ABSTRACT
BACKGROUND: Aggression after acquired brain injury has a major impact on daily functioning for the patient, their family, and caregivers.
AIM: To present the prevalence and manifestations of aggression in patients with different types of brain injury.
METHOD: Systematic search of the literature in PubMed, Psycinfo and Embase.
RESULTS: Fourty-one studies were included in which 15 different outcome measures for aggression were used. The prevalence of agitation ranged between 4.0%-93.9% (median 35.8%), of aggression between 3.7%-88.0% (median 35.3%) and of hostility between 4.0%-45.7% (median 9.1%). Prevalence rates were highest in patients with traumatic brain injury. Verbal aggression occurred more frequently (median 33.0%, 14.0%-70.0%) than physical aggression (median 11.5%, 1.5%-33.8%), but manifestations of aggression were only examined in ten studies.
CONCLUSION: Aggression is a common behavioral problem after brain injury. The prevalence varies and depends on the type of brain injury, the specific target behavior and the outcome measure. It is recommended to reach consensus on definitions and outcome measures.
Subject(s)
Aggression , Brain Injuries/complications , Brain Injuries/psychology , Aggression/psychology , Humans , Prevalence , Problem Behavior , Treatment OutcomeABSTRACT
BACKGROUND: In some Dutch mental health care organisations specific neuropsychiatric departments have been developed for patients with brain injury. AIM: To identify the characteristics of patients with brain injury who form a specific population in mental health care and to determine whether such patients require either specialised care or a special type of care. METHOD: A cross-sectional analysis of typical brain injury inpatients was performed. We noted the age and gender of these patients and recorded any previous periods of inpatient care. We listed patients' impairments, the diagnoses they had been given and the treatment they had received. This inventory formed the basis of our conclusions. RESULTS: The typical clinical patient with brain injury in this setting was a male of 51 years or older, most probably affected by a stroke or traumatic brain injury, admitted for a period of 6 months, many years after the incident. He was mostly referred from home or hospital by a physician and was expected to return home again. A combination of cognitive and psychiatric impairments was often found. Physically the patient had no or only mild disabilities, but societal participation was low and many cognitive-affective disorders were seen. Treatment was relatively infrequent and mostly directed at daily activities. The most frequent diagnosis was & lquo;cognitive deficits not otherwise specified'. Irritability, agitation, apathy and depression were frequent symptoms. CONCLUSION: This inventory suggests that brain injury patients in a mental health care setting need special care which is not available in other health care settings.
Subject(s)
Brain Injuries/therapy , Health Services Needs and Demand , Mental Health Services/statistics & numerical data , Adult , Aged , Cross-Sectional Studies , Female , Hospitals, Psychiatric/statistics & numerical data , Humans , Inpatients , Male , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Disorders/rehabilitation , Middle Aged , Netherlands , Young AdultABSTRACT
The objective of this prospective cohort study was to examine the effectiveness of an outpatient neuropsychological rehabilitation programme for patients with acquired brain injury (ABI) and their relatives. The participants were 26 ABI patients with a mean age of 44.7 (SD 11.7) years and 24 caregivers. Mean time since injury was 3.0 (SD 3.6) years. The intervention consisted of a patient-tailored process-oriented neuropsychological rehabilitation programme focusing on facilitation of the adaptation process. Repeated measurements were taken prior to treatment (T0), directly after treatment (T1) and 6 months later (T2). Primary outcome measures were cognitive failures (CFQ), quality of life (SA-SIP30), and individualised goals (GAS). Patients improved significantly on individualised goals between T0 and T1 (p < .01). This effect retained at T2. There were no significant differences on CFQ and SA-SIP30. The programme had a positive effect on attainment of the patient's individual goals. This was not associated with a higher level of participation or a better quality of life.
