Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nußbaumstr. 7, 80336, Munich, Bavaria, Germany.
Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Eur Arch Psychiatry Clin Neurosci. 2021 Sep;271(6):1065-1076. doi: 10.1007/s00406-020-01223-x. Epub 2020 Dec 28.
Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder with limited approved pharmacological treatment options and high symptom burden. Therefore, real-life prescription patterns may differ from guideline recommendations, especially in psychiatric inpatient settings. The European Drug Safety Program in Psychiatry ("Arzneimittelsicherheit in der Psychiatrie", AMSP) collects inpatients' prescription rates cross-sectionally twice a year in German-speaking psychiatric hospitals. For this study, the AMSP database was screened for psychiatric inpatients with a primary diagnosis of PTSD between 2001 and 2017. N = 1,044 patients with a primary diagnosis of PTSD were identified with 89.9% taking psychotropics. The average prescription rate was 2.4 (standard deviation: 1.5) psychotropics per patient with high rates of antidepressant drugs (72.0%), antipsychotics drugs (58.4%) and tranquilizing drugs (29.3%). The presence of psychiatric comorbidities was associated with higher rates of psychotropic drug use. The most often prescribed substances were quetiapine (24.1% of all patients), lorazepam (18.1%) and mirtazapine (15.0%). The use of drugs approved for PTSD was low (sertraline 11.1%; paroxetine 3.7%). Prescription rates of second-generation antipsychotic drugs increased, while the use of tranquilizing drugs declined over the years. High prescription rates and extensive use of sedative medication suggest a symptom-driven prescription (e.g., hyperarousal, insomnia) that can only be explained to a minor extent by existing comorbidities. The observed discrepancy with existing guidelines underlines the need for effective pharmacological and psychological treatment options in psychiatric inpatient settings.
创伤后应激障碍（PTSD）是一种使人衰弱的精神疾病，其批准的药物治疗选择有限，症状负担沉重。因此，实际的处方模式可能与指南建议不同，尤其是在精神科住院环境中。欧洲精神病药物安全计划（"Arzneimittelsicherheit in der Psychiatrie"，AMS P）每年两次在德语区的精神病医院中横截面对住院患者的处方率进行收集。在这项研究中，对 AMS P 数据库进行了筛选，以确定 2001 年至 2017 年间患有 PTSD 主要诊断的住院精神科患者。共确定了 1044 例 PTSD 主要诊断的患者，其中 89.9%的患者使用了精神药物。每位患者的平均处方率为 2.4（标准差：1.5）种精神药物，其中抗抑郁药（72.0%）、抗精神病药（58.4%）和镇静剂（29.3%）的使用率较高。精神共病的存在与精神药物使用的更高比率相关。最常开的药物是喹硫平（所有患者的 24.1%）、劳拉西泮（18.1%）和米氮平（15.0%）。批准用于 PTSD 的药物使用率较低（舍曲林 11.1%；帕罗西汀 3.7%）。第二代抗精神病药物的处方率增加，而镇静剂的使用多年来呈下降趋势。高处方率和广泛使用镇静药物表明存在症状驱动的处方（例如，过度警觉、失眠），这只能在较小程度上由现有的共病来解释。与现有指南之间的这种差异突出了在精神科住院环境中需要有效的药物和心理治疗选择。
