Fugate L P, Spacek L A, Kresty L A, Levy C E, Johnson J C, Mysiw W J
Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus 43210, USA.
Arch Phys Med Rehabil. 1997 Sep;78(9):924-8. doi: 10.1016/s0003-9993(97)90051-4.
Determine national patterns of measuring and treating agitation after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors.
A 70% random sample of members of the Brain Injury Special Interest Group of the American Academy of Physical Medicine and Rehabilitation was surveyed by telephone.
The survey instrument was designed to determine the most common pharmacologic interventions for agitation and, where possible, match each drug with the target behavioral and cognitive characteristics for which it is prescribed. Data were also collected on the manner in which participants measured agitation and judged treatment efficacy.
One hundred twenty-nine of 157 responded, yielding an 82% response rate. The majority of respondents were not measuring agitation in a standard fashion. The five most frequently prescribed drugs by the expert stratum were carbamazepine, tricyclic antidepressants (TCAs), trazodone, amantadine, and beta-blockers. In comparison, the nonexperts most often reported prescribing carbamazepine, beta-blockers, haloperidol, TCAs, and benzodiazepines. Desyrel (p = .06) and amantadine (p = .001) were significantly more likely to be chosen by experts than by nonexperts. Experts chose haloperidol significantly less often than nonexperts (p = .01). Prescription of sedating drugs such as haloperidol or benzodiazepines was not found to be associated with the acuity of injury of TBI patients in the respondent's practice, practice setting, or years of practice since completing residency. Choice of haloperidol to treat agitation was not significantly associated with the degree to which explosive anger, verbal aggression, or physical aggression were considered important to the respondent's definition of agitation.
The majority of physiatrists surveyed did not formally measure agitation. Treatment strategies differ significantly between general physiatrists and those who specialize in the treatment of patients with TBI. The breadth of pharmacologic agents and strategies identified in this survey probably reflects the lack of research specific to the pathophysiology of the disorder of posttraumatic agitation.
确定对治疗创伤性脑损伤（TBI）幸存者感兴趣的物理治疗师对TBI后激越进行测量和治疗的全国模式。
通过电话对美国物理医学与康复学会脑损伤特别兴趣小组70%的成员进行随机抽样调查。
该调查问卷旨在确定治疗激越最常用的药物干预措施，并在可能的情况下，将每种药物与其所针对的目标行为和认知特征相匹配。还收集了参与者测量激越和判断治疗效果的方式的数据。
157名受访者中有129人回复，回复率为82%。大多数受访者没有以标准方式测量激越。专家层最常开具的五种药物是卡马西平、三环类抗抑郁药（TCA）、曲唑酮、金刚烷胺和β受体阻滞剂。相比之下，非专家最常报告开具的药物是卡马西平、β受体阻滞剂、氟哌啶醇、TCA和苯二氮䓬类药物。专家选择安他乐（p = 0.06）和金刚烷胺（p = 0.001）的可能性明显高于非专家。专家选择氟哌啶醇的频率明显低于非专家（p = 0.01）。在受访者的临床实践、执业环境或完成住院医师培训后的执业年限中，未发现开具氟哌啶醇或苯二氮䓬类等镇静药物与TBI患者的损伤严重程度相关。选择氟哌啶醇治疗激越与爆发性愤怒、言语攻击或身体攻击对受访者定义激越的重要程度之间无显著关联。
大多数接受调查的物理治疗师没有正式测量激越。普通物理治疗师与专门治疗TBI患者的物理治疗师之间的治疗策略存在显著差异。本次调查中确定的药物和策略范围可能反映了针对创伤后激越障碍病理生理学的研究不足。
