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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: eric.hermes@yale.edu)
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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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