Use of the antipsychotic olanzapine to treat agitation in traumatic brain injury

Olanzapine, Optimal Environmental Management: Treatment will be administered orally in capsule form initially at a dosage of 5mg/day at night. If agitation scores do not reduce after 3 days (as measured by the Agitated Behaviour Scale), the dose will be increased by 5 mg every 3 days up to a maximum daily dose of 20mg/day. Escalation will be as follows: Escalation one - 5mg morning, 5mg night; escalation two - 5mg morning, 10mg night; escalation three - 10mg morning, 10mg night. Participants will also receive optimal environmental management to minimise agitation. Treatment will continue until the patient emerges from post-traumatic amnesia, defined as the third of three consecutive days in which a score of 12 is obtained on the Westmead Post-Traumatic Amnesia Scale, or when a maximum of 6 months in a state of post-traumatic amnesia have elapsed. Each active capsule will contain 5mg olanzapine, as well as Flocel (filler). During this trial, all participants will receive environmental management designed to minimise agitation including being located in a secure and quiet ward, avoiding restraint and overstimulation, allowing frequent rest, with dedicated, consistent staff optimising communication, reassurance and orientation. They will receive any physiotherapy, speech therapy or occupational therapy treatment on the ward. Visitors will be regulated to avoid overstimulation.