Background

Irritability and aggression are common disorders associated with neuropsychiatric conditions, such as stroke, dementia, traumatic brain injury, and Huntington's disease (Burns et al. 1990; Paradiso et al. 1996; Chemerinski et al. 1998; Kim et al. 1999). These symptoms create a major stress for the families of patients with stroke (Brooks et al. 1986; Williams 1994) and lead to a poorer quality of life for the patient (Angeleri et al. 1993). Aggressive behavior is a common reason for referral to geriatric services or admission to a nursing home or hospital (Margo et al. 1980; Clarke et al. 1981). Aggressive behavior in institutions poses a major management problem and a significant stress on nursing staff (Winger et al. 1987).

As with many behaviors, there are multiple etiologies and numerous factors which contribute to the expression of this behavioral disturbance. Environmental precipitants and risk factors for violent behavior associated with neurological disease include social factors such as prior exposure to violence, psychological factors such as loss of job or social position, psychopathological factors, such as the presence of depression, delusions, or hallucinations, and medication effects such as disinhibition associated with benzodiazepines or other medications. In addition to these environmental and psychological factors, violent behavior is also more common in males, those who are younger age, and those of low intelligence (Hodgins 1992).