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Pharmacological management of agitation among individuals with moderate to severe acquired brain injury: A systematic review

ABSTRACT Objective: To conduct a systematic review examining the effectiveness of pharmacological management of agitation among individuals with acquired brain injury (ABI). Data sources: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published in English from 1980 to January 2016. Study selection: Studies were included for analysis all participants had moderate to severe ABI, n ≥ 3, and a pharmacological intervention was provided for the treatment of agitation and its effectiveness was assessed. Data extraction: Data extracted included participant demographics, inclusion and exclusion criteria, study design, outcome measure(s), and results. Study quality was assessed using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs). A level of evidence was assigned to each intervention using a modified Sackett scale. Data synthesis: Among 165 retrieved studies, 19 met inclusion criteria. The included studies consisted of 6 RCTs and 13 observational studies. Antipsychotic medications were studied predominately (n = 6), followed by anticonvulsants (n = 4) and dopaminergic (n = 4), antidepressants (n = 3), and beta-blockers (n = 2). Dopaminergic medications, specifically amantadine, had the highest level of evidence (Level 1a). The antipsychotic lithium carbonate was shown to be effective but was not recommended for use due to high risk of neurotoxicity. Conclusions: Studies consistently demonstrated that pharmacological treatment was effective in reducing agitation post ABI; however, there was insufficient information to develop a conclusion due to the limited number of studies and overall weakness of evidence for each individual medication.