Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3017 — The Use of Second Generation Neuroleptics for the Treatment of Posttraumatic Stress Disorder in VISN-7 FY1999-2005

Davis LL (Tuscaloosa VAMC) , Frazier E (Tuscaloosa VAMC), Saunders D (Birmingham VAMC), Litaker MS (Birmingham VAMC), Salas M (Birmingham VAMC), Dahl D (University of Alabama), Garner C (Tuscaloosa VAMC), Jones R (Birmingham VAMC), Lowe J (Tuscaloosa VAMC), Safford M (Birmingham VAMC)

Objectives:
Serotonin reuptake inhibitors (SSRI) are the FDA-approved and first line treatment for posttraumatic stress disorder (PTSD). However, many PTSD patients fail to respond fully to SSRI treatment. Increasingly, second generation neuroleptics are being used adjunctively. This study examined the pattern of use of second generation neuroleptics in veterans with PTSD over a 7-year period in VISN-7.

Methods:
De-identified clinical data was retrieved from the VISN-7 Data Warehouse (includes 8 VA Medical Centers [VAMCs] in AL, GA, and SC). Individuals with ICD-9 code for PTSD (excluding bipolar, psychotic, and dementia diagnoses) in fiscal years (FY) 1999-2005 were selected and their electronic pharmacy data for a prescription for a second generation neuroleptic was examined.

Results:
The number of unique veterans with PTSD increased from 6939 in FY99 (3.5% of total in VISN-7) to 17,574 in FY2005 (6.1% of total). The use of second generation neuroleptics increased from 9.8% in FY99 to 27.7% in FY2005 (p < .0001) in veterans with PTSD. The increase in use of second generation neuroleptics varied by VAMC (p < .0001), with some VAMCs having 34% of veterans with PTSD treated in 2005, and others having as few as 4% treated. Multivariable regression models examining the effect of patient characteristics that predicted use of second generation neuroleptics revealed that certain Axis I comorbidities (OR 1.439, CI 1.314-1.575), Axis II comorbidity (OR 1.546, CI 1.326-1.802), certain concomitant psychotropic medication use (ranges of OR from 1.299 CI 1.199-1.407 for tricyclic use to OR 3.242, CI 2.992-3.513 for SSRI use); gender (OR 2.112, CI 1.187-2.455), race (OR 0.732, CI 0.685-0.782); and age (OR 0.992, CI 0.988-0.995) were independent predictors. Characteristics that were not independent predictors included V-codes and use of certain concomitant psychotropic medications during FY99-2005.

Implications:
The off-label use of second generation neuroleptics has significantly increased in PTSD patients since FY99 with marked variations in use by VAMC.

Impacts:
Since second generation neuroleptics have been associated with the development of metabolic syndrome and strong evidence for their efficacy in PTSD is still lacking, guidelines for their appropriate use may be warranted.