Psychotropics and neuroprotection: Literature review and case series report

Agitation is a common manifestation of acute brain injury. When not addressed, agitation can lead to slower recovery rates, including delayed admission to acute rehabilitation programs. Antipsychotics are commonly used to control agitation in acute brain injury in the ICU. However, there is no current consensus on the most "efficacious and safest strategy" for use of antipsychotics in acute TBI. Haloperidol is arguably the commonly used antipsychotic for agitation in ICU setting at present. Interestingly, there are no studies to our knowledge that assess for haloperidol use in TBI patient's specifically. Further, there are some concerns with the use of Haloperidol given that it does not offer a neuroprotective effect and may have some adverse effects that are particularly harmful for this population. In this paper, we offer a review of alternate medications that may be more appropriate for the treatment of agitation in acute brain injury, with less aversive effects. One stand out alternative is Valproic Acid. Aside from its anti-epileptic benefit, which is important in this population, valproic acid outshines other agents in that it has been shown to also be neuroprotective and offer anti-oxidant benefits. Aripiprazole may also be considered given that it has been found to be neuroprotective and reduce oxidative stress. Other medications such as olanzapine, risperidone, paliperidone, lithium, pramiprexole, and ziprasidone have shown to be either neuroprotective or have antioxidant properties. Quetiapine also shows promise. Case studies are also provided.