Pharmacotherapy of 1,044 inpatients with posttraumatic stress disorder: current status and trends in German-speaking countries

Reinhard, Matthias; Seifert, Johanna; Greiner, Timo; Toto, Sermin; Bleich, Stefan; Grohmann, Renate

doi:10.1007/s00406-020-01223-x

Cited by 5 publications

(3 citation statements)

References 48 publications

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“…Overall, the proportion of patients receiving more than two psychotropic drugs greatly exceeded the percentage of patients with monotherapy. Several other studies examining psychopharmacotherapy of psychiatric inpatients within the AMSP database also found high rates of polypharmacotherapy among patients with post-traumatic stress disorder (Reinhard et al 2020 ), schizophrenia (Toto et al 2019 ), and bipolar disorder (Haeberle et al 2012 ), suggesting that combinations of psychotropic drugs are the rule rather than the exception among psychiatric inpatients. Hahn and colleagues reported similar observations without consideration of the psychiatric diagnosis in 2008 (Hahn et al 2013 ): 47.8% of patients were treated with over three psychotropic drugs at admission.…”

Section: Discussionmentioning

confidence: 93%

Pharmacological treatment of major depressive disorder according to severity in psychiatric inpatients: results from the AMSP pharmacovigilance program from 2001–2017

Seifert

Maier

Führmann³

et al. 2022

J Neural Transm

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The International Classification of Diseases (10th Version) categorizes major depressive disorder (MDD) according to severity. Guidelines provide recommendations for the treatment of MDD according to severity. Aim of this study was to assess real-life utilization of psychotropic drugs based on severity of MDD in psychiatric inpatients. Drug utilization data from the program “Drug Safety in Psychiatry” (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) were analyzed according to the severity of MDD. From 2001 to 2017, 43,868 psychiatric inpatients with MDD were treated in participating hospitals. Most patients were treated with ≥ 1 antidepressant drug (ADD; 85.8% of patients with moderate MDD, 89.8% of patients with severe MDD, and 87.9% of patients with psychotic MDD). More severely depressed patients were more often treated with selective serotonin–norepinephrine reuptake inhibitors and mirtazapine and less often with selective serotonin reuptake inhibitors (p < 0.001 each). Use of antipsychotic drugs (APDs), especially second-generation APDs, increased significantly with severity (37.0%, 47.9%, 84.1%; p < 0.001 each). APD + ADD was the most used combination (32.8%, 43.6%, 74.4%), followed by two ADDs (26.3%, 29.3%, 24.9%). Use of lithium was minimal (3.3%, 6.1% ,7.1%). The number of psychotropic drugs increased with severity of MDD—patients with psychotic MDD had the highest utilization of psychotropic drugs (93.4%, 96.5%, 98.7%; p < 0.001). ADD monotherapy was observed to a lesser extent, even in patients with non-severe MDD (23.2%, 17.1%, 4.4%). Findings reveal substantial discrepancies between guideline recommendations and real-life drug utilization, indicating that guidelines may insufficiently consider clinical needs within the psychiatric inpatient setting.

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Section: Discussionmentioning

confidence: 93%

Pharmacological treatment of major depressive disorder according to severity in psychiatric inpatients: results from the AMSP pharmacovigilance program from 2001–2017

Seifert

Maier

Führmann³

et al. 2022

J Neural Transm

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“…Present guidelines state that there is insufficient evidence to recommend for or against antipsychotic medication for PTSD [17] and use should be restricted to situations where symptoms have not responded to other drug or psychological treatments [18]. However, a European study reported that nearly 60% of more than 1,000 patients with a diagnosis of PTSD were prescribed antipsychotics, most commonly quetiapine, olanzapine and risperidone [19]. Further, a population-based study from Norway suggested that the majority of quetiapine prescriptions during 2004-2015 were for indications other than psychosis [5].…”

Section: Discussionmentioning

confidence: 99%

Second-generation antipsychotic use during pregnancy and risk of congenital malformations

