Psychotropic medication use during inpatient rehabilitation for traumatic brain injury

Flora Hammond, Ryan S. Barrett, Timothy Shea, Ronald T. Seel, Thomas W. McAlister, Darryl Kaelin, David K. Ryser, John D. Corrigan, Nora Cullen, Susan D. Horn

Research output: Contribution to journalArticle

23 Citations (Scopus)

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. Design Prospective observational cohort. Setting Multiple acute inpatient rehabilitation units or hospitals. Participants Individuals with TBI (N=2130; complicated mild, moderate, or severe) admitted for inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures 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.

Original languageEnglish (US)
Pages (from-to)S256-S273e14
JournalArchives of Physical Medicine and Rehabilitation
Volume96
Issue number8
DOIs
StatePublished - Aug 1 2015

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Inpatients
Rehabilitation
Narcotics
Anticonvulsants
Antipsychotic Agents
Antiparkinson Agents
Anti-Anxiety Agents
Antidepressive Agents
Hospital Units
Traumatic Brain Injury
Hypnotics and Sedatives
Cognition
Substance-Related Disorders
Seizures
Anxiety
Outcome Assessment (Health Care)
Depression
Pain
Wounds and Injuries

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

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Psychotropic medication use during inpatient rehabilitation for traumatic brain injury. / Hammond, Flora; Barrett, Ryan S.; Shea, Timothy; Seel, Ronald T.; McAlister, Thomas W.; Kaelin, Darryl; Ryser, David K.; Corrigan, John D.; Cullen, Nora; Horn, Susan D.

In: Archives of Physical Medicine and Rehabilitation, Vol. 96, No. 8, 01.08.2015, p. S256-S273e14.

Research output: Contribution to journalArticle

Hammond, F, Barrett, RS, Shea, T, Seel, RT, McAlister, TW, Kaelin, D, Ryser, DK, Corrigan, JD, Cullen, N & Horn, SD 2015, 'Psychotropic medication use during inpatient rehabilitation for traumatic brain injury', Archives of Physical Medicine and Rehabilitation, vol. 96, no. 8, pp. S256-S273e14. https://doi.org/10.1016/j.apmr.2015.01.025
Hammond, Flora ; Barrett, Ryan S. ; Shea, Timothy ; Seel, Ronald T. ; McAlister, Thomas W. ; Kaelin, Darryl ; Ryser, David K. ; Corrigan, John D. ; Cullen, Nora ; Horn, Susan D. / Psychotropic medication use during inpatient rehabilitation for traumatic brain injury. In: Archives of Physical Medicine and Rehabilitation. 2015 ; Vol. 96, No. 8. pp. S256-S273e14.
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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. Design Prospective observational cohort. Setting Multiple acute inpatient rehabilitation units or hospitals. Participants Individuals with TBI (N=2130; complicated mild, moderate, or severe) admitted for inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures 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.",
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AU - Kaelin, Darryl

AU - Ryser, David K.

AU - Corrigan, John D.

AU - Cullen, Nora

AU - Horn, Susan D.

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N2 - Objective To describe psychotropic medication administration patterns during inpatient rehabilitation for traumatic brain injury (TBI) and their relation to patient preinjury and injury characteristics. Design Prospective observational cohort. Setting Multiple acute inpatient rehabilitation units or hospitals. Participants Individuals with TBI (N=2130; complicated mild, moderate, or severe) admitted for inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures 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.

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