Ann Rehabil Med.  2018 Feb;42(1):35-41. 10.5535/arm.2018.42.1.35.

Pharmacotherapy Prescription Trends for Cognitive-Behavioral Disorder in Patients With Brain Injury in Korea

Affiliations
  • 1Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. drkohy@gmail.com
  • 2Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

Abstract


OBJECTIVE
To investigate the current status of pharmacotherapy prescribed by physiatrists in Korea for cognitive-behavioral disorder.
METHODS
A cross-sectional study was performed by mailing questionnaires to 289 physiatrists working at teaching hospitals. Items on the questionnaire evaluated prescribing patterns of 16 drugs related to cognitive-behavioral therapy, the status of combination pharmacotherapy, and tools for assessing target symptoms.
RESULTS
Fifty physiatrists (17.3%) including 24 (48%) specializing in neurorehabilitation completed the questionnaires. The most common target symptom was attention deficit (29.5%). Donepezil and methylphenidate (96.0%) were the most frequently prescribed drugs for cognitive-behavioral improvement. Mostly, a combination of two drugs was prescribed (38.0%), and the most common combination therapy included donepezil plus methylphenidate (19.1%). Pharmacotherapy for cognitive-behavioral disorder after brain injury was typically initiated within 2 months (69.5%). A follow-up assessment was usually performed at 1 month after treatment initiation (31.0%). The most common reason for treatment discontinuation was improvement of target symptoms (37.8%). The duration of pharmacotherapy was 3-12 months (57.7%), 1-2 years (17.9%), or 1-2 months (13.6%).
CONCLUSION
According to the survey, combination pharmacotherapy is preferred to monotherapy for the treatment of cognitive-behavioral disorder in patients with brain injury. Physiatrists expressed diverse views on the definition of target symptoms, prescribing patterns, and the status of drug combination therapy. Guidelines are needed for cognitive-behavioral pharmacotherapy. Further research should investigate drug costs and aim to reduce polypharmacy and adverse drug reactions.

Keyword

Cognition; Behavioral symptoms; Drug therapy; Brain injuries

MeSH Terms

Behavioral Symptoms
Brain Injuries*
Brain*
Cognition
Cross-Sectional Studies
Drug Costs
Drug Therapy*
Drug-Related Side Effects and Adverse Reactions
Follow-Up Studies
Hospitals, Teaching
Humans
Korea*
Methylphenidate
Neurological Rehabilitation
Polypharmacy
Postal Service
Prescriptions*
Methylphenidate

Figure

  • Fig. 1 Target cognitive-behavioral symptoms.

  • Fig. 2 Proportion of the number of medications prescribed for cognitive-behavioral treatment.

  • Fig. 3 Prescribing preferences for combination pharmacotherapy for cognitive-behavioral treatment.


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