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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.