Research Reports - Psychotropic medication use during rehabilitation for traumatic brain injury

Arch Phys Med Rehabil. 2015 Aug;96(8 Suppl):S256-S273.e14. doi:10.1016/j.apmr.2015.01.025.

Hammond FM(1), Barrett RS(2), Shea T(3), Seel RT(4), McAlister TW(5), Kaelin
D(6), Ryser DK(7), Corrigan JD(3), Cullen N(8), Horn SD(2).

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.
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. 

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