The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review
Background: Aggression is a commonly reported problem following traumatic brain injury (TBI). It may present as verbal insults or outbursts, physical assaults, and/or property destruction. Aggressive behavior can fracture relationships and impede participation in treatment as well as a broad range o...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.01169/full |
| _version_ | 1819227935306940416 |
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| author | Amelia J. Hicks Fiona J. Clay Fiona J. Clay Fiona J. Clay Malcolm Hopwood Malcolm Hopwood Amelia C. James Mahesh Jayaram Luke A. Perry Rachel Batty Jennie L. Ponsford |
| author_facet | Amelia J. Hicks Fiona J. Clay Fiona J. Clay Fiona J. Clay Malcolm Hopwood Malcolm Hopwood Amelia C. James Mahesh Jayaram Luke A. Perry Rachel Batty Jennie L. Ponsford |
| author_sort | Amelia J. Hicks |
| collection | DOAJ |
| description | Background: Aggression is a commonly reported problem following traumatic brain injury (TBI). It may present as verbal insults or outbursts, physical assaults, and/or property destruction. Aggressive behavior can fracture relationships and impede participation in treatment as well as a broad range of vocational and social activities, thereby reducing the individual's quality of life. Pharmacological intervention is frequently used to control aggression following TBI. The aim of this systematic review was to critically evaluate the evidence regarding efficacy of pharmacological interventions for aggression following TBI in adults.Methods: We reviewed studies in English, available before December 2018. MEDLINE, PubMed, CINAHL, EMBASE, PsycINFO, and CENTRAL databases were searched, with additional searching of key journals, clinical trials registries, and international drug regulators. The primary outcomes of interest were reduction in the severity of aggression and occurrence of harms. The secondary outcomes of interest were changes in quality of life, participation, psychological health (e.g., depression, anxiety), and cognitive function. Evidence quality was assessed using the Cochrane Risk of Bias tool and the Joanna Briggs Institute Critical Appraisal Instruments.Results: Ten studies were identified, including five randomized controlled trials (RCTs) and five case series. There were positive, albeit mixed, findings for the RCTs examining the use of amantadine in reducing irritability (n = 2) and aggression (n = 2). There were some positive findings favoring methylphenidate in reducing anger (n = 1). The evidence for propranolol was weak (n = 1). Individual analysis revealed differential drug response across individuals for both methylphenidate and propranolol. The less rigorous studies administered carbamazepine (n = 2), valproic acid (n = 1), quetiapine (n = 1), and sertraline (n = 1), and all reported reductions in aggression. However, given the lack of a control group, it is difficult to discern treatment effects from natural change over time.Conclusions: This review concludes that a recommendation for use of amantadine to treat aggression and irritability in adults following TBI is appropriate. However, there is a need for further well-designed, adequately powered and controlled studies of pharmacological interventions for aggression following TBI. |
| first_indexed | 2024-12-23T10:49:17Z |
| format | Article |
| id | doaj.art-71171acdd40a4b4f98ba7de0fd613ac4 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-23T10:49:17Z |
| publishDate | 2019-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-71171acdd40a4b4f98ba7de0fd613ac42022-12-21T17:49:56ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-11-011010.3389/fneur.2019.01169477526The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic ReviewAmelia J. Hicks0Fiona J. Clay1Fiona J. Clay2Fiona J. Clay3Malcolm Hopwood4Malcolm Hopwood5Amelia C. James6Mahesh Jayaram7Luke A. Perry8Rachel Batty9Jennie L. Ponsford10Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, AustraliaDepartment of Psychiatry, University of Melbourne, Melbourne, VIC, AustraliaDepartment of Forensic Medicine, Monash University, Southbank, VIC, AustraliaProfessorial Psychiatry Unit Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, AustraliaDepartment of Psychiatry, University of Melbourne, Melbourne, VIC, AustraliaProfessorial Psychiatry Unit Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, AustraliaMonash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, AustraliaDepartment of Psychiatry, University of Melbourne, Melbourne, VIC, AustraliaDepartment of Psychiatry, University of Melbourne, Melbourne, VIC, AustraliaDepartment of Psychiatry, University of Melbourne, Melbourne, VIC, AustraliaMonash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, AustraliaBackground: Aggression is a commonly reported problem following traumatic brain injury (TBI). It may present as verbal insults or outbursts, physical assaults, and/or property destruction. Aggressive behavior can fracture relationships and impede participation in treatment as well as a broad range of vocational and social activities, thereby reducing the individual's quality of life. Pharmacological intervention is frequently used to control aggression following TBI. The aim of this systematic review was to critically evaluate the evidence regarding efficacy of pharmacological interventions for aggression following TBI in adults.Methods: We reviewed studies in English, available before December 2018. MEDLINE, PubMed, CINAHL, EMBASE, PsycINFO, and CENTRAL databases were searched, with additional searching of key journals, clinical trials registries, and international drug regulators. The primary outcomes of interest were reduction in the severity of aggression and occurrence of harms. The secondary outcomes of interest were changes in quality of life, participation, psychological health (e.g., depression, anxiety), and cognitive function. Evidence quality was assessed using the Cochrane Risk of Bias tool and the Joanna Briggs Institute Critical Appraisal Instruments.Results: Ten studies were identified, including five randomized controlled trials (RCTs) and five case series. There were positive, albeit mixed, findings for the RCTs examining the use of amantadine in reducing irritability (n = 2) and aggression (n = 2). There were some positive findings favoring methylphenidate in reducing anger (n = 1). The evidence for propranolol was weak (n = 1). Individual analysis revealed differential drug response across individuals for both methylphenidate and propranolol. The less rigorous studies administered carbamazepine (n = 2), valproic acid (n = 1), quetiapine (n = 1), and sertraline (n = 1), and all reported reductions in aggression. However, given the lack of a control group, it is difficult to discern treatment effects from natural change over time.Conclusions: This review concludes that a recommendation for use of amantadine to treat aggression and irritability in adults following TBI is appropriate. However, there is a need for further well-designed, adequately powered and controlled studies of pharmacological interventions for aggression following TBI.https://www.frontiersin.org/article/10.3389/fneur.2019.01169/fulltraumatic brain injuryTBIaggressionirritabilitypharmacotherapyintervention |
| spellingShingle | Amelia J. Hicks Fiona J. Clay Fiona J. Clay Fiona J. Clay Malcolm Hopwood Malcolm Hopwood Amelia C. James Mahesh Jayaram Luke A. Perry Rachel Batty Jennie L. Ponsford The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review Frontiers in Neurology traumatic brain injury TBI aggression irritability pharmacotherapy intervention |
| title | The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review |
| title_full | The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review |
| title_fullStr | The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review |
| title_full_unstemmed | The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review |
| title_short | The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review |
| title_sort | efficacy and harms of pharmacological interventions for aggression after traumatic brain injury systematic review |
| topic | traumatic brain injury TBI aggression irritability pharmacotherapy intervention |
| url | https://www.frontiersin.org/article/10.3389/fneur.2019.01169/full |
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