Care management of the agitation or aggressiveness crisis in patients with TBI. Systematic review of the literature and practice recommendations / Jacques Luauté in Annals of physical and rehabilitation medicine, Vol. 59, n°1 (February 2016)

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 59, n°1 (February 2016) . - p.58-67 Titre : Care management of the agitation or aggressiveness crisis in patients with TBI. Systematic review of the literature and practice recommendations Type de document : texte imprimé Auteurs : Jacques Luauté ; David Plantier ; Laurent Wiart Année de publication : 2016 Article en page(s) : p.58-67 Langues : Anglais (eng) Mots-clés : traumatisme cérébral  agitation  agressivité  comportement  recommandation Résumé : The agitation crisis in the awakening phase after traumatic brain injury (TBI) is one of the most difficult behavioral disorders to alleviate. Current treatment options are heterogeneous and may involve excessive sedation. Practice guidelines are required by professionals in charge of TBI patients. Few reviews were published but those are old and based on expert opinions. The purpose of this work is to propose evidence-based guidelines to treat the agitation crisis. Methods The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. Guidelines were elaborated on the basis of a systematic and critical review of the literature. Results Twenty-eight articles concerning 376 patients were analyzed. Recommendations are: when faced with an agitation crisis, the management strategy implies to search for an underlying factor that should be treated such as pain, acute sepsis, and drug adverse effect (expert opinion). Physical restraints should be discarded when possible (expert opinion). Neuroleptic agent with a marketing authorization can be used in order to obtain a quick sedation so as to protect the patient from himself, closed ones or the healthcare team but the duration should be as short as possible (expert opinion). The efficacy of beta-blockers and antiepileptics with mood regulation effects like carbamazepine and valproate yield the most compelling evidence and should be preferably used when a background regimen is envisioned (grade B for beta-blocker and C for antiepileptics). Neuroleptics, antidepressants, benzodiazepines, buspirone may be prescribed but are considered second-line treatments (expert opinion). Conclusion This study provides a strategy for treating the agitation crisis based on scientific data and expert opinion. The level of evidence remains low and published data are often old. New studies are essential to validate results from previous studies and test new drugs and non-pharmaceutical therapies. Permalink : ./index.php?lvl=notice_display&id=42785 [article] Care management of the agitation or aggressiveness crisis in patients with TBI. Systematic review of the literature and practice recommendations [texte imprimé] / Jacques Luauté ; David Plantier ; Laurent Wiart . - 2016 . - p.58-67. Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 59, n°1 (February 2016) . - p.58-67 Mots-clés : traumatisme cérébral  agitation  agressivité  comportement  recommandation Résumé : The agitation crisis in the awakening phase after traumatic brain injury (TBI) is one of the most difficult behavioral disorders to alleviate. Current treatment options are heterogeneous and may involve excessive sedation. Practice guidelines are required by professionals in charge of TBI patients. Few reviews were published but those are old and based on expert opinions. The purpose of this work is to propose evidence-based guidelines to treat the agitation crisis. Methods The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. Guidelines were elaborated on the basis of a systematic and critical review of the literature. Results Twenty-eight articles concerning 376 patients were analyzed. Recommendations are: when faced with an agitation crisis, the management strategy implies to search for an underlying factor that should be treated such as pain, acute sepsis, and drug adverse effect (expert opinion). Physical restraints should be discarded when possible (expert opinion). Neuroleptic agent with a marketing authorization can be used in order to obtain a quick sedation so as to protect the patient from himself, closed ones or the healthcare team but the duration should be as short as possible (expert opinion). The efficacy of beta-blockers and antiepileptics with mood regulation effects like carbamazepine and valproate yield the most compelling evidence and should be preferably used when a background regimen is envisioned (grade B for beta-blocker and C for antiepileptics). Neuroleptics, antidepressants, benzodiazepines, buspirone may be prescribed but are considered second-line treatments (expert opinion). Conclusion This study provides a strategy for treating the agitation crisis based on scientific data and expert opinion. The level of evidence remains low and published data are often old. New studies are essential to validate results from previous studies and test new drugs and non-pharmaceutical therapies. Permalink : ./index.php?lvl=notice_display&id=42785

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Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations / Laurent Wiart in Annals of physical and rehabilitation medicine, Vol. 59, n°1 (February 2016)

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 59, n°1 (February 2016) . - p.31-41 Titre : Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations Type de document : texte imprimé Auteurs : Laurent Wiart ; Jacques Luauté ; Angélique Stéfan Année de publication : 2016 Article en page(s) : p.31-41 Langues : Anglais (eng) Mots-clés : traumatisme cérébral  troubles du comportement  psychologie  psychothérapie  trouble cognitif  thérapie holistique  thérapie familiale Résumé : Introduction The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives. Method The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group. Results 458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury. Conclusion Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations. Permalink : ./index.php?lvl=notice_display&id=42780 [article] Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations [texte imprimé] / Laurent Wiart ; Jacques Luauté ; Angélique Stéfan . - 2016 . - p.31-41. Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 59, n°1 (February 2016) . - p.31-41 Mots-clés : traumatisme cérébral  troubles du comportement  psychologie  psychothérapie  trouble cognitif  thérapie holistique  thérapie familiale Résumé : Introduction The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives. Method The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group. Results 458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury. Conclusion Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations. Permalink : ./index.php?lvl=notice_display&id=42780

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