Irritability and Aggression after Brain Injury

Brain Injury Blog by Flora Hammond, M.D.

May 30, 2012

Irritability and Aggression after Brain Injury

Changes in a survivor’s emotions and anger are stressful for families

Janice is about at the end of her rope. Her husband John suffered a traumatic brain injury (TBI) over a year ago. After a long rehabilitation, it seemed like things might return to a somewhat normal state. John returned to work and, for the most part, appeared to cope with the day to day.

But recently, the smallest irritations are causing John to become a font of emotion and anger. Janice wonders if this is a result of his brain injury. Researchers at the Rehabilitation Hospital of Indiana are aware that a TBI may cause long-lasting changes in behavior, ranging in severity from irritability all the way to physical outbursts. These changes often impact relationships, work performance, social interactions and community life. They add to the other stressors imposed by a TBI. 

Although irritability is a common post-TBI occurrence, there is little known about what it is, what causes it, the impact on individuals and family members’ lives, and more importantly, what treatments are effective.

Research on irritability and aggression after brain injury

Researchers at RHI are answering these questions by working alongside individuals with TBI and their families using a “participatory research” approach. Participatory research uses the expertise of the individuals living with a problem day-in and day-out by allowing these “experts” to help shape the direction of the research and interpret the findings.

With her team of researchers, Dr. Flora Hammond, M.D. has conducted fifty focus groups to learn about the lives of individuals experiencing post TBI irritability. Areas that appear to be important to the occurrence of irritability include our perceptions, mood and behaviors, environment, and relationships. This information will help find out how to better treat irritability.

Drug amantadine being studied for treatment

Irritability and aggression are problems that greatly affect the lives of many people living with traumatic brain injury and their families. There has been little research to help guide physicians on how to best treat these challenging behaviors. Recent studies suggest that the drug amantadine might have a new use in helping people with TBI.

Amantadine is a medication that has been used for decades to treat Parkinson’s disease, prevent viral infections, and promote recovery from coma after brain injury. Dr. Hammond, project director of one of the nation’s 16 TBI Model systems sites, recently completed a 76 person pilot study that found amantadine reduced irritability and aggression in people with brain injuries.

She is currently heading a multicenter trial of amantadine for irritability and aggression in which RHI is participating. Dr. Hammond was also part of the research team that recently reported in the New England Journal of Medicine a positive effect of amantadine on early recovery after brain injury. 

This article was reproduced with permission from Dr. Hammond and was originally published in RHI Research Today in May 2012.

Recommended Reading

Emotions after Brain Injury in Adults and Veterans: Tips and information for families and survivors

By Samantha Backhaus, Ph.D., Janelle Breese Biagioni, Ann Deaton Ph.D., Pamela Law, Ph.D., Taryn Stejskal, Ph.D., Judy Sullivan, B.A.

3 Responses to “Irritability and Aggression after Brain Injury”

  1. William Ansberry says:

    I have a 21 year-old son who has severe TBI from an auto accident on 01-12-2014. As of today, 05-01-2014, he is still in the hospital. Currently he is in a rehabilitation hospital, behavioral floor. He has been at this facility for 5 days. Prior to that he was on the rehab wing of a local hospital. At the local hospital, he exihibited the anger/agitation of Rancho Level 4. He would at times roar at the nurses and utter curse words. He also attempted to head-butt another nurse. Another he bit and left a bruise the size of a softball. (They were all great and took it all as part of the job.) Now at the rehab hospital, he has gotten much angrier and physical. He is on four psychotic drugs and spends a good bit of time in a padded room. Mom is staying with him and offers some comfort. (I am back at home with the rest of the children which is 5 hours away.) My question deals with the anger. Is the increase a sign that he is moving through the Rancho 4 level and improving or is it a sign of backpetalling? I need to know where we could be in the journey. I know this is really not enough information to go on but we really don’t know what to expect. His doctors are good, but the nursing staff leaves something to be desired. They complain to my wife when he assult them.

  2. Pat Walley says:

    I have a 18 yr.old adopted son that has TBI/ABI. TBI from a horrible beating at 18mos. when he came into our home. after my husband passed away his behavior became so bad that we had to place him in a residential school. They did wonders for him and was told to place him in a school where he would be with children like himself and could learn a trade, whichI did, , then in March of 2009 he had to have a tumor removed in the same spot as the injury, the results of that has been horrible, his memory is like 50% but his irritability and agitation is far worse. he breaks things, like windows,and doors, etc. this last time he punched a lady in the face, thank god she didn’t press charges and the school came and picked him up. ( he was on a home visit). the doctor at the school has tried all kinds of meds which after awhile don’t work , he nows has him on”Clozaril” He seems to help but last night he was upset because it was fathers day and he missed him. (went into deep grieving after surgery.) and went crazy, broke several windows, cut his arm and had to be held, after it was over he was in complete remorse. I live in upstate NY and he goes to school in Mass. I am so scared for him as I am 73 years old and If he gets in trouble with the law after he finishes school what will happen to him if something happens to me. sorry this is so long but no other way to say it all.

  3. Janet Cromer says:

    Thank you for this information, Dr. Hammond. Participator research has tremendous potential to find answers to the problems survivors and families care about most. Irritability and agitation can disturb families for years after the brain injury. My husband often found his episodes of severe agitation disorienting and troubling in retrospect. We tried combinations of prevention, behavioral approaches, and medication with mixed results. One consequence was that, after an episode, it took days for me to trust Alan’s predictability again and want to be close to him. That’s a high price to pay.

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