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The use of second generation antipsychotics for post-traumatic stress disorder in a US Veterans Health Administration Medical Center

Published online by Cambridge University Press:  05 September 2013

E. Hermes ,
M. Sernyak  and
R. Rosenheck
E. Hermes*
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
M. Sernyak
Affiliation:
Connecticut Mental Health Center and the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
R. Rosenheck
Affiliation:
VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut USA and the Departments of Psychiatry, Public Health, and the Child's Study Center, Yale School of Medicine, New Haven, Connecticut, USA
*
*Address for correspondence: Dr E. D. A. Hermes, Department of Psychiatry, Yale School of Medicine, 300 George Street, Ste. 901, New Haven, CT 06511, USA. (Email: [email protected])
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Abstract

Background.

Prior studies of antipsychotic use in individuals with post-traumatic stress disorder (PTSD) are limited because administrative data lacks information on why providers choose particular medications.

Methods.

This study examined 2613 provider surveys completed at the time any second generation antipsychotic (SGA) was prescribed over a 20-month period at a single Veterans Affairs medical center. Clinical correlates and reasons for SGA selection among individuals with PTSD compared to those with other psychiatric disorders were identified using chi-square.

Results.

PTSD was the sole diagnosis in n = 339 (13%) and one of several psychiatric diagnoses in n = 236 (9%) surveys. ‘Efficacy’ was the most common reason given for the prescriptions of SGAs in all surveys (51%) and among individuals with PTSD (46%). ‘Sleep/sedation’ was the only reason cited, significantly more frequently among those with PTSD (39% with PTSD only, 35% with PTSD plus another diagnosis, and 31% without PTSD [χ2 = 12.86, p < 0.0016)]. The proportion identifying ‘efficacy’ as a reason for SGA use was smaller in patients with PTSD (44% with PTSD only, 49% with PTSD and another diagnosis, and 53% without PTSD [χ2 = 8.78, p < 0.0125)]. Quetiapine was the most frequently prescribed SGA in the entire sample and among veterans with PTSD (47%).

Conclusions.

Clinician use of SGAs is often driven by efficacy, for which there is limited evidence, and distinctly driven by the goal of sedation among patients with PTSD.

Keywords

Atypical antipsychoticsoff-labelpharmaco-epidemiologypost-traumatic stress disorder
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 23 , Issue 3 , September 2014 , pp. 281 - 288
Copyright
Copyright © Cambridge University Press 2013. This is a work of the U.S. Government and is not subject to copyright protection in the United States. 

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References

Allison, DB, Mentore, JL, Heo, M, Chandler, LP, Cappelleri, JC, Infante, MC, Weiden, PJ (1999). Antipsychotic-induced weight gain: a comprehensive research synthesis. American Journal of Psychiatry 156, 1686–1696.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Bernardy, NC, Lund, BC, Alexander, B, Friedman, MJ (2012). Prescribing trends in veterans with posttraumatic stress disorder. Journal of Clinical Psychiatry 73, 297–303.Google Scholar
Greenberg, R, Rosenheck, R (2007). Department of Veterans Affairs National Mental Health Program Performance Monitoring System: Fiscal Year 2007 Report. West Haven Connecticut: Northeast Program Evaluation Center, VA Connecticut Healthcare System.Google Scholar
Hartung, DM, Wisdom, JP, Pollack, DA, Hamer, AM, Haxby, DG, Middleton, L, Mcfarland, BH (2008). Patterns of atypical antipsychotic subtherapeutic dosing among oregon medicaid patients. Journal of Clinical Psychiatry 69, 1540–1547.Google Scholar
Hermes, ED, Rosenheck, RA, Desai, R, Fontana, AF (2012). Recent trends in the treatment of posttraumatic stress disorder and other mental disorders in the VHA. Psychiatric Services 63, 471–476.Google Scholar
Hoge, CW, Castro, CA, Messer, SC, McGurk, D, Cotting, DI, Koffman, RL (2004). Combat duty in Iraq and Afghanistan. Mental Health Problems, and Barriers to Care. New England Journal of Medicine 351, 13–22.Google Scholar
Kane, JM, Fleischhacker, WW, Hansen, L, Perlis, R, Pikalov, A, Assunção-Talbott, S (2009). Akathisia: an updated review focusing on second-generation antipsychotics. Journal of Clinical Psychiatry 70, 627–643.Google Scholar
Kok, BC, Herrell, RK, Thomas, JL, Hoge, CW (2012). Posttraumatic stress disorder associated with combat service in Iraq or Afghanistan: reconciling prevalence differences between studies. Journal of Nervous and Mental Disease 200, 444–450.CrossRefGoogle ScholarPubMed
Krystal, JH, Rosenheck, RA, Cramer, JA, Vessicchio, JC, Jones, KM, Vertrees, JE, Stock, C (2011). Adjunctive risperidone treatment for antidepressant-resistant symptoms of chronic military service-related PTSD. Journal of American Medical Association 306, 493–502.Google Scholar
Leslie, DL, Mohamed, S, Rosenheck, RA (2009). Off-label use of antipsychotic medications in the department of veterans affairs health care system. Psychiatric Services 60, 1175–1181.Google Scholar
Lund, BC, Bernardy, NC, Alexander, B, Friedman, MJ (2012). Declining benzodiazepine use in veterans with posttraumatic stress disorder. Journal of Clinical Psychiatry 73, 292–296.Google Scholar
Management of Post-Traumatic Stress Working Group (2004). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Department of Veterans Affairs and Department of Defense: Washington, DC.Google Scholar
Management of Post-Traumatic Stress Working Group (2010 a). Management of Post-Traumatic Stress. Department of Veterans Affairs and Department of Defense: Washington, DC.Google Scholar
Management of Post-Traumatic Stress Working Group (2010 b). Management of Post-Traumatic Stress. (Version 2.0). Department of Veterans Affairs and Department of Defense: Washington, DC. Retrieved 1 September 2012 from http://www.healthquality.va.gov/Post_Traumatic_Stress_Disorder_PTSD.asp.Google Scholar
Miller, DD, Caroff, SN, Davis, SM, Rosenheck, RA, McEvoy, JP, Saltz, BL, Keefe, RSE (2008). Extrapyramidal side-effects of antipsychotics in a randomized trial. British Journal of Psychiatry 193, 279–288.Google Scholar
Mohamed, S, Rosenheck, RA (2008). Pharmacotherapy of PTSD in the US Department of Veterans Affairs: diagnostic- and symptom-guided drug selection. Journal of Clinical Psychiatry 69, 959–965.Google Scholar
National Collaborating Centre for Mental Health (2005). Post-traumatic Stress Disorder (PTSD) the Management of PTSD in Adults and Children in Primary and Secondary Care. National Institute for Clinical Excellence (NICE): London.Google Scholar
Philip, NS, Mello, K, Carpenter, LL, Tyrka, AR, Price, LH (2008). Patterns of quetiapine use in psychiatric inpatients: an examination of off-label use. Annals of Clinical Psychiatry 20, 15–20.Google Scholar
Robert, S, Hamner, MB, Kose, S, Ulmer, HG, Deitsch, SE, Lorberbaum, JP (2005). Quetiapine improves sleep disturbances in combat veterans with PTSD: sleep data from a prospective, open-label study. Journal of Clinical Psychopharmacology 25, 387.Google Scholar