title: Psychotropic Medication Use During Inpatient Rehabilitation for Traumatic Brain Injury.
abstract: OBJECTIVE
  To describe psychotropic medication administration patterns during inpatient rehabilitation for traumatic brain injury (TBI) and their relation to patient preinjury and injury characteristics.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  Multiple acute inpatient rehabilitation units or hospitals.
  
  
  METHODS
  Individuals with TBI (N=2130; complicated mild, moderate, or severe) admitted for inpatient rehabilitation.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Carolinas Rehabilitation, Charlotte, NC; Indiana University School of Medicine, Indianapolis, IN. Electronic address: flora.hammond@rhin.com.
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.affiliation: Institute for Clinical Outcomes Research, Salt Lake City, UT.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Barrett
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Timothy
authors.initials: T
authors.lastname: Shea
authors.affiliation: Crawford Research Institute, Shepherd Center, Atlanta, GA.
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Seel
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: McAlister
authors.affiliation: University of Louisville School of Medicine and Frazier Rehabilitation Institute, Louisville, KY.
authors.forename: Darryl
authors.initials: D
authors.lastname: Kaelin
authors.affiliation: Intermountain Medical Center, Salt Lake City, UT.
authors.forename: David K
authors.initials: DK
authors.lastname: Ryser
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: John D
authors.initials: JD
authors.lastname: Corrigan
authors.affiliation: Toronto Rehabilitation Institute, Toronto, ON, Canada.
authors.forename: Nora
authors.initials: N
authors.lastname: Cullen
authors.affiliation: Institute for Clinical Outcomes Research, Salt Lake City, UT.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000188:drug therapy* / Q000534:rehabilitation*; D002170:Canada; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019338:Polypharmacy; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000145:classification / Q000627:therapeutic use*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D014481:United States
chemical_list: D011619:Psychotropic Drugs
keywords: Amantadine; Antidepressive agents; Antipsychotic agents; Brain injuries; Central nervous system stimulants; Drug therapy; Medication therapy management; Patient care; Physician's practice patterns; Polypharmacy; Rehabilitation