Grau Peter P, Pfeiffer Paul N, Austin Karen, Saulnier Kevin G, Bowersox Nicholas W
Veterans Affairs Office of Mental Health.
Department of Psychiatry, University of Michigan Medical School.
Psychol Trauma. 2025 Jun 12. doi: 10.1037/tra0001954.
Treatment guidelines recommend only a few medications for the treatment of posttraumatic stress disorder (PTSD). There is substantial guideline-nonconcordant treatment for individuals with PTSD, including antipsychotics and mood stabilizers, which have potentially serious adverse side effects. As part of health system monitoring, we examined patient and clinical factors that may be associated with prescribing these medications among Veterans Health Administration (VHA) patients diagnosed with PTSD and without diagnosed comorbid bipolar or psychotic disorders.
The study cohort included all VHA patients with PTSD diagnoses in fiscal year 2019 who did not have comorbid diagnoses of schizophrenia, psychotic spectrum disorders, bipolar disorder, or major depressive disorder with psychotic features in fiscal year 2019 or the prior two fiscal years ( = 122,292). Logistic regressions assessed demographic (e.g., age, race) and clinical (e.g., psychiatric diagnosis, health care engagement) factors associated with antipsychotic and mood stabilizer prescription receipt.
11.9% of the cohort received an antipsychotic, the strongest predictors of which were the presence of a suicide risk flag (adjusted odds ratio [a] = 1.57) and benzodiazepine prescription (a = 1.79). 12.4% of the cohort received a mood stabilizer, the strongest predictors of which were a service-connected disability above 70% (a = 1.56) and a comorbid personality disorder diagnosis (a = 1.76).
VHA patients with PTSD who have psychiatric comorbidity and receive multiple psychiatric medications were more likely to receive guideline-nonconcordant mood stabilizers and antipsychotics. Additional work is needed to better understand the impact of these prescribing practices to help providers balance the risks and benefits of these medication combinations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
治疗指南仅推荐了少数几种用于治疗创伤后应激障碍（PTSD）的药物。对于PTSD患者，存在大量不符合指南的治疗方法，包括使用抗精神病药物和心境稳定剂，这些药物可能有潜在的严重不良副作用。作为卫生系统监测的一部分，我们研究了在退伍军人健康管理局（VHA）中被诊断患有PTSD且未被诊断患有共病双相或精神障碍的患者中，可能与开具这些药物相关的患者和临床因素。
研究队列包括2019财年所有被诊断患有PTSD的VHA患者，这些患者在该财年或前两个财年中没有共病精神分裂症、精神谱系障碍、双相情感障碍或伴有精神病性特征的重度抑郁症（n = 122,292）。逻辑回归评估了与抗精神病药物和心境稳定剂处方开具相关的人口统计学（如年龄、种族）和临床（如精神科诊断、医疗保健参与度）因素。
该队列中11.9%的患者接受了抗精神病药物治疗，其中最强的预测因素是存在自杀风险标记（调整后的优势比[aOR] = 1.57）和苯二氮䓬类药物处方（aOR = 1.79）。该队列中12.4%的患者接受了心境稳定剂治疗，其中最强的预测因素是70%以上的与服役相关的残疾（aOR = 1.56）和共病的人格障碍诊断（aOR = 1.76）。
患有精神科共病且接受多种精神科药物治疗的VHA PTSD患者更有可能接受不符合指南的心境稳定剂和抗精神病药物治疗。需要开展更多工作以更好地理解这些处方行为的影响，并帮助医疗服务提供者平衡这些药物组合的风险和益处。（PsycInfo数据库记录（c）2025美国心理学会，保留所有权利）
