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Individuals who exhibit aggressive behavior after sustaining TBI require a thorough assessment. Multiple factors may play a significant role in the production of aggressive behaviors in these patients. During the time period of emergence from coma, agitated behaviors can occur as the result of delirium. The usual clinical picture is one of restlessness, confusion, and disorientation. (The assessment and treatment of delirium are discussed in Chapter 9, Delirium and Posttraumatic Confusion.) For patients who become aggressive after TBI, it is important to systematically assess the presence of concurrent neuropsychiatric disorders, because such assessment may guide subsequent treatment. Thus, the clinician must diagnose psychosis, depression, mania, mood lability, anxiety, seizure disorders, and other concurrent neurological conditions.

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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.
Table Reference Number
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

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