What is common drugs used to treat irratability in brain damaged patient?

My son suffered right frontal lobe damage at age 15. He is now forty years old. He suffers from poor impulse control, has difficulty speaking, limited vision (not due to eye problem)and has had until now, a successful placement in a residential treatment facility for the last 25 years.

Recently there has been two cases of unpredictable fighting, resulting in eviction from one placement. After much work, he was placed in another treatment facility, but after two months, has once again been "baker act removed" .

The conditions specified for his return include the use of respiradol, paxil, ativan and depakote, which have proved unworkable in the past,(the second episode of fighting occured while on all of those drugs at the first placement). The listed side effects worry me. No one seems able to give me an understandable game plan, seeming like the treatment is a shot in the dark, trial and error method.

The fighting is usually precipitated by staff forcing their will upon him in a physical way. He has never used force while on a home visit. He is intelligent and enjoys games and conversations, but will always need supervision. (He can remember how to drive a car, and will try to, even though he cannot see well enough to drive. He makes other bad decisions following impulse. Once he managed to elope and make it to a home town 1200 miles away, only to be "rolled" upon his arrival).

I have developed a tendency to "not believe" reports, understanding that it is not the health professionals that are on hand when these things happen, but at some entry level staff person that cover themselves when reporting the incidents.

I have to believe that there is a ton of experience out there to help me find support for whatever medications are available to him to prolong a fair quality of life in a group home situation.

The present placement also wants me to cancell the son's 800 number for easy access to us by any phone, implication being that his connection to home and parents work against their efforts. And all I can see is the next fight happening when a $4.50 per hour attendant takes the phone out of his hands.

Any help on any one of these questions will be appreciated.

[HFHS M.D.-SW]

Dear Pat Yacques,


Your son's situation must be taking an emotional toll on you.  Impulsive behavior and poor problem solving are not unusual with frontal lobe damage.
The medications you mentioned Risperdal, Ativan, Paxil and Depakote may all be used for irritable, impulsive, and combative behavior.  There are other medications such as Lithium, Tegretol, other antidepressants such as Paxil, and other antipsychotic medications such as Risperdal. which may also be tried if not already tried.  It may be helpful to consult with a neuropsychiatrist who can discuss with you and your son the best treatment options, as well as the adverse effects.
The problem could also be environmental.  You mentioned better behavior when he is at home with his family.  A behavioral therapy plan in his group home may also help curb behavior problems.  Your psychiatrist should be able to help with such a referral.
In general proper medications and environment maybe the best help for your son's behavior.
Best Wishes


Sincerely,

HFHS M.D.-SW

*Keywords: Combative Behavior, Brain injury