Concordance between psychotropic prescribing for veterans with PTSD and clinical practice guidelines.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Prescribing patterns appeared generally consistent with treatment guidelines. Notable exceptions and areas worthy of future attention are discussed.
National Center for PTSD, Sierra-Pacific Mental Illness Research, Education and Clinical Center, Menlo Park, CA 94205, USA. shaili.jain@va.gov
Shaili
S
Jain
Mark A
MA
Greenbaum
Craig
C
Rosen
D000293:Adolescent; D000328:Adult; D000368:Aged; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D014149:Tranquilizing Agents / Q000627:therapeutic use; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology; D055815:Young Adult
D011619:Psychotropic Drugs; D014149:Tranquilizing Agents