|
| |
 |
|
| RESEARCH ARTICLE |
|
| Year : 2017 | Volume
: 14
| Issue : 1 | Page : 25-27 |
|
Prevalence of aggression in patients post traumatic brain injury taking treatment at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi
Tenzin Nyidol1, Sandhya Gupta2, Deepak Agarwal3, Ramandeep Pattnayak4
1 Nursing Officer, AIIMS, India
2 Department of Mental Health Nursing, College of Nursing, AIIMS, New Delhi, India
3 Department of Nurosurgery, AIIMS, New Delhi, India
4 Department of Psychiatry, AIIMS, New Delhi, India
| Date of Web Publication | 9-Jul-2019 |
Correspondence Address:
Sandhya Gupta
Department of Mental Health Nursing, College of Nursing, AIIMS, New Delhi
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2231-1505.262417
Background of the study: Traumatic Brain Injury is a health problem occurring equally globally. About 40% of traumatic brain injury victims suffer from various psychiatric disorders and adverse cognitive and emotional effects which may affect the outcome of treatment from complete recovery to permanent disability. Aim of the study was to assess the prevalence of aggression and its correlates among patients post traumatic brain injury seeking treatment from Trauma Centre, AIIMS, New Delhi. Methodology: A cross-sectional study was done on patients post taking follow up treatment. Ethical clearance was obtained from Ethics Committee, AIIMS. Results: Most of the patients post-TBI were male. The prevalence of aggression among patients post TBI was found to be 55%. Occurrence of aggression was associated with use of tobacco (p=0.04) by patients, and was not found to be associated with duration of injury. Conclusion: The post-TBI patients are at a high risk of developing aggression and use of tobacco can put the patients at a higher risk of developing aggression post TBI. Thus nurses need to emphasize on management of aggressive behavior and also train patients in social skills, when patients visit follow up clinic for rehabilitation.
Keywords: Traumatic Brain Injury, Aggression, Correlates of aggression
How to cite this article:
Nyidol T, Gupta S, Agarwal D, Pattnayak R. Prevalence of aggression in patients post traumatic brain injury taking treatment at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. Indian J Psy Nsg 2017;14:25-7 |
How to cite this URL:
Nyidol T, Gupta S, Agarwal D, Pattnayak R. Prevalence of aggression in patients post traumatic brain injury taking treatment at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. Indian J Psy Nsg [serial online] 2017 [cited 2023 May 28];14:25-7. Available from: https://www.ijpn.in/text.asp?2017/14/1/25/262417 |
| Introduction | |  |
Traumatic brain injury is a health problem worldwide and has been referred as the “silent epidemic” as the problems the victims face are often not visible[1]. TBI is a global scenario but is more serious in developing countries as they lack the health system for immediate action and also have higher number and types of risk factors which further complicate the recovery process. Traumatic brain injury (TBI) also called intracranial injury or traumatic head injury, it occurs when an external force injures (trauma) the brain. TBI is classified based on severity (mild, moderate and severe using the Glasgow Coma Score), mechanism (closed or penetrating head injury) or other features (e.g., occurring in a specific location or over a widespread area).
TBI is a main cause of disability and death worldwide, especially in children and young adults. Injury of all types, especially those to the brain are most likely to result in disability or death. A study in 2003 found 87% of the patients reported TBI in their lifetime and had got significantly worse anger and aggression scores and had a poor trend towards cognitive test results and a higher prevalence of psychiatric disorders than the group without TBI in the prior year[2].
About 40% of TBI victims suffer from two or more forms of psychiatric disorders and can host cognitive and emotional effects which may remain unmet[3] and the results range from complete recovery to permanent disability or death.
Following TBI, individuals can experience chronic problems with irritability or aggression and may need treatment to minimize the impact on their relationships, home life, social interactions, community participation and employment.
| Need for the Study | | |
Aggression is the most common complication after TBI, it disrupts the social life of the patients with TBI and there is disruption in the family functioning of the patients after TBI. So in order to guide the patients and their family regarding management of aggression the baseline information is required about the type of aggression and how to act in a therapeutic manner.
Further the nurses working with these patients also can be trained accordingly. Hence this study is planned to identify the correlates of aggression in patientspost TBI.
