Today we had a very well-done Clinical Problems in Consultation Psychiatry (CPCP) done by a couple of talented second year medical students rotating through the psychiatry consultation service. This the one of the very first such presentations by students at this level of training and I’m very excited about it. This is about managing agitation and aggression in patients with traumatic brain injury. Both Ethan Craig and Evelyn Qin worked on it although Evelyn presented because Ethan is on another service this week.
This is a common issue for consultation psychiatrists working with neurosurgeons and neurologists. It really pays to stay current on the literature, which in this case is somewhat thin as Evelyn points out.
Evelyn and Ethan are finding out I rarely use the elevator and running up and down the stairs. Incidentally, yesterday was a busy day and my socks took a beating:
My wife got me some new socks for Valentine’s Day and they were not Darn Tough Socks. They’re Dickies. At the end of the workday yesterday, I noticed a hole in an odd place in the right sock. They have a guarantee but I figure we’ll just not buy them anymore.
OK, now that the critically important business about my socks has been transacted, let’s get back to how to manage agitation in traumatic brain injury. I think it’s important to point out that many physiatrists don’t believe that high potency antipsychotics are appropriate for managing agitation in this context. It might interfere with rehabilitation in their view and there is some animal evidence to support their position. This presentation didn’t include anything about behavioral methods in managing this population but it’s important. It’s also good to remember that delirium is one of the most common acute neuropsychiatric complications of traumatic brain injury.
It’s probably a good idea to avoid benzodiazepines. I have never used buspirone in this setting. Maybe a reader has an opinion about it. I prefer valproate to carbamazepine because it tends to be better tolerated.
In order to see the picture galleries of photos or PowerPoint slides, click on the one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view any annotations.