To give an overview of the management of behavioral disorders following traumatic brain injury (TBI) in a cohort of 129 patients, in post-acute period.

This cross-sectional regional cohort study included 129 adults suffering from moderate-to-severe TBI, in post-acute period, and referred to medical or community-based facilities in our region. A structured interview of patients and proxies collected information regarding socio-demographic data and the ongoing interventions, including psychotherapy and medication. Psychiatric outcomes were assessed by the Hospital Anxiety and Depression scale (HADS), and behavioral disorders by the Behavioral Dysexecutive Syndrome Inventory (BDSI). Each type of intervention was expressed as the prevalence in percentage of the study sample. Chi² test, Fisher's exact test or Student's t-test were used to search an association between the type of intervention and behavioral disorders, living area, psychiatric outcomes, psychiatric history, or delay after TBI.

Patients were predominantly young men (mean age 26 years and 76% males) having sustained traffic accidents (78%). Forty-four percent received no interventions; 33% received psychotherapy and 43% were on pharmacological medication. Twenty-three percent received medication alone with no other intervention. The prescribed medications were antidepressants (21%), neuroleptics (18%), anxiolytics (16%), mood stabilizers (14%) but no beta-blockers. Polypharmacy concerned 20% of patients. BDSI was completed for 120 patients and 85 (71%) presented current BDS. The main factor that was found to be associated with the different types of prescription was BDS. Patients with current BDS received more frequently interventions (P=0.004), psychotherapy (P=0.048), medications, all types combined (P=0.007), and antiepileptics mood stabilizers (P=0.037).

Our study highlights that compliance with the current recommendations remains insufficient. Non-pharmacological interventions, like psychotherapy, are inadequately implemented, although they are recommended as a first line treatment. Medications are overused, especially neuroleptics. Recommended medications, such as mood stabilizers and beta-blockers, are poorly used.