There is currently a lack of evidence-based guidelines to guide the pharmacological treatment of neurobehavioral problems that commonly occur after traumatic brain injury (TBI). It was our objective to review the current literature on the pharmacological treatment of neurobehavioral problems after traumatic brain injury in three key areas: aggression, cognitive disorders, and affective disorders/anxiety/ psychosis. Three panels of leading researchers in the field of brain injury were formed to review the current literature on pharmacological treatment for TBI sequelae in the topic areas of affective/anxiety/ psychotic disorders, cognitive disorders, and aggression. A comprehensive Medline literature search was performed by each group to establish the groups of pertinent articles. Additional articles were obtained from bibliography searches of the primary articles. Group members then independently reviewed the articles and established a consensus rating. Despite reviewing a significant number of studies on drug treatment of neurobehavioral sequelae after TBI, the quality of evidence did not support any treatment standards and few guidelines due to a number of recurrent methodological problems. Guidelines were established for the use of methylphenidate in the treatment of deficits in attention and speed of information processing, as well as for the use of beta-blockers for the treatment of aggression following TBI. Options were recommended in the treatment of depression, bipolar disorder/mania, psychosis, aggression, general cognitive functions, and deficits in attention, speed of processing, and memory after TBI. The evidence-based guidelines and options established by this working group may help to guide the pharmacological treatment of the person experiencing neurobehavioral sequelae following TBI. There is a clear need for well-designed randomized controlled trials in the treatment of these common problems after TBI in order to establish definitive treatment standards for this patient population.

This study investigated distress and self-esteem levels of 147 federal correctional officers working in that system's six different security level institutions. The General Severity Index (GSI), a scale of the Brief Symptom Inventory (BSI), was used to measure distress; the Rosenberg Self-Esteem Scale (SES) operationalized the other dependent variable. In addition, 13 variables were used as part of a multiple regression analysis to determine a prediction equation for the two outcomes studied. Lack of participation in decision making and years of continual employment were significantly related to distress, whereas responsibility for people and role conflict were related to self-esteem. Federal correctional officers across all security levels scored in the “clinical” range on the GSI and yielded high SES scores. Differences among security levels were not significant.

Active amateur boxers from six US cities were studied in 1986-1990 to determine whether changes in central nervous system function over a 2-year interval (as evaluated by tests of perceptual/motor function, attention/concentration, psychomotor speed, memory, visuoconstructional ability, and mental control, measures of ataxia and brain-stem auditory evoked potentials, and electroencephalography) were associated with degree of participation in amateur boxing. A total of 484 participants were examined at baseline; 393 (81.2%) were examined 2 years later. At baseline, 22% of the participants had not yet competed in a bout; 9% had never competed in a bout by the second examination. Exposure was defined by number bouts, sparring-years, and sparring with a professional boxer. Very few statistically significant odds ratios were found between exposure and change in function. Significant tests of trend were found between the total number of bouts incurred before the baseline examination and changes in memory, visuoconstructional ability, and perceptual/motor ability. The significant trends for change in function in the latter two domains were primarily due to performance on the Block Design test, which was common to both test domains. No statistically significant associations were found between more recent bouts (after the baseline visit) and any functional domains, nor between bouts or sparring and any other outcome measures. The significant trends with past bouts, but not more recent bouts, may reflect the need for a long latency period before effects are manifest. Alternatively, given changes in safety practices, the observed association may be related to more severe exposure from bouts that occurred before 1986, when new safety measures were imposed.

An initial sample of n = 316 MMPI profiles, produced by inmates at a Security Level III Federal Correctional Institution in Ashland, Kentucky, were subjected to the classification rules delineated by Megargee and Bohn (1979). Only 22 of these 316 profiles failed to meet the criteria for inclusion in at least one of the 10 Myer-Megargee types. The resultant 294 classifiable profiles (93%) were uniquely classified using only minimal (Set I) rules in combination with the accessory (Set II) rules provided by Megargee and Bohn (1979). Such a uniquely classifiable sample was intentionally selected for a potential bias towards stability. A final sample of n = 85 inmates were voluntarily retested (median test-retest interval = 9.78 months) and were classified. Only 16 of 85 inmates retained their original type designation upon retesting. On a subset of the overall sample (median test-retest = 3.15 months) only one of 14 profiles remained unchanged. These results both parallel and extend the data presented by Simmons, Johnson, Gouvier, and Muzyczka (1981) indicating marked instability sf the Myer-Megargee inmate typology. Thus, further data are amassed that question the efficacy of the Myer-Megargee typology for correctional decision-making.