Agitation after traumatic brain injury: a review of current and future concepts in diagnosis and management

Hoover, Gary L; Whitehair, Victoria C.

doi:10.1080/01616412.2020.1797374

Cited by 4 publications

(11 citation statements)

References 96 publications

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“…A TBI is a disruption of normal brain function due to an external force applied to the head, which can result in altered consciousness, posttraumatic amnesia, changes in cognition, and behavioral disturbances 31 . Agitation is a frequently encountered behavioral change, defined as a state of confusion after a TBI where disruptive behaviors, such as disorientation, restlessness, impulsivity, disorganized thinking, perceptual disturbances, inattention, and aggression can occur 31,32 . Posttraumatic agitation occurs in 20% to 41% of acutely hospitalized patients and is associated with increased hospital length of stay, delay in rehabilitation, and decreased functional independence at hospital discharge 31 …”

Section: Discussionmentioning

confidence: 99%

“…The first step in agitation management is environmental modifications, such as a low stimulus setting, decreased lighting, limiting visitors, and avoiding restraints 32 . In addition, management of other contributing factors is essential, including pain control, urinary retention, constipation, and infection 32 .…”

Section: Discussionmentioning

confidence: 99%

“…Aripiprazole is a less frequently used medication for posttraumatic agitation 33 . Other atypical antipsychotics more commonly used for agitation include quetiapine, olanzapine, ziprasidone, and risperidone, all of which have been associated with antipsychotic-induced hypothermia 7,32 . Interestingly, these 4 atypical antipsychotics were responsible for 40% to 48% of reported cases, with risperidone and olanzapine most commonly identified 7,10 .…”

Section: Discussionmentioning

confidence: 99%

“…31 Agitation is a frequently encountered behavioral change, defined as a state of confusion after a TBI where disruptive behaviors, such as disorientation, restlessness, impulsivity, disorganized thinking, perceptual disturbances, inattention, and aggression can occur. 31,32 Posttraumatic agitation occurs in 20% to 41% of acutely hospitalized patients and is associated with increased hospital length of stay, delay in rehabilitation, and decreased functional independence at hospital discharge. 31 The first step in agitation management is environmental modifications, such as a low stimulus setting, decreased lighting, limiting visitors, and avoiding restraints.…”

Section: Discussionmentioning

confidence: 99%

“…33 Other atypical antipsychotics more commonly used for agitation include quetiapine, olanzapine, ziprasidone, and risperidone, all of which have been associated with antipsychotic-induced hypothermia. 7,32 Interestingly, these 4 atypical antipsychotics were responsible for 40% to 48% of reported cases, with risperidone and olanzapine most commonly identified. 7,10 To our knowledge, this is the first case in the literature detailing antipsychotic-induced hypothermia after a TBI.…”

Section: Discussionmentioning

confidence: 99%

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Antipsychotic-Induced Hypothermia After Starting Aripiprazole for Posttraumatic Agitation Management: A Case Report

2022

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ObjectivesAntipsychotic-induced hypothermia is an uncommon type of secondary hypothermia resulting from neurotransmitter derangements within the nervous system thermoregulation pathway. The most common causative medications include olanzapine, haloperidol, and risperidone, with one published report of aripiprazole. Most individuals who develop antipsychotic-induced hypothermia receive neuroleptic treatment for psychiatric disorder management, with significantly fewer occurrences in those with neurologic disorders. There are currently no reports of antipsychotic-induced hypothermia after a traumatic brain injury (TBI), where antipsychotics are used for the off-label management of posttraumatic agitation.MethodsA retrospective chart review of the patient's medical record was performed.ResultsWe present a case of a 56-year-old man with a moderate TBI who developed recurrent episodes of antipsychotic-induced hypothermia after starting aripiprazole for posttraumatic agitation management.ConclusionsTo our knowledge, this is the first publication detailing antipsychotic-induced hypothermia occurring in a TBI patient. Clinicians who initiate antipsychotics for posttraumatic agitation in a TBI patient should be aware of this potential adverse effect, as well as clinical presentation, evaluation, and management strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Antipsychotic-Induced Hypothermia After Starting Aripiprazole for Posttraumatic Agitation Management: A Case Report

2022

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A Clinical Review of Mood Stabilizers in Traumatic Brain Injury

Shwae,

Acosta,

Kalra

2024

Curr Phys Med Rehabil Rep

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Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

et al. 2023

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Each year, approximately 70 million people suffer traumatic brain injury, which has a significant physical, psychosocial and economic impact for patients and their families. It is recommended in the UK that all patients with traumatic brain injury and a Glasgow coma scale ≤ 8 should be transferred to a neurosurgical centre. However, many patients, especially those in whom neurosurgery is not required, are not treated in, nor transferred to, a neurosurgical centre. This review aims to provide clinicians who work in non-neurosurgical centres with a summary of contemporary studies relevant to the critical care management of patients with traumatic brain injury. A targeted literature review was undertaken that included guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials (published in English between 1 January 2017 and 1 July 2022). Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also eligible for inclusion. Analysis of the topics identified during the review was then summarised. These included: fundamental critical care management approaches (including ventilation strategies, fluid management, seizure control and osmotherapy); use of processed electroencephalogram monitoring; non-invasive assessment of intracranial pressure; prognostication; and rehabilitation techniques. Through this process, we have formulated practical recommendations to guide clinical practice in non-specialist centres.

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Agitation after traumatic brain injury: a review of current and future concepts in diagnosis and management

Cited by 4 publications

References 96 publications

Antipsychotic-Induced Hypothermia After Starting Aripiprazole for Posttraumatic Agitation Management: A Case Report

Antipsychotic-Induced Hypothermia After Starting Aripiprazole for Posttraumatic Agitation Management: A Case Report

A Clinical Review of Mood Stabilizers in Traumatic Brain Injury

Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

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