Key Points

  • The effectiveness of sertraline in treating depression post-traumatic brain injury is unclear.
  • Citalopram and carbamazepine may be effective in the treatment of mood disorders.
  • Desipramine may be effective in reducing depression.
  • Results of various surveys indicate that those who have sustained an acquired brain injury have a higher incidence of depression post injury.
  • Music therapy may be more efficacious in improving anxiety and depression than standard rehabilitation alone.
  • Systematic Motivational Counselling may reduce negative affect.
  • Teaching coping skills to those who have sustained a traumatic brain injury helps to reduce anxiety and depression.
  • Compassion Focused Therapy may reduce depression and anxiety while improving self-compassion.
  • Exercise is associated with feeling less depressed and an improved quality of life post-traumatic brain injury
  • A mindfulness-based stress reduction programme may be efficacious in reducing depressed mood.
  • Cognitive Behavioural Therapy and supportive psychotherapy may decrease patient symptoms associated with depression.
  • There is no difference in reduction of depressive symptoms between Cognitive Behavioural Therapy delivered over the phone or in person.
  • Cognitive Behavioural Therapy and supportiv psychotherapy may decrease patient symptoms associated with depression.
  • There is no difference in reduction of depressive symptoms between Cognitive Behavioural Therapy delivered over the phone or in person.
  • Positive psychology, involving patients writing down things they enjoy in life, may increase patient happiness.
  • Cognitive Behavioural Therapy does reduce anxiety and depression post-acquired brain injury.
  • Although Obsessive Compulsive Disorder has been identified post-acquired brain injury, there does not appear to be one method of intervention that works for all, but rather interventions remain individualized.
  • Little research has been conducted looking at the effects of various interventions on Obsessive Compulsive Disorder post-acquired brain injury.
  • Little research has been conducted regarding Post-Traumatic Stress Disorder in patients with moderate-severe traumatic brain injury, additional research is needed.
  • Little research has been conducted regarding treatment for suicide in individuals with moderate or severe traumatic brain injury; further research is warranted.
  • Amantadine requires further research before conclusions can be drawn on its effects on aggression
  • Carbamazepine may decrease agitated behaviour post-traumatic brain injury.
  • Lamotrigine may be successful in reducing pathologic laughing post-traumatic brain injury. More research is needed, with a greater number of subjects, to validate these findings.
  • Valproic acid may assist in the reduction of aggressive behaviours; however more research is needed.
  • Anticonvulsants may be used to decrease the incidence of agitated behaviour; however, more research is needed.
  • Sertraline HCL may be useful in reducing aggressive and irritable behaviours
  • Amitriptyline may be used to decrease agitation.
  • Pindolol can decrease aggressive behaviour following brain injury. 
  • Propranolol may reduce the intensity of aggressive and agitated symptoms following brain injury.
  • Although there is evidence to suggest that quetiapine does help reduce aggressive behaviour, more research is needed.
  • Ziprasidone in one small study has been shown to assist in the controlling of agitation; however more research is needed.
  • Lithium may reduce behavioural problems but is associated with a high risk of neurotoxicity.
  • Medroxyprogesterone intramuscularly may reduce sexual aggression.
  • Methylphenidate may be safe for controlling agitation following an acquired brain injury.
  • Methylphenidate is effective in reducing anger following a brain injury.
  • Droperidol may be an effective agent for calming agitated patients.
  • Haloperidol appears to have little negative effect on recovery following traumatic brain injuries.
  • There is limited evidence that pharmacological interventions can reduce verbal, physical and/or sexual aggressive behaviours. Rigorous, randomized controlled trials are needed.
  • Anger self-management training is effective in teaching those with a traumatic brain injury identify anger signals and develop more appropriate ways of dealing with anger and frustration.
  • Cognitive Behavioural Therapy with focus on anger and aggression management may be effective at reducing aggressive behaviours.
  • Antecedent management and/or feedback of consequences may reduce undesirable behaviour.
  • Anger management and social skills training reduce aggressive behaviour.
  • Music therapy may reduce psychomotor agitation post coma and improve mood following severe traumatic brain injury.
  • Substance abuse and intoxication at time of injury is a frequent phenomenon in the traumatic brain injury population.
  • Substance addiction pre injury is predictive of substance addiction post injury.
  • The impact that blood alcohol levels have on Glasgow Coma Scale, Injury Severity Score, mortality, and long term outcomes has yet to be determined.
  • Although alcohol and elevated blood alcohol levels have been linked to an increase risk of sustaining a TBI, there is evidence to suggest that elevated blood alcohol levels are not linked to an increase risk of mortality post injury.
  • The possible neuroprotective role acute alcohol intoxication plays in TBI warrants further investigation.
  • Earlier studies indicated that elevated blood alcohol levels are associated with poorer performance on a variety of cognitive communication tasks; however, these finding have generally not been supported in most recent studies.
  • Recent research has found age at injury to be negatively associated with cognitive outcome. More research needs to be conducted investigating the impact of alcohol on cognitive outcomes post injury.
  • Education and motivational interviewing do not appear to have a strong impact on excessive alcohol consumption post-traumatic brain injury.
  • Providing financial incentives does encourage those with a traumatic brain injury and a substance addiction to attend treatment more so than offering solutions to other barriers.
  • Despite their use, there is no evidence to support the use of restraints in those who have sustained an acquired brain injury/traumatic brain injury.
  • Staff education programs to reduce the use of physical restraints, without increasing the risk of falls, have been shown to be somewhat successful with staff in nursing homes. Further research needs to be completed looking at the impact these education programs would have on those staff working in rehabilitation hospitals.