Albrecht Jennifer S, Mullins Daniel C, Smith Gordon S, Rao Vani
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.
Am J Geriatr Psychiatry. 2017 Apr;25(4):415-424. doi: 10.1016/j.jagp.2016.11.018. Epub 2016 Dec 28.
To characterize psychotropic medication use before and after traumatic brain injury (TBI) hospitalization among older adults. A secondary objective is to determine how receipt of indicated pharmacologic treatment for anxiety and post-traumatic stress disorder (PTSD) differs following TBI.
Retrospective cohort.
United States.
Medicare beneficiaries aged ≥65 years hospitalized with TBI between 2006 and 2010 with continuous drug coverage for 12 months before and after TBI (N = 60,276).
We obtained monthly psychotropic medication use by drug class and specific drugs from Medicare Part D drug event files.ICD-9 codes were used to define anxiety (300.0x) and PTSD (309.81).
Average monthly prevalence of psychotropic medication use among all patients hospitalized for TBI was 44.8%; antidepressants constituted 73%. Prevalence of psychotropic medication use increased from 2006 to 2010. Following TBI, psychotropic medication use increased slightly (OR: 1.05; 95% CI: 1.03, 1.06.) Tricyclic antidepressant use decreased post-TBI (OR: 0.76; 95% CI: 0.73, 0.79) whereas use of the sedating antidepressants mirtazapine (OR: 1.31; 95% CI: 1.25, 1.37) and trazadone (OR: 1.11; 95% CI: 1.06, 1.17) increased. Antipsychotic (OR: 1.15; 95% CI: 1.12, 1.19) use also increased post-TBI. Beneficiaries newly diagnosed with anxiety (OR: 0.42; 95% CI: 0.36, 0.48) and/or PTSD (OR: 0.39; 95% CI: 0.18, 0.84) post-TBI were less likely to receive indicated pharmacologic treatment.
Older adults hospitalized with TBI have a high prevalence of psychotropic medication use yet are less likely to receive indicated pharmacological treatment for newly diagnosed anxiety and PTSD following TBI.
描述老年人创伤性脑损伤（TBI）住院前后精神药物的使用情况。次要目的是确定TBI后焦虑症和创伤后应激障碍（PTSD）的指定药物治疗的接受情况有何不同。
回顾性队列研究。
美国。
2006年至2010年间因TBI住院的65岁及以上医疗保险受益人，在TBI前后连续12个月享有药物保险（N = 60,276）。
我们从医疗保险D部分药物事件文件中获取了按药物类别和特定药物划分的每月精神药物使用情况。使用国际疾病分类第九版（ICD-9）编码来定义焦虑症（300.0x）和PTSD（309.81）。
所有因TBI住院患者中精神药物使用的平均月患病率为44.8%；抗抑郁药占73%。从2006年到2010年，精神药物使用患病率有所上升。TBI后，精神药物使用略有增加（比值比：1.05；95%置信区间：1.03，1.06）。TBI后三环类抗抑郁药的使用减少（比值比：0.76；95%置信区间：0.73，0.79），而镇静性抗抑郁药米氮平（比值比：1.31；95%置信区间：1.25，1.37）和曲唑酮（比值比：1.11；95%置信区间：1.06，1.17）的使用增加。抗精神病药物（比值比：1.15；95%置信区间：1.12，1.19）的使用在TBI后也增加。TBI后新诊断为焦虑症（比值比：0.42；95%置信区间：0.36，0.48）和/或PTSD（比值比：0.39；95%置信区间：0.18，0.84）的受益人接受指定药物治疗的可能性较小。
因TBI住院治疗的老年人精神药物使用率很高，但TBI后新诊断出焦虑症和PTSD时，接受指定药物治疗的可能性较小。
