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Chapter 14. Aggressive Disorders

Jonathan M. Silver, M.D.; Stuart C. Yudofsky, M.D.; Karen E. Anderson, M.D.
DOI: 10.1176/appi.books.9781585624201.677066

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Explosive and violent behavior has long been associated with focal brain lesions, as well as with diffuse damage to the central nervous system (CNS). Irritability and/or aggressiveness are major sources of disability to individuals with brain injury and sources of stress to their families. Agitation that occurs during the acute stages of recovery from brain injury can endanger the safety of the patients and their caregivers. Agitation may be predictive of longer length of hospital stay and decreased cognition (Bogner et al. 2001). Subsequently, low frustration tolerance and explosive behavior may develop that can be set off by minimal provocation or occur without warning. These episodes range in severity from irritability to outbursts that result in damage to property or assaults on others. In severe cases, it may be unsafe for affected individuals to remain in the community or with their families, and they often are referred to long-term psychiatric or neurobehavioral facilities. Therefore, it is essential that all psychiatrists be aware of neurologically induced aggression and its assessment and treatment so that they can provide effective care to patients with this condition and to their families.

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Figure 14–1. The Overt Aggression Scale.Source. Reprinted from Yudofsky SC, Silver JM, Jackson W, et al.: "The Overt Aggression Scale for the Objective Rating of Verbal and Physical Aggression." American Journal of Psychiatry 143:35–39, 1986. Used with permission.

Figure 14–2. The Overt Agitation Severity Scale.Source. Reprinted from Yudofsky SC, Kopecky HJ, Kunik ME, et al.: "The Overt Agitation Severity Scale for the Objective Rating of Agitation." The Journal of Neuropsychiatry and Clinical Neurosciences 9:541'€“548, 1997. Used with permission.

Figure 14–3. Agitated Behavior Scale.Source. Adapted from Bogner et al. 1999.

Figure 14–4. Neuropsychiatric factors associated with agitation and aggression.
Table Reference Number
Table 14–1. Characteristic features of aggression after brain injury
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Table 14–2. DSM-IV-TR criteria for personality change due to a general medical condition
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Table 14–3. Neuropathology of aggression
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Table 14–4. Medications and drugs associated with aggression
Table Reference Number
Table 14–5. Common etiologies of aggression in individuals with traumatic brain injury
Table Reference Number
Table 14–6. Pharmacotherapy of agitation/aggression

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