Objectives of the study was to find out the prevalence of aggression in patients post traumatic brain injury (TBI).
| Methods and Techniques | | |
A Descriptive survey, cross sectional design was selected for the study. Setting: Neuro surgery Follow up OPD, Trauma Centre, AIIMS, New Delhi. Sample and Sampling technique: The 100 patients with TBI taking treatment were selected by convenience sampling technique. Inclusion criteria: Patients with GCS score of 9-15., >18 years of age, <1year post TBI and who could understand Hindi or English in addition who were accompanied by family caregivers. Tools:
On the basis of achieving the objectives of the study, the Overt Aggression Scale (OAS) was used that divides aggressive behaviors into four categories those are verbal aggression, physical aggression against objects, physical aggression against self and physical aggression against others having internal consistency reliability ranged from r = 0.77-0.89 and co-relational coefficient is r = 0.87 besides using a subject data sheet for demographic profile and selected variables. Data was analyzed using STATA 11.2 software.
| Ethical Consideration | | |
The ethics committee of AIIMS approved the study protocol. Informed written consent was taken from the subjects after explaining the details of study. Informed consent was taken verbally from caregivers for validation of data. Confidentiality of the subjects were maintained throughout the study. Permission to use OAS tool was taken from copyright authors.
| Description of the Subjects | | |
Most of the patients post TBI were from the age group of 18-38 years (73%) and were mostly male (88%).Forty three percent of the patients had an educational status of secondary education. Most patients belonged to Hindu religion (84%).More than half the patients post traumatic brain injury were married (55%) and lived in joint family (64%). Most of them resided in urban areas (82%) and38% of the patients had a monthly income of<Rs.10,000/-. Most of the patients post TBI were being treated for head injury for the first time (82%). Most of them reported no impairments post traumatic brain injury (87%) and were currently taking medications prescribed to them (91%). More than half of the patients had TBI within three months (63%) and more than half of the patients reported no use of substance (58%). More than half the patients post traumatic brain injury were diagnosed with minor head injury (52%) and reported history of aggression prior to head injury (65%).
| Major Findings and Discussion | | |
Fifty five percent of aggression was prevalent in patients post traumatic brain injury. The most prevalent type of aggression was verbal aggression, ss depicted in [Table 1]. | Table NO. 1: Prevalence of aggression and types among patients post traumatic brain injur (n=100)
Click here to view |
- Most of the patients post traumatic brain injury belonged to the age group of 18-38 years which is similar to findings of study done by Finnanger TG et.al.[5], Baguley IJ et.al.[6], Kevin WG et.al.[7].
- Most of the patients post traumatic brain injury were male which is similar to findings of study done by Ilie G et.al.[8], Wood RL et.al.[9].
- Patients reported to have a history of aggressive behavior prior to head injury were 35% which is similar to the findings of study done by Johansson SH et.al.9 but contradictory to the study findings done by Kevin WG et.al.[7].
- The verbal aggression was found to be the most prevalent subtype of reported aggression in patients post TBI (100%), followed by physical aggressive against others (18.18%) and the least frequent form of aggression was physical aggression against self(7.27%)
- Aggression was found to be present among patients post traumatic brain injury and was found to be 55% which is similar to the findings of study done by Singh R et.al.[10], Ciurli P et.al.[11], Rao V et.al.[12], Johansson SH et.al.[13], Baguley IJ et.al.[6], Dyer KF et.al.[14] and Nott MT et.al.[15].
- Most prevalent type of reported aggression by the patients was verbal aggression (100%) and the least prevalent type of reported aggression was physical aggression against self (7.27%) which is similar to the findings of study done by Rao V et.al.[12].
