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Haldol and Traumatic Brain Injury

 

Traumatic brain injury (TBI) represents a uniquely challenging medical condition. Repair of the physical, emotional, and cognitive damage is a long and often grueling process. In the wake of brain injury, patients often experience amnesia, altered consciousness, and profound confusion. Many of these symptoms mirror the psychotic states of schizophrenia; however, the root causes of these symptoms are, of course, quite distinct. Still, it’s not an uncommon practice for attending physicians to prescribe antipsychotic drugs such as Haldol (haloperidol) for TBI patients who exhibit aggression or restlessness. This practice is not without controversy, as several studies have shown that psychotropic medications, especially the typical antipsychotic drugs, may slow recovery from brain injury. A study published in Life Sciences adds even more compelling data to the argument against antipsychotic drugs for patients with TBI.

In a study of brain recovery rates under different conditions, a small group of rats were subjected to a controlled brain injury. The control group was anesthetized but no surgery was performed. The rats were further divided into three distinct groups. One group received a regular dose of Haldol, another received Risperdal (risperidone, an atypical antipsychotic), and a third group received neither drug. All the rats were given daily assessments of motor skills, reflexes, and cognitive functioning. Because antipsychotic drugs have a sedative effect, the drugs were only administered after each day’s performance testing. This is an important distinction because previous studies often gave drugs before testing, potentially skewing the results. Researchers sought to uncover any ill effects from these medications independent of sedation.

Although the sample size of this particular study was small, the results were quite significant. Regardless of whether the rats were given Haldol or Risperdal, their performance tests showed a slower rate of improvement than their unmedicated counterparts. They were slower to regain reflexes and slower to make their way through a specific kind of maze. It was previously argued that the newer so-called atypical antipsychotic drugs like Risperdal might be a better choice for aggressive or psychotic TBI patients. This study argues that there is no significant difference between the older and newer drugs. What does that mean for humans with brain injuries? In a nutshell, these results argue for avoidance of antipsychotic medications while recovering from TBI unless absolutely necessary.

References
Hoffman, A., Cheng, J., Zafonte, R., Kline, A. (2008). Administration of haloperidol and risperidone after neurobehavioral testing hinders the recovery of traumatic brain injury-induced deficits. Life Sciences83(17-18), 602-607.  doi: 10.1016/j.lfs.2008.08.007

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