Article

In cases of agitation and aggressive behavior after severe
traumatic brain injury (TBI), the benefits/risks ratio of pharmacological
treatments remains unclear. A qualitative analysis of clinical situations could
highlight the relevance of psychotherapy care. CASE REPORT: In January 2005, this
24-year-old patient sustained severe traumatic brain injury (Glasgow at 4/15),
with bilateral frontotemporal injury and temporal extradural hematoma. On the
third day, a temporal lobectomy was performed. The patient's evolution showed
severe neurobehavioral disorders, with agitation and aggressive behavior towards
family members and medical caregivers. Maximum doses of antipsychotic drugs
brought no improvement. Antidepressant medication improved social contact.
Several stays in the psychiatric unit, where institutionalized and psychotherapy
care were implemented, showed systematically a real improvement of the behavioral
disorders, increased participation in group activities and the ability to walk
around alone in a closed environment. CONCLUSION: Aggressive behavior
can unveil organic brain injuries, depressive syndrome as well as iatrogenic
nature of the environment. This clinical case is based on the fact that
antipsychotic drugs, aside from their sedative effect, are not the proper
treatment for agitation following traumatic brain injury. This case also
highlights how management of behavioral disorders following TBI should not be
based on pharmacological treatments only but instead should focus on
multidisciplinary strategies of care.
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Langue : ANGLAIS ; FRANCAIS