title: What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices.
abstract: Behavioral disorders are major sequelae of severe traumatic brain injury. Before considering care management of these disorders, and in the absence of a precise definition for TBI-related behavioral disorder, it is essential to refine, according to the data from the literature, incidence, prevalence, predictive factors of commonly admitted disruptive symptoms.
  
  
  METHODS
  Systematic review of the literature targeting epidemiological data related to behavioral disorders after traumatic brain injury in order to elaborate good practice recommendations according to the methodology established by the French High Authority for Health.
  
  
  RESULTS
  Two hundred and ninety-nine articles were identified. The responsibility of traumatic brain injury (TBI) in the onset of behavioral disorders is unequivocal. Globally, behavioral disorders are twice more frequent after TBI than orthopedic trauma without TBI (Masson et al., 1996). These disorders are classified into disruptive primary behaviors by excess (agitation 11-70%, aggression 25-39%, irritability 29-71%, alcohol abuse 7-26% drug abuse 2-20%), disruptive primary behaviors by default (apathy 20-71%), affective disorders - anxiety - psychosis (depression 12-76%, anxiety 0.8-24,5%, posttraumatic stress 11-18%, obsessive-compulsive disorders 1.2-30%, psychosis 0.7%), suicide attempts and suicide 1%.
  
  
  CONCLUSIONS
  The improvement of care management for behavioral disorders goes through a first step of defining a common terminology. Four categories of posttraumatic behavioral clinical symptoms are defined: disruptive primary behaviors by excess, by default, affective disorders-psychosis-anxiety, suicide attempts and suicide. All these symptoms yield a higher prevalence than in the general population. They impact all of life's domains and are sustainable over time.
authors.affiliation: Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Saint-Jacques, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex, France. Electronic address: stefan.angelique@wanadoo.fr.
authors.forename: Angélique
authors.initials: A
authors.lastname: Stéfan
authors.affiliation: Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Saint-Jacques, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Mathé
mesh_terms: D000374:Aggression; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D001930:Brain Injuries / Q000523:psychology*; D003415:Crime; D019317:Evidence-Based Medicine; D006801:Humans; D015994:Incidence; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology*; D019964:Mood Disorders / Q000453:epidemiology / Q000209:etiology; D017410:Practice Guidelines as Topic; D011618:Psychotic Disorders / Q000453:epidemiology / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology; D013405:Suicide
keywords: Behavioral disorders; Brain injury; Classification; Good practices recommendations