National Center for PTSD, Sierra-Pacific Mental Illness Research, Education and Clinical Center, Menlo Park, CA 94205, USA.
Psychiatr Serv. 2012 Feb 1;63(2):154-60. doi: 10.1176/appi.ps.201100199.
Clinical practice guidelines for the pharmacological treatment of posttraumatic stress disorder (PTSD) do not support the use of benzodiazepines and cite insufficient evidence to recommend mood stabilizers. Although guidelines previously recommended second-generation antipsychotics as adjunct medication, recent research findings have also brought this recommendation into question. This study aimed to determine which characteristics of veterans with diagnosed PTSD were associated with receiving prescriptions for benzodiazepines and mood stabilizers and second-generation antipsychotics.
The survey responses of 482 veterans with PTSD were combined with prescription information from Veterans Affairs national pharmacy databases. The researchers assessed the use of eight classes of psychotropics prescribed for patients with PTSD in the year after a new PTSD diagnosis. Multivariate logistic regressions identified demographic characteristics, symptom severity, co-occurring psychiatric diagnoses, health service use, and attitudinal characteristics associated with prescribing of benzodiazepines, second-generation antipsychotics, and mood stabilizers.
In the absence of a clearly indicated co-occurring psychiatric diagnosis, long-term benzodiazepines were prescribed to 14%, second-generation antipsychotics to 15%, and mood stabilizers to 18% of veterans with PTSD. Benzodiazepine prescribing was associated with symptoms of insomnia. Having a mental health inpatient stay (odds ratio [OR]=8.01, p<.001) and at least one psychotherapy visit (OR=5.37, p<.001) were predictors of being prescribed a second-generation antipsychotic. Reporting more symptom severity (OR=1.84, p<.001) and fewer alcohol use problems (OR=.36, p<.03) predicted being prescribed a mood stabilizer.
Prescribing patterns appeared generally consistent with treatment guidelines. Notable exceptions and areas worthy of future attention are discussed.
创伤后应激障碍（PTSD）的药理学治疗临床实践指南不支持使用苯二氮䓬类药物，并引用证据不足来推荐情绪稳定剂。尽管指南先前推荐第二代抗精神病药作为辅助药物，但最近的研究结果也使这一建议受到质疑。本研究旨在确定哪些 PTSD 诊断患者的特征与开具苯二氮䓬类药物、情绪稳定剂和第二代抗精神病药的处方有关。
将 482 名 PTSD 退伍军人的调查答复与退伍军人事务部全国药房数据库中的处方信息相结合。研究人员评估了在 PTSD 新诊断后的一年中，为 PTSD 患者开具的八种精神药物的使用情况。多变量逻辑回归确定了与开具苯二氮䓬类药物、第二代抗精神病药和情绪稳定剂处方相关的人口统计学特征、症状严重程度、共病精神诊断、卫生服务使用和态度特征。
在没有明确共病精神诊断的情况下，14%的 PTSD 退伍军人长期开苯二氮䓬类药物，15%开第二代抗精神病药，18%开情绪稳定剂。苯二氮䓬类药物的处方与失眠症状有关。有精神科住院治疗（优势比[OR]=8.01，p<.001）和至少一次心理治疗就诊（OR=5.37，p<.001）是开第二代抗精神病药的预测因素。报告更多的症状严重程度（OR=1.84，p<.001）和较少的酒精使用问题（OR=.36，p<.03）预测开情绪稳定剂。
开处方模式总体上与治疗指南一致。讨论了一些值得注意的例外情况和未来值得关注的领域。
