Managing aggression in global amnesia following herpes simplex virus encephalitis: The case of E.B.

Abstract

Aim: This article describes an integrative approach to the case of EB, a 33 year old male who presented with agitation, delusional ideation and global amnesia after contracting herpes simplex virus encephalitis (HSVE) while in a state prison in 2004.

Case study: Although several prior case studies have described outcome following acute onset of HSVE, this case presents a unique challenge for rehabilitation in several respects. First, EB’s pre-morbid history is complicated; in contrast with prior HSVE case studies that have typically involved individuals with a relatively high level of pre-morbid functioning, EB presents with limited educational attainment and a prior history of several incarcerations for violent offenses. Post-injury, his presentation includes significant verbal aggression, threats of harm toward others, physical posturing and occasional physical aggression toward his caretakers. Third, EB presents with a fixed delusion that others are constantly taking advantage of him. These features are present in the context of global amnesia and relatively intact cognitive functioning in other domains. Following a brief review of prior HSVE case studies, this study reviews the outcomes of various pharmacological, cognitive, behavioural and integrative interventions designed for management of EB’s aggression and agitation.

• Aggression
• amnesia
• encephalitis
• neuropsychological
• rehabilitation
• traumatic brain injury

Acknowledgements

We would like to acknowledge the dedicated clinical team and residential staff at Lakeview Neurorehabilitation Center, who provided countless hours in assisting with implementation of the interventions described in this article.

Declaration of interest

The following paper was authored by Tracy E. Shannon PsyD and Stefanie L. Griffin PhD. The authors report no conflicts of interest. Dr Shannon was the primary author and Dr Griffin was the secondary author. Order of authorship was discussed prior to journal submission. Dr Shannon worked at Lakeview Neurorehabilitation Center as a behaviour specialist for the majority of the study. During 1 year of the study, Dr Shannon worked as a pre-doctoral intern at Lakeview Neurorehabilitation Center. Dr Griffin was the director of training and the primary supervisor of Dr Shannon during the study. Prior to the initiation of the study, approval and permission was obtained from the Human Rights Committee at Lakeview Neurorehabilitation and from the guardian of the study participant.