Review of subjectThe role of pharmacotherapy in the management of behaviour disorders in traumatic brain injury patients

@article{Deb2004ReviewOS,
  title={Review of subjectThe role of pharmacotherapy in the management of behaviour disorders in traumatic brain injury patients},
  author={Shoumitro Deb and Tina Crownshaw},
  journal={Brain Injury},
  year={2004},
  volume={18},
  pages={1 - 31}
}
The aim of this paper was to systematically review the research published in English language on the effectiveness of drugs for the treatment of neurobehavioural disorders in patients with traumatic brain injury (TBI). A literature search using Medline, Pre-Medline, Embase, Psychlit and Cochrane Library databases between 1990 and January 2003 as well as a hand search of Brain Injury since 1996 were carried out. Phrases such as ‘head injury’, ‘brain injury’, ‘drug treatment’, ‘drug trials’ and… 
Pharmacological interventions for agitated behaviours in patients with traumatic brain injury: a systematic review
TLDR
Propranolol, methylphenidate, valproic acid and olanzapine may offer some benefit; however, they need to be further studied.
Pharmacotherapy for Postacute Traumatic Brain Injury: A Literature Review for Guidance in Psychological Practice
TLDR
Clear clinical guidelines for the use of pharmacotherapy in TBI are lacking, however, because of the few conclusive findings regarding the effectiveness of any particular agent.
Pharmacological interventions for agitation in patients with traumatic brain injury: protocol for a systematic review and meta-analysis
TLDR
There is a need for an updated systematic review to summarize the evidence in order to inform practice and future research on a safe and effective treatment for agitation following TBI.
Overview of pharmacological interventions after traumatic brain injuries: impact on selected outcomes
TLDR
A need for adequately powered and rigorous randomized clinical trials (RCTs) to provide generalizable evidence on the effectiveness of pharmacologic interventions for TBI is demonstrated.
Interventions for apathy after traumatic brain injury.
TLDR
No evidence was provided to support the use of CES treatment for inertia, a component of apathy, in adults who have sustained a TBI, and it was not possible to determine the efficacy of the treatment relative to no treatment or sham treatment.
Evidence for the management of challenging behaviours in patients with acute traumatic brain injury or post-traumatic amnesia: An Umbrella Review
TLDR
The current evidence for the management of challenging behaviours in patients with acute TBI/PTA is generally equivocal, potentially reflecting the heterogeneity of patients with TBI and their clinical behaviours.
Efficacy and Harms of Pharmacological Interventions for Neurobehavioral Symptoms in Post-Traumatic Amnesia after Traumatic Brain Injury: A Systematic Review.
TLDR
There is a paucity of well-designed, adequately powered and controlled studies of pharmacological interventions for NBS in PTA following TBI in adults, and more research is needed to provide evidence-based treatment recommendations and improve care.
Pharmacotherapy for the treatment of aggressive behavior in general adult psychiatry: A systematic review.
TLDR
Weak evidence for antiaggressive effects of antipsychotics, anti-depressants, anticonvulsants, and beta-adrenergic-blocking drugs was found.
Efficacy of amantadine on behavioural problems due to acquired brain injury: A systematic review
TLDR
Amantadine may be efficacious on irritability and aggression after ABI and is a safe drug in the presence of adequate creatinine clearance.
Efficacy and harms of pharmacological interventions for neurobehavioral symptoms in post traumatic amnesia after traumatic brain injury: a systematic review and meta-analysis protocol
TLDR
A systematic review of the evidence on the effectiveness and harms of pharmacotherapy as compared to all types of comparators for the management of neurobehavioral symptoms in post-traumatic amnesia in adults aged 16 years and over who have sustained a traumatic brain injury.
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References

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TLDR
The psychostimulant drugs methylphenidate and DEA were administered in separate trials to a young man who suffered from similar symptoms secondary to a chronic closed head injury and there was a consistent, positive drug effect across behavioral assessments.
Stimulant treatment for the neurobehavioural sequelae of traumatic brain injury.
TLDR
The results support the idea that at least some symptomatic improvement may be gained from low-dose stimulant treatment, although the statistical analysis of the data was compromised by the occurrence of carryover effects from one drug condition to another.
Stimulant treatment for the neurobehavioural sequelae of traumatic brain injury
TLDR
The results support the idea that at least some symptomatic improvement may be gained from low-dose stimulant treatment, although the statistical analysis of the data was compromised by the occurrence of carryover effects from one drug condition to another.
Methotrimeprazine in the treatment of agitation in acquired brain injury patients.
TLDR
While MTZ has been used as a safe and effective neuroleptic in psychiatry for over 40 years, this is the first report of its use in treating agitation in ABI.
Rate of psychiatric illness 1 year after traumatic brain injury.
TLDR
A history of psychiatric illness, an unfavorable global outcome according to the Glasgow Outcome Scale, a lower score on the Mini-Mental State examination, and fewer years of formal education seemed to be important risk factors in the development of a psychiatric illness.
Moclobemide in the treatment of major depressive disorder (DSM-3) following traumatic brain injury.
TLDR
It is concluded that moclobemide may be an effective treatment for MDD following TBI, but properly controlled studies must be carried out to confirm this.
A double-blind controlled study of methylphenidate treatment in closed head injury.
TLDR
The data do not support the clinical use of methylphenidate in the treatment of CHI patients and no significant differences were found between drug and placebo conditions on any of the neurobehavioural measures.
Mood and behavioural disorders following traumatic brain injury: clinical evaluation and pharmacological management.
TLDR
It is suggested that citalopram combined with carbamazepine is effective in reducing depression and behavioural disorders following TBI, and these disturbances should be addressed as soon as possible during the acute rehabilitation period.
Cognitive and behavioural efficacy of amantadine in acute traumatic brain injury: an initial double-blind placebo-controlled study.
TLDR
This initial exploratory study found no differences in rate of cognitive improvement between subjects given amantadine versus those given placebo, however, the small sample size, heterogeneous population, acute time course, and large number of dependent variables limit power and generalizability.
The use of lithium in the treatment of aggressive behaviours with two brain-injured individuals in a state psychiatric hospital.
TLDR
The authors conclude that the use of lithium, within the context of an intensive, behavioural rehabilitation programme, may yield positive effects in the control of aggressive behaviour even in long-term post-injury cases.
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