- There is statistically significant association between aggression post TBI with use of tobacco (p=0.04) among patients al.[16].
| Conclusion | | |
Fifty five percent of aggression was prevalent in patients post traumatic brain injury. The most prevalent type of aggression was verbal aggression.Thus, it is suggesting there is need to take action to manage patients presenting with aggression post TBI. Also the nurses working in critical care units can be given specific training to manage behavior of aggression effectively and guide other caregivers as well.
| References | | |
| 1. | |
| 2. | |
| 3. | Jorge RE, Starkstein SE. Pathophysiologic Aspects of Major Depression Following Traumatic Brain Injury. Journal of Head Trauma Rehabilitation. November/December 2005; 20(6):475-487 Available in: http://www.ncbi.nlm.nih.gov/pubmed/16304485. Accessed on 24th November 2015  |
| 4. | Tateno A, Jorge RE, Robinson RG. Clinical correlates of aggressive behavior after traumatic brain injury. Journal of Neuropsychiatry & Clinical Neurosciences. 2003; 15:155–160 Available on: http://www.ncbi.nlm.nih.gov/pubmed/12724455. Accessed on 24th November 2015 |
| 5. | G, Mann RE, Boak A, Adlaf EM, Hamilton H, et al. Suicidality, Bullying and Other Conduct and Mental Health Correlates of Traumatic Brain Injury in Adolescents. PLoS ONE. 2014; 9(4): e94936. Available in: doi:10.1371/journal.pone.0094936. Accessed on: 3rd January 2017 |
| 6. | Baguley IJ, Cooper J, Felmingham K. Aggressive behavior following traumatic brain injury: How common is common? Journal of Head Trauma Rehabilitation. 2006; 21:45– 56 Available in: http://www.ncbi.nlm.nih.gov/pubmed/16456391. Accessed on 18th November 2015 |
| 7. | Kevin W. Greve, Elisabeth Sherwin, Matthew S. Stanford, Charles Mathias, Jeff Love, Paul Ramzinski. Personality and neurocognitive correlates of impulsive aggression in long-term survivors of severe traumatic brain injury. Brain Injury. 2001; 15(3):255-262 Available in http://www.ncbi.nlm.nih.gov/pubmed/11260773. Accessed on 20th November 2015 |
| 8. | Ilie G, Mann RE, Ialomiteanu A, Adlaf EM, Hamilton H, Wickens CM, Asbridge M, Rehm J, Cusimano MD. The impact of childhood symptoms of conduct disorder on driver aggression in adulthood. Accid Anal Prev. 2015;78: 87-93. Available in: doi: 10.1016/j.aap.2015.02.013. Accessed on: 3rd January 2017. |
| 9. | Wood RL, Liossi C. Neuropsychological and neurobehavioral correlates of aggression following traumatic brain injury. J Neuropsychiatry Clin Neurosci.2006; 18(3):333-41. Available in: http://www.ncbi.nlm.nih.gov/pubmed/16963582. Accessed 0n 18th November 2015 |
| 10. | |
| 11. | Ciurli P, Formisano R, Bivona U,et.al. Neuropsychiatric Disorders in Persons with Severe Traumatic Brain Injury: Prevalence, Phenomenology, and Relationship with Demographic, Clinical, and Functional Features. Journal of Head Trauma Rehabilitation. 2011. March/April; 26(2):116–1 26 Available in: http://www.ncbi.nlm.nih.gov/pubmed/20485191 .Accessed on 23rd November 2015 |
| 12. | Vani Rao, et.al. Aggression after Traumatic Brain Injury: Prevalence and Correlates. The Journal of Neuropsychiatry and Clinical Neurosciences. 2009; 21:420– 429 Available in http://www.ncbi.nlm.nih.gov/pubmed/19996251. Accessed on 22nd September 2015 |
| 13. | |
| 14. | Dyer KF, Bell R, McCann J, Rauch R. Aggression after traumatic brain injury: Analyzing socially desirable responses and the nature of aggressive traits. Brain Injury. 2006; 20(11):1163-1173 Available in: http://www.ncbi.nlm.nih.gov/pubmed/17123933. Accessed on 24th November 2015) |
| 15. | Nott MT, Chapparo C, Baguley IJ. Agitation following traumatic brain injury: An Australian sample. Brain. 2006; 20(11): 1175-1182 Available in: http://www.ncbi.nlm.nih.gov/pubmed/17123934. Accessed on 24th November 2015 |
| 16. | G, Mann RE, Boak A, Adlaf EM, Hamilton H, et al. Suicidality, Bullying and Other Conduct and Mental Health Correlates of Traumatic Brain Injury in Adolescents. PLoS ONE. 2014; 9(4): e94936. Available in: doi:10.1371/journal.pone.0094936. |
[Table 1]
|
Search Pubmed for