[Pharmacological treatment of post-traumatic behavioural disorders].
OBJECTIVE
Literature review of the data concerning pharmacologic treatment of post-traumatic behavioural disorders. This review is limited to the treatment of agitation, excitation, mood lability, hostility and agressivity as defined by the NRS and excludes pharmacologic treatment of mental slowness, cognitive disorders and depression.


METHODS
Medline interrogation using keywords Traumatic Brain Injury, Agitation, Agressivity, Behaviour, Pharmacology, Neuroleptics, Benzodiazepines, Carbamazepine, Valproate, Buspirone, SSRI, Propanolol, Methylphenidate and review of recent contents. The data finally includes 29 original studies.


RESULTS
The overall level of evidence is quite low as the data mainly consist in open studies and case reports. These data and data from reviews or didactic articles suggest the efficiency of a variety of treatments. Mood-stabilizing antiepileptics, and specially carbamazepine constitute together with SSRI antidepressants the first choices. Some data suggest efficiency of buspirone, methylphenidate and atypic neuroleptics. Lithium requires close monitoring but is probably efficient. It is difficult to conclude concerning propanolol.


CONCLUSIONS
The available data is in favour of the use of CBZ and SSRI antidepressants. Further studies are required. It is necessary to establish clear evidence of the efficiency of CBZ and assess the effects of methylphenidate, which is almost not prescribed in France.
Richard
I
I
Service de médecine physique et réadaptation, centre hospitalier universitaire, rue des Capucins, BP 40329, 49103, Angers, France. isabelle.richard@med.univ-angers.fr <isabelle.richard@med.univ-angers.fr>
Perrouin-Verbe
B
B
Rome
J
J
Bernat
C
C
Mathé
J F
JF
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000374:Aggression; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications*; D002220:Carbamazepine / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D004311:Double-Blind Method; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D001523:Mental Disorders / Q000188:drug therapy* / Q000209:etiology; D008774:Methylphenidate / Q000627:therapeutic use; D010919:Placebos; D011446:Prospective Studies; D011595:Psychomotor Agitation; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D014149:Tranquilizing Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants; D018020:Lithium Compounds; D010919:Placebos; D011619:Psychotropic Drugs; D014149:Tranquilizing Agents; D008774:Methylphenidate; D002220:Carbamazepine