Prevalence of neuropsychiatric symptoms and psychotropic drug use in patients with acquired brain injury in long-term care: a systematic review

Figures & data

Table 1. Used search terms in Pubmed.

Setting:
(“Long Term Care”[MeSH] OR “Long Term Care”[All Fields] OR “Nursing Homes”[MeSH] OR Nursing Home*[All Fields] OR “Skilled Nursing Facilities”[MeSH] OR Skilled Nursing Facilit*[All Fields])
Causes:
(“Brain Abscess”[MeSH] OR Brain Abscess*[All Fields] OR “Brain Anoxia”[All Fields] OR Brain Hemorrhage*[All Fields] OR “Brain Infarction”[MeSH] OR Brain Infarction*[All Fields] OR Brain Inflammation*[All Fields] OR “Brain Injury, Chronic”[MeSH] OR “Brain Injuries”[MeSH] OR Brain Injur*[All Fields] OR “Brain Stem Hemorrhage, Traumatic”[MeSH] or Brain Stem Hemorrhage*[All Fields] OR Brainstem Hemorrhage*[All Fields] OR “Brain Stem Infarctions”[MeSH] OR Brain Stem Infarction*[All Fields] OR Cerebral Abscess*[All Fields] OR “Cerebral Anoxia”[All Fields] OR “Cerebral Hemorrhage”[MeSH] OR “Cerebral Hemorrhage, Traumatic”[MeSH] OR Cerebral Hemorrhage*[All Fields] OR “Cerebrovascular Trauma”[MeSH] OR “Encephalitis”[MeSH] OR Encephalitis[All Fields] OR Encephalopath*[All Fields] OR “Head Injuries, Penetrating”[MeSH] OR Head Injur*[All Fields] OR “Hypoxia, Brain”[MeSH] OR “Intracranial Hemorrhage, Hypertensive”[MeSH] OR “Leukoencephalitis, Acute Hemorrhagic”[MeSH] OR Locked In Syndrome[All Fields] OR Locked-in Syndrome[All Fields] OR “Meningioma”[MeSH] OR Meningioma*[All Fields] OR “Meningitis”[MeSH] OR Meningitis[All Fields] OR “Quadriplegia”[MeSH] OR Quadriplegia[All Fields] OR “Stroke”[MeSH] OR Stroke*[All Fields] OR “Subarachnoid Hemorrhage”[MeSH] OR Subarachnoid Hemorrhage*[All Fields] OR TBI[All Fields])
Neuropsychiatric Symptoms:
(“Affect”[MeSH] OR Affect[All Fields] OR “Aggression”[MeSH] OR Aggression[All Fields] OR Agitation[All Fields] OR “Anxiety”[MeSH] OR Anxiety[All Fields] OR “Apathy”[MeSH] OR Apathy[All Fields] OR “Appetite”[MeSH] OR Appetite[All Fields] OR “Behavioral Symptoms”[MeSH] OR Behavioral Symptom*[All Fields] OR Behavioural Symptom*[All Fields] OR “Cooperative Behavior”[MeSH] OR Cooperative Behavior*[All Fields] OR Cooperative Behaviour*[All Fields] OR “Delusions”[MeSH] OR Delusion*[All Fields] OR “Depression”[MeSH] OR Depression[All Fields] OR “Depressive Disorder”[MeSH] OR Depressive Disorder*[All Fields] OR Disinhibition[All Fields] OR Eating Disorder*[All Fields] OR “Euphoria”[MeSH] OR Euphoria[All Fields] OR “Feeding and Eating Disorders”[MeSH] OR “Hallucinations”[MeSH] OR Hallucination*[All Fields] OR “Hearing Loss”[MeSH] OR Hearing[All Fields] OR “Irritable Mood”[MeSH] OR Irritable Mood[All Fields] OR Irritability[All Fields] OR “Mental Health”[MeSH] OR Mental[All Fields] OR “Mood Disorders”[MeSH] OR Mood Disorder*[All Fields] “Neurobehavioral Manifestations”[MeSH] OR Neurobehavioral Manifestation*[All Fields] OR Neurobehavioural Manifestation*[All Fields] OR “Neuropsychiatry”[MeSH] OR Neuropsychiatry[All Fields] OR Neuropsychiatric[All Fields] OR “Neuropsychology”[MeSH] OR Neuropsychology[All Fields] OR “Personality”[MeSH] OR Personality[All Fields] OR “Psychomotor Agitation”[MesH] OR Psychosis[All Fields] OR “Psychotic Disorders”[MeSH] OR Psychotic Disorder*[All Fields] OR “Sexual Behavior”[MeSH] OR Sexual Behavior*[All Fields] OR Sexual Behaviour*[All Fields] OR Sleep Behavior Disorder*[All Fields] OR Sleep Behaviour Disorder*[All Fields] OR “Sleep Wake Disorders”[MeSH] OR Sleep Disorder*[All Fields] OR “Social Behavior Disorders”[MeSH] OR Social behavior Disorder*[All Fields] OR Social Behaviour Disorder*[All Fields] OR “Somnambulism”[MeSH] OR Vision[All Fields] OR “Vision Disorders”[MeSH] OR “Wandering Behavior”[MeSH] OR Wandering Behavior*[All Fields] OR Wandering Behaviour*[All Fields] OR Nocturnal Wandering[All Fields])
Psychotropic Drugs:
(“Antidepressive Agents”[MeSH] OR Antidepressive[All Fields] OR “Antipsychotic Agents”[MeSH] OR Antipsychotic[All Fields] OR “Drug Prescriptions”[MeSH] OR “Hallucinogens”[MeSH] OR Hallucinogen*[All Fields] OR Pharmacologic*[All Fields] OR Pill*[All Fields] OR Prescribing[All Fields] OR Prescription*[All Fields] OR “Psychotropic Drugs”[MeSH] OR Psychotropic[All Fields] OR “Tranquilizing Agents”[MeSH] OR Tranquilizing[All Fields] OR Tranquilizer*[All Fields] OR Hypnotic*[All Fields] OR Sedative*[All Fields])

