Richard I, Perrouin-Verbe B, Rome J, Bernat C, Mathé J F
Service de médecine physique et réadaptation, centre hospitalier universitaire, rue des Capucins, BP 40329, 49103, Angers, France.
Ann Readapt Med Phys. 2003 Feb;46(1):49-57. doi: 10.1016/s0168-6054(02)00353-7.
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.
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.
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.
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.
对创伤后行为障碍药物治疗的数据进行文献综述。本综述仅限于对由NRS定义的激越、兴奋、情绪不稳定、敌意和攻击性的治疗，不包括对精神迟缓、认知障碍和抑郁的药物治疗。
使用关键词“创伤性脑损伤”“激越”“攻击性”“行为”“药理学”“抗精神病药”“苯二氮䓬类”“卡马西平”“丙戊酸盐”“丁螺环酮”“选择性5-羟色胺再摄取抑制剂（SSRI）”“普萘洛尔”“哌醋甲酯”检索Medline，并查阅近期文献。最终纳入29项原始研究。
证据总体水平较低，因为数据主要包括开放性研究和病例报告。这些数据以及综述或指导性文章的数据表明多种治疗方法有效。心境稳定剂类抗癫痫药，尤其是卡马西平与SSRI类抗抑郁药是首选。一些数据表明丁螺环酮、哌醋甲酯和非典型抗精神病药有效。锂盐需要密切监测，但可能有效。关于普萘洛尔难以得出结论。
现有数据支持使用卡马西平和SSRI类抗抑郁药。需要进一步研究。有必要明确卡马西平有效性的证据，并评估哌醋甲酯的效果，哌醋甲酯在法国几乎未被处方使用。
