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The Use of Atypical Antipsychotics for Managing Agitation After Traumatic Brain Injury.

OBJECTIVE
This study examined the use of antipsychotics for managing agitation during posttraumatic amnesia (PTA) after traumatic brain injury (TBI) and its relationship with agitated behavior.


DESIGN
Observational prospective study with correlational design.


SETTING
Inpatient rehabilitation hospital for TBI.


PARTICIPANTS
A total of 125 consecutive admissions who were in PTA and had moderate-severe TBI.


MEASURES
Antipsychotic use was compared with agitation levels as measured by the total scores on the Agitated Behavior Scale (ABS).


RESULTS
Atypical antipsychotics were used in one-third of participants to manage agitation. Antipsychotic use was more common in participants with high levels of global agitation; however, there were many on antipsychotics who had mild or even no agitation according to the ABS. Uncontrolled observational data found no reduction in agitation after antipsychotic commencement or dose increase.


CONCLUSIONS
Antipsychotics are commonly used to manage agitation after TBI despite limited evidence of efficacy. Agitation should be formally monitored in PTA to ensure antipsychotics are used to manage more severe agitation and for evaluating treatment response. Research is needed to understand why prescribers are using antipsychotics when agitation is mild or below clinical thresholds.