Behavior and Emotions - My Shepherd Connection

Behavioral and Personality Changes After a Brain Injury

Changes in personality and behavior are common following a brain injury. The degree and type of changes are related to the part of the brain that was injured and the severity of the injury. An example of a personality change is a person who was very outgoing before the injury and is now withdrawn.

Behavioral changes are usually described as behavior excesses or behavior deficits.

Behavior excesses are behaviors that are exaggerations or overreactions. They may include acts of anger, rudeness, impulsivity or poor emotional control.

Behavior deficits are characterized by a failure to behave in ways that are typical in a specific situation. They may include lack of awareness, decreased ability to react to social cues and decreased ability to independently begin activities, including those related to health, hygiene, planning and organizing.

Common Behavior Changes:

Agitation
Denial
Dependency (may not realize the severity of the injury and its effects on oneself or others)
Egocentrism (inability to understand any perspective other than one's own)
Excessive talking
Impatience
Inappropriate social behavior
Irritability
Lack of motivation
Loss of control (may not be able to control what one says or does in social situations)
Perseveration (thinking, saying or doing one thing for an extended period of time)
Poor Initiation (decreased ability to independently start or plan activities)
Verbal and/or physical outbursts

Behavior problems can be a temporary part of recovery. How long the behaviors will last depends on the person's injury. Some problems may go away, while others may stay the same or lessen in frequency and/or severity.

Medications

Medications are often helpful to manage problem behaviors. The type of medicine that a person is given will depend on his/her specific situation. For example, antipsychotics work to decrease dopamine in the brain. After a brain injury, this helps to stop agitation, hyperactivity, hallucinations and hostility. While this is good, antipsychotics can also cause problems with memory, learning and cognition. For this reason, the doctor might use them sparingly or try other therapies first. Common brands of antipsychotics include: Risperdal, Zyprexa and Haldol.

Another category of medicine that may be used to treat agitated behaviors are "beta blockers." Beta blockers have typically been used to treat people with heart problems; however, they are also helpful in "blocking" messages for anxiety, nervousness and sweating.

In patients with brain injury, beta blockers have been used to treat agitation and aggression. Common brand names include Inderal and Corgard.

Other medicines that are used to treat behavior problems are anticonvulsants such as Dilantin and Tegretol. They are commonly used to treat seizures, but they may also be useful in managing explosive and/or aggressive episodes. Lithium (also known as Lithobid) can be used for the same reason. Lithium, Dilantin and Tegretol all have significant side effects and must be monitored by a doctor on a regular basis.

If you have any questions about the medicines that your loved one is taking, please ask your doctor, pharmacist or nurse.