Magazine article Drug Topics

New Report Offers Guide to Brain Injuries

Magazine article Drug Topics

New Report Offers Guide to Brain Injuries

Article excerpt

With traumatic brain injury (TBI), the first question we often ask is, Will the patient recover? Beyond concerns about cognitive function and disability, little is generally known about the milestones and setbacks patients encounter while recovering from a TBI.

Most don't realize that neurobehavioral problems are the most debilitating sequelae in individuals attempting to reestablish family and work relationships after a TBI. New evidence-based guidelines, published in October's ]ournal of Neurotrauma, offer treatment recommendations for several neurobehavioral disorders associated with TBIs, such as mood and anxiety disorders, psychotic syndromes, aggression, and problems with attention and speed of information processing. "TBI may result in a complex mixture of mental impairment and psychiatric disorders for which pharmacotherapy ... should be a mainstay of treatment," asserted Tamira Mullarkey, R.Ph., M.S., clinical pharmacist at Clara Maass Medical Center in N.J.

As a general consideration, the report noted that patients with TBIs are more refractory to treatment, more prone to the various side effects of psychotropic agents, and may not respond to traditional psychotropic therapy. A number of clinicians are said to feel strongly that some standard agents are ineffective or may be associated with excess toxicity in brain-injured patients. And at this point, it would be difficult to agree or disagree with this statement since the three panels of experts who developed the guidelines concluded that, with some exceptions, "the quality of evidence was insufficient to support specific therapeutic standards." The guidelines should, therefore, be used only to "guide pharmacologie treatment recommendations."

Despite the absence of concrete evidence, many therapeutic recommendations in the guidelines appear to follow a rationale similar to that for non-brain-injured patients. "You want to use agents with the best tolerability profiles-especially in complicated patients such as those with TBI," noted Mullarkey. And "since these patients will require numerous medications, it's important to closely monitor for response to therapy and adverse effects."

For depression, a common occurrence in patients with TBI, the guidelines recommend the tricydic antidepressants amitriptyline and desipramine but contend that side effects may limit their utility. …

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