3.3 Pharmacological Management of Agitation and Disruptive Behaviour

Case Study (continued)

The patient continued to exhibit aggressive and agitated behaviour.  His Agitated Behaviour Scale score was 32.  The staff is pushing for pharmacological treatment of his aggressive and agitated behaviour.

3.3.1   Principles of Pharmacological Management

What are some principles for using pharmacological measures in the treatment of aggressive and agitated behaviour?
  1. Pharmacological agents should only be used as a last resort (ABS > 28).
  2. Careful considerations of the sensitivity of people with TBI to psychotropic medications which should be used with caution.
  3. With medications “start low and go slow” and titrate to an optimal dose; but get to a therapeutic dosing before abandoning use.
  4. Develop clear cut goals and metrics to assist in determining when to stop treatment (i.e. consider weaning off medication when ABS < 21).
  5. Be alert to side effects and undesired effects.
  6. Minimize use of Benzodiazepines and neuroleptic antipsychotic medications such as Haldol as animal studies suggest these medications may slow brain recovery.