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Titre : | Psychotropic Medication Use During Inpatient Rehabilitation for Traumatic Brain Injury (2015) |
Auteurs : | Flora M. Hammond ; Ryan S. Barrett ; Timothy Shea |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (2015/8 suppl., 2015) |
Article en page(s) : | p. S256S273 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Neuroleptiques ; Polypharmacie ; Rééducation et réadaptation ; Traitement médicamenteux ; Types de pratiques des médecins |
Mots-clés: | Amantadine ; Antidepressive agents ; Antidépresseurs ; Antipsychotic agents ; Brain injuries ; Lésions encéphaliques ; Central nervous system stimulants ; Stimulants du système nerveux central ; Drug therapy ; Medication therapy management ; Gestion de la pharmacothérapie ; Patient care ; Soins aux patients ; Practice Patterns ; Physicians' ; Polypharmacy |
Résumé : |
Objective To describe psychotropic medication administration patterns during inpatient rehabilitation for traumatic brain injury (TBI) and their relation to patient preinjury and injury characteristics. Design Prospective observational cohort. Setting Multiple acute inpatient rehabilitation units or hospitals. Participants Individuals with TBI (N=2130; complicated mild, moderate, or severe) admitted for inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures Not applicable. Results Most frequently administered were narcotic analgesics (72% of sample), followed by antidepressants (67%), anticonvulsants (47%), anxiolytics (33%), hypnotics (30%), stimulants (28%), antipsychotics (25%), antiparkinson agents (25%), and miscellaneous psychotropics (18%). The psychotropic agents studied were administered to 95% of the sample, with 8.5% receiving only 1 and 31.8% receiving ≥6. Degree of psychotropic medication administration varied widely between sites. Univariate analyses indicated younger patients were more likely to receive anxiolytics, antidepressants, antiparkinson agents, stimulants, antipsychotics, and narcotic analgesics, whereas those older were more likely to receive anticonvulsants and miscellaneous psychotropics. Men were more likely to receive antipsychotics. All medication classes were less likely administered to Asians and more likely administered to those with more severe functional impairment. Use of anticonvulsants was associated with having seizures at some point during acute care or rehabilitation stays. Narcotic analgesics were more likely for those with history of drug abuse, history of anxiety and depression (premorbid or during acute care), and severe pain during rehabilitation. Psychotropic medication administration increased rather than decreased during the course of inpatient rehabilitation in each of the medication categories except for narcotics. This observation was also true for medication administration within admission functional levels (defined by cognitive FIM scores), except for those with higher admission FIM cognitive scores. Conclusions Many psychotropic medications are used during inpatient rehabilitation. In general, lower admission FIM cognitive score groups were administered more of the medications under investigation compared with those with higher cognitive function at admission. Considerable site variation existed regarding medications administered. The current investigation provides baseline data for future studies of effectiveness. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999315003822 |