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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Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice / David Plantier 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.42-57 Titre : Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice Type de document : texte imprimé Auteurs : David Plantier ; Jacques Luauté ; The SOMFER group Année de publication : 2016 Article en page(s) : p.42-57 Langues : Anglais (eng) Mots-clés : traumatisme cérébral  troubles du comportement  neuroleptique  antidépresseur  bêtabloquant  stabilisateurs de l'humeur  médicament  benzodiazépine  amantadine Résumé : Objective There are no handbook or recommendations for the use of pharmacological agents to treat neurobehavioral disorders after traumatic brain injury (TBI). This work proposes a systematic review of the literature and a user guide on neuroleptics, antidepressants, beta-blockers, mood stabilizers and other medications for irritability, aggressiveness, agitation, impulsivity, depression, apathy… Method Steering, working and reading groups (62 people) were formed under the control of the French High Authority for Health (HAS) in collaboration with the SOFMER scientific society (French Society of Physical and Rehabilitation Medicine). Articles were searched by HAS officers in the Medline database from 1990 to 2012, crossing TBI and pharmacological agents. The HAS method to select, read and analyze papers is close to the PRISMA statements. Results Out of 772 references, 89 were analyzed, covering a total of 1306 people with TBI. There is insufficient evidence to standardize drug treatments for these disorders. There are however some elements to establish consensus recommendations for good clinical practice. Propranolol can improve aggression (B grade). Carbamazepine and valproate seem effective on agitation and aggression and are recommended as first line treatment (Expert Consensus [EC]). There is no evidence of efficacy for neuroleptics. Their prescription is based on emergency situation for a crisis (loxapine) but not for long-term use (EC). Antidepressants are recommended to treat depression (EC) with a higher standard of proof for Selective Serotonin Reuptake Inhibitors (SSRI, grade B). Other products are described. Conclusion The choice of treatment depends on the level of evidence, target symptoms, custom objectives, clinical experience and caution strategies. Permalink : ./index.php?lvl=notice_display&id=42783 [article] Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice [texte imprimé] / David Plantier ; Jacques Luauté ; The SOMFER group . - 2016 . - p.42-57. Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 59, n°1 (February 2016) . - p.42-57 Mots-clés : traumatisme cérébral  troubles du comportement  neuroleptique  antidépresseur  bêtabloquant  stabilisateurs de l'humeur  médicament  benzodiazépine  amantadine Résumé : Objective There are no handbook or recommendations for the use of pharmacological agents to treat neurobehavioral disorders after traumatic brain injury (TBI). This work proposes a systematic review of the literature and a user guide on neuroleptics, antidepressants, beta-blockers, mood stabilizers and other medications for irritability, aggressiveness, agitation, impulsivity, depression, apathy… Method Steering, working and reading groups (62 people) were formed under the control of the French High Authority for Health (HAS) in collaboration with the SOFMER scientific society (French Society of Physical and Rehabilitation Medicine). Articles were searched by HAS officers in the Medline database from 1990 to 2012, crossing TBI and pharmacological agents. The HAS method to select, read and analyze papers is close to the PRISMA statements. Results Out of 772 references, 89 were analyzed, covering a total of 1306 people with TBI. There is insufficient evidence to standardize drug treatments for these disorders. There are however some elements to establish consensus recommendations for good clinical practice. Propranolol can improve aggression (B grade). Carbamazepine and valproate seem effective on agitation and aggression and are recommended as first line treatment (Expert Consensus [EC]). There is no evidence of efficacy for neuroleptics. Their prescription is based on emergency situation for a crisis (loxapine) but not for long-term use (EC). Antidepressants are recommended to treat depression (EC) with a higher standard of proof for Selective Serotonin Reuptake Inhibitors (SSRI, grade B). Other products are described. Conclusion The choice of treatment depends on the level of evidence, target symptoms, custom objectives, clinical experience and caution strategies. Permalink : ./index.php?lvl=notice_display&id=42783

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