Table 2. Methodological evaluation of the studies (Boyle, 1998).

	Buchanan et al., 2003 (21)	McMillan et al., 2004 (22)	Gabella et al., 2007 (23)	Karon et al., 2007 (24)	Belanger et al., 2008 (25)	Wolf-Ostermann et al., 2004 (26)
1. Was the target population defined clearly?	1	1	1	1	1	1
2. Was probability sampling used to identify potential respondents, or the whole population approached?	1	1	1	1	1	1
3. Did characteristics of respondents match the target population?	1	1	1	1	1	1
4. Were the data collection methods standardized?	1	1	1	1	1	1
5. Were the survey instruments reliable?	?	0.5	?	0.5	0.5	1
6. Were the survey instruments valid?	0.5	0.5	0.5	0.5	0.5	0.5
7. Were special features of the sampling design accounted for in the analysis, through appropriate weighting of the data, or the whole population approached?	1	1	1	1	1	1
8. Do the reports include confidence intervals for statistical estimates or was the whole population approached?	1	1	1	1	1	1
Quality Score	6.5	7	6.5	7	7	7.5

Figure 1. Search and selection procedure of the articles.

Table 3. Characteristics of the studies.

Reference	Country	Study Design	Setting	N	Age (SD/Range)	Type of ABI	Instruments
Buchanan et al., 2003 (21)	USA	Cross-sectional	Nursing Home	12300	53.1 (21.2)	Traumatic Brain Injury	Minimum Data Set
McMillan et al., 2004 (22)	Scotland	Cross-sectional	Nursing Home	92	50 (10)	Traumatic Brain Injury Stroke Alcohol Related Other Brain Injury	Questionnaire Medication Cardex
Gabella et al., 2007 (23)	USA	Cross-sectional	Nursing Home	239*	53 (18–99) †	Traumatic Brain Injury	Minimum Data Set
Karon et al., 2007 (24)	USA	Cross-sectional	Nursing Home	3912‡ 26472§	54.3 64.6	Traumatic Brain Injury	Minimum Data Set
Belanger et al., 2008 (25)	USA	Cross-sectional	Nursing Home	537‖	61.56 (14.85)	Traumatic Brain Injury	Minimum Data Set
Wolf-Ostermann et al., 2014 (26)	Germany	Longitudinal	RLF/SLA	40	46.2 (12.1)	Traumatic Brain Injury Subarachnoidal Haemorrhage Inflammation/Toxic Stroke Other Brain Injury	Hospital Anxiety Depression Scale

SD = Standard Deviation. NPS = Neuropsychiatric Symptoms. RLF = Residential Living Facility. SLA = Supported Living Accommodations. USA = United States of America. * = Population of patients with only TBI. † = Median. ‡ = Common Definition. § = Expanded Definition. ‖ = TBI Nonwanderers.

Table 4. Neuropsychiatric symptoms and psychotropic drug use.

Reference	Behaviour/NPS	N	Psychotropic Use	N
Buchanan et al. (21).	Depression Physically Abuse Others Verbally Abuse Others Socially Inappropriate Behaviour	21% 9% 13% 16%	Antidepressant Antipsychotic Anxiolytic	26% 19% 12%
McMillan et al. (22).	Challenging Behaviour Physically Violent	32 9	Major Tranquillizer Anticonvulsant Antidepressant Minor Tranquillizer	33 (36%)* 36 (35%)* 31 (34%)* 21 (23%)*
Gabella et al. (23).	Depression Anxiety Abusive Behaviour Inappropriate Behaviour	39.3% 10% 15% 18%
Karon et al. (24).	Verbally Abusive‡ Physically Abusive Socially Inappropriate Verbally Abusive§ Physically Abusive Socially Inappropriate	17.2% 9.8% 25.2% 13.9% 7.8% 19.8%
Belanger et al. (25).	Anxiety Disorder Depression Bipolar Disease Schizophrenia	47 (8.75%) 152 (28.31%) 12 (2.23%) 33 (6.15%)
Wolf-Ostermann et al. (26).	Borderline Anxiety Anxiety Borderline Depression Depression	4/36 (11.1%) 1/36 (2.8%) 5/36 (13.9%) 5/36 (13.9%)

NPS = Neuropsychiatric Symptoms. * = Some patients received more than one medication of this type. ‡ = Common Definition. § = Expanded Definition.

Boyle MH. Guidelines for evaluating prevalence studies. Evid Based Ment Health. 1998;1(2):37–39. doi:10.1136/ebmh.1.2.37.

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