title: Prescribing practice and off-label use of psychotropic medications in post-acute brain injury rehabilitation centres: a cross-sectional survey.
abstract: OBJECTIVE
  Guidance on pharmacotherapy of neurobehavioural sequelae post-acquired brain injury (ABI) is limited. Clinicians face the choice of prescribing off-label. This survey assesses prescribing practice and off-label use of psychotropic medications in Italian brain injury rehabilitation centres and factors associated with atypical antipsychotics use.
  
  
  METHODS
  Centres were identified through the roster of the Italian Society for Rehabilitation Medicine. Information was collected through a structured questionnaire. This study calculated the prevalence of centres reporting to use off-label individual medications and unconditional logistic regression Odds Ratio (OR), with 95% confidence interval (95% CI) of atypical antipsychotics use.
  
  
  RESULTS
  Psychotropic medications were commonly used. More than 50% of the 35 centres (participation ratio 87.5%) reported to use off-label selected antipsychotics, mostly for agitation (90.5%) and behavioural disturbances (19.0%), and antidepressants, mostly for insomnia (37.5%) and pain (25.0%). Atypical antipsychotic use was directly associated with age <40 years (OR = 2.68; 95% CI = 1.25-5.76), recent ABI (1.74; 0.74-4.09), not with reported off-label use (0.98; 0.44-2.18).
  
  
  CONCLUSIONS
  In clinical practice, the effectiveness and safety of medications, in particular off-label, should be systematically monitored. Studies are needed to improve the quality of evidence guiding pharmacotherapy and to evaluate effectiveness and safety of off-label prescribing.
authors.affiliation: Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine , Udine , Italy .
authors.forename: Federica Edith
authors.initials: FE
authors.lastname: Pisa
authors.forename: Giorgia
authors.initials: G
authors.lastname: Cosano
authors.forename: Manuela
authors.initials: M
authors.lastname: Giangreco
authors.forename: Tullio
authors.initials: T
authors.lastname: Giorgini
authors.forename: Emanuele
authors.initials: E
authors.lastname: Biasutti
authors.forename: Fabio
authors.initials: F
authors.lastname: Barbone
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000188:drug therapy* / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data
chemical_list: D011619:Psychotropic Drugs
keywords: Acquired brain injuries; antidepressants; antiepileptic agents; antipsychotics; off-label; pharmacoepidemiology; prescribing; prevalence; psychotropic medications; survey