay K, Badler R. Neuronal organisation of defensive strategies in the periaqueductal grey matter. Neuropsychopharmacology 1994; 10(3): 408
Newburn GM. Impulse control and aggression following head injury. Paper presented at Canadian Brain Injury Coalition Annual Meeting, Calgary, 1995 Jun 1–3
O’Neill M, Page N, Adkins WH, et al. Tryptophan-trazodone treatment of aggressive behaviour. Lancet 1986; II: 859–60
Simpson DM, Foster D. Improvement in organically disturbed behaviour with trazodone treatment. J Clin Psychiatry 1986; 47: 191–3
Pinner E, Rich CL. Effects of trazodone on aggressive behaviour in seven patients with organic mental disorders. Am J Psychiatry 1988; 145: 1295–6
Sobin P, Schneider L, McDermott H. Fluoxetine treatment of impulsive aggression in DSM-3-R personality disorder patients. J Clin Psychopharmacol 1990; 10: 373–5
Coccaro EF, Astill JL, Herbert JL, et al. Fluoxetine treatment of impulsive aggression in DSM-3-R personality disorder patients. J Clin Psychopharmacol 1990; 10: 373–5
Seliger GM, Hornstein A, Flax J, et al. Fluoxetine improves emotional continence. Brain Inj 1992; 6: 267–70
Sloan RL, Brown KW, Pentland B. Fluoxetine as a treatment for emotional lability after brain injury. Brain Inj 1992; 6: 315–9
Hornstein A, Seliger G, Flax J, et al. Fluoxetine in treating emotional lability [letter]. Brain Inj 1993; 7(2): 189
Haas JP, Cope N. Neuropharmacologic management of behaviour sequelae in head injury: a case report. Arch Phys Med Rehabil 1985; 66: 472–4
Yudofsky SC, Silver JM, Schneider SE. Pharmacologic treatment of aggression. Psychiatr Ann 1987; 17: 397–407
Elliott FA. Propranolol for the control of belligerent behaviour following acute brain damage. Ann Neurol 1977; 1: 489–91
Yudofsky SC, Williams D, Gorman J. Propranolol in the treatment of rage and violent behaviour in patients with chronic brain syndromes. Am J Psychiatry 1981; 138: 218–20
Hjorth S, Carlsson A. Is pindolol a mixed agonist/antagonist at central serotonin receptors. Eur J Pharmacol 1986; 129: 131–8
Mooney GF, Haas LJ. Effect of methylphenidate on brain injury-related anger. Arch Phys Med Rehabil 1993; 74: 153–60
Gleason RP, Schneider LS. Carbamazepine treatment of agitation in Alzheimer’s patients refractory to neuroleptics. J Clin Psychiatry 1990; 51: 115–88
Silver JM, Yudofsky SC. Aggressive disorders. In: Silver JM, Yudofsky SC, Hales RE, editors. Neuropsychiatry of traumatic brain injury. Washington, DC: American Psychiatric Press, 1994: 313–53
Giakas WJ, Seibyl JP, Mazure CM. Valproate in the treatment of temper outbursts. J Clin Psychiatry 1990; 51: 525
Wrobleswki BA, Joseph AB, Kupfer J, et al. Effectiveness of valproic acid on destructive and aggressive behaviours in patients with acquired brain injury. Brain Inj 1997; 11(1): 37–47
Herrera JN, Sramek JJ, Costs JF, et al. High potency neuroleptics and violence in schizophrenia. J Nerv Ment Dis 1988; 176: 558–61
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Newburn, G. Psychiatric Disorders Associated with Traumatic Brain Injury. Mol Diag Ther 9, 441–456 (1998). https://doi.org/10.2165/00023210-199809060-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00023210-199809060-00003