Psychotropic Medication Use During Inpatient Rehabilitation for Traumatic Brain Injury
Psychotropic Medication Use During Inpatient Rehabilitation for Traumatic Brain Injury
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DOI：
10.1016/j.apmr.2015.01.025
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发表时间：
2015-08-01
影响因子：
4.3
通讯作者：
Horn, Susan D.
中科院分区：
文献类型：
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作者：
Hammond, Flora M.;Barrett, Ryan S.;Horn, Susan D.
目的：探讨创伤性脑损伤（TBI）住院康复期间精神药物给药方式及其与患者损伤前和损伤特征的关系。设计:前瞻性观察队列。环境：多个急性住院康复单位或医院。参与者：接受住院康复治疗的TBI患者（N=2130；合并轻度、中度或重度）。干预措施：不适用。主要结果测量：不适用。结果：使用最多的是麻醉性镇痛药（占样本的72%），其次是抗抑郁药（67%）、抗惊厥药（47%）、抗焦虑药（33%）、催眠药（30%）、兴奋剂（28%）、抗精神病药（25%）、抗帕金森药（25%）和其他精神药物（18%）。95%的患者服用了所研究的精神药物，其中8.5%的患者只服用了1种，31.8%的患者服用了>= 6。不同部位的精神药物使用程度差异很大。单变量分析表明，年轻患者更有可能接受抗焦虑药、抗抑郁药、抗帕金森药、兴奋剂、抗精神病药和麻醉性镇痛药，而年龄较大的患者更有可能接受抗惊厥药和其他精神药物。男性更有可能接受抗精神病药物。所有的药物类别都不太可能给亚洲人使用，而更可能给那些功能障碍更严重的人使用。使用抗惊厥药与急性护理或康复期间的癫痫发作有关。有药物滥用史、焦虑和抑郁史（发病前或急性护理期间）、康复期间疼痛严重的患者更可能使用麻醉性镇痛药。在住院康复过程中，除麻醉药品外，每种药物类别的精神药物使用均增加而非减少。这一观察结果也适用于入院功能水平（由认知FIM评分定义）的药物管理，除了那些入院FIM认知评分较高的患者。结论：住院康复过程中使用多种精神药物。总的来说，与入院时认知功能较高的组相比，入院时FIM认知评分较低的组服用了更多的药物。用药方面存在相当大的部位差异。目前的调查为今后的有效性研究提供了基线数据。(C) 2015年由美国康复医学大会发布
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. (C) 2015 by the American Congress of Rehabilitation Medicine