title: Behavioral and affective disorders after brain injury: French guidelines for prevention and community supports.
abstract: OBJECTIVE
  The purpose of this study was to elaborate practice guidelines for the prevention of behavioral and affective disorders in adult outpatients after traumatic brain injury (TBI); but also to identify the support systems available for family, caregivers of patients with TBI within the community.
  
  
  METHODS
  The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. This involved a systematic and critical review of the literature looking for studies that investigated the impact of programs in community settings directed to behavioral and affective disorders post-TBI. Recommendations were than elaborated by a group of professionals and family representatives.
  
  
  RESULTS
  Only six articles were found comprising 4 studies with a control group. Two studies showed a beneficial effect of personalized behavior management program delivered within natural community settings for persons with brain injury and their caregivers. Two other studies showed the relevance of scheduled telephone interventions to improve depressive symptoms and one study emphasized the usefulness of physical training. One study investigated the relevance of an outreach program; this study showed an improvement of the patients' independence but did not yield any conclusions regarding anxiety and depression.
  
  
  CONCLUSIONS
  In addition to the application of care pathways already established by the SOFMER, prevention of behavioral and affective disorders for brain-injured outpatients should involve pain management, as well as development of therapeutic partnerships. It is recommended to inform patients, their family and caregivers regarding the local organization and facilities involved in the management of traumatic brain injury. The relevance of therapeutic education for implementing coping strategies, educating caregivers on behavioral disorder management, follow-up telephone interventions, and holistic therapy seems established. The level of evidence is low and preliminary studies should be confirmed with larger controlled trials.
authors.affiliation: Service de médecine physique et de réadaptation, rééducation neurologique, hôpital Henry-Gabrielle, CHU de Lyon, 69230 Saint-Genis-Laval, France; Équipe IMPACT, Inserm, U1028, CNRS, UMR 5292, centre de recherche en neuroscience de Lyon (CRNL), Lyon, France. Electronic address: jacques.luaute@chu-lyon.fr.
authors.forename: J
authors.initials: J
authors.lastname: Luauté
authors.affiliation: Service de médecine physique et réadaptation, CHU de Limoges, 87042 Limoges, France.
authors.forename: J
authors.initials: J
authors.lastname: Hamonet
authors.affiliation: Service de rééducation, hôpital de la Salpetrière, AP-HP, CHU de Paris, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Pradat-Diehl
mesh_terms: D000359:Aftercare; D001930:Brain Injuries / Q000523:psychology*; D017028:Caregivers / Q000193:education*; D003156:Community Mental Health Services; D032921:Consensus; D005602:France; D006801:Humans; D001523:Mental Disorders / Q000209:etiology / Q000517:prevention & control*; D019964:Mood Disorders / Q000209:etiology / Q000517:prevention & control; D010353:Patient Education as Topic; D017216:Telemedicine
keywords: Affective disorders; Behavioral disorders; Community; Outpatients; Support systems; Traumatic brain injury