Ellfolk

Leinonen

Gissler

et al. 2021

Eur J Clin Pharmacol

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Purpose To study if second-generation antipsychotic (S-GA) use during the first trimester of pregnancy is associated with an increased risk of major congenital malformations (MCM). Methods A population-based birth cohort study using national register data extracted from the Drugs and Pregnancy database in Finland, years 1996–2017. The sampling frame included 1,273,987 pregnant women. We included singleton pregnancies ending in live or stillbirth or termination of pregnancy due to severe malformation. Pregnancies with exposure to known teratogens were excluded. Women were categorized into three groups: exposed to S-GAs (n = 3478), exposed to first-generation antipsychotics (F-GAs) (n = 1030), and unexposed (no purchases of S-GAs or F-GAs during pregnancy, n = 22,540). We excluded genetic conditions and compared the prevalence of MCMs in S-GA users to the two comparison groups using multiple logistic regression models. Results Use of S-GAs during early pregnancy was not associated with an increased risk of overall MCMs compared to unexposed (adjusted odds ratio, OR 0.92; 95% CI 0.72–1.19) or to F-GA users (OR 0.82; 95% CI 0.56–1.20). Of individual S-GAs, olanzapine use was associated with an increased risk of overall MCMs (OR 2.12; 95% CI 1.19–3.76), and specifically, an increased risk of musculoskeletal malformations (OR 3.71; 95% CI 1.35–10.1) when compared to unexposed, while comparisons to F-GA users did not show significant results. Conclusions Olanzapine use is associated with an increased risk of major congenital malformations and specifically, musculoskeletal malformations. Use during pregnancy should be restricted to situations where no safer alternatives exist.

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“…From 1999 to 2018, quetiapine remained the most commonly prescribed anti- psychotic in Veterans Health Administration care [7][8][9]. This primacy is confirmed also by large sample studies on traumatized civilians in which quetiapine prescription rate achieved 25−30% [10,11]. Although off-label quetiapine is widely prescribed in clinical practice and its efficacy in treating PTSD symptoms has been described, to the best of our knowledge no systematic collection of the available findings has yet supported or disconfirmed clinical recommendations [6].…”

Section: Introductionmentioning

confidence: 95%

Quetiapine Treatment for Post-traumatic Stress Disorder: A Systematic Review of the Literature

Crapanzano¹,

Damiani

Casolaro

et al. 2023

Clin Psychopharmacol Neurosci

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Paroxetine and Sertraline are the only medications approved in posttraumatic stress disorder (PTSD). However, about 60% of traumatized patients fail to show an adequate clinical response. Second generation antipsychotics are recommended as second-line monotherapy or third-line augmentation strategies and quetiapine appears as one of the most used and promising agents. Up to date, no reviews assessed the efficacy of quetiapine in the treatment of PTSD. We aimed to assess the effectiveness and general safety of quetiapine on PTSD. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting studies that evaluated the efficacy of quetiapine on global or specific PTSD symptomatology. Ten studies (n = 894) were considered eligible for qualitative synthesis: one case report, one case series, one prospective cohort study, 3 open-label trials, 3 retrospective studies, one randomized controlled trial. Quetiapine was effective on global PTSD symptomatology assessed in 6 studies as well as on re-experiencing (4/4 studies), avoidance (4/3 studies) and hyperarousal (4/4 studies), flashbacks (2/2 studies), depressive (4/4 studies), anxiety (1/1 studies), psychotic (3/3 studies), insomnia (4/5 studies), nightmares (3/3 studies) specific symptoms and PTSD domains. Sedation was among the most frequently observed adverse effects and the main cause of drug discontinuation. Preliminary findings support the efficacy of quetiapine in ameliorating symptoms relative to PTSD and its overall safety. However, quetiapine use in PTSD cannot be recommended yet as studies mainly rely on open-label, retrospective studies or case series.

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Pharmacotherapy of 1,044 inpatients with posttraumatic stress disorder: current status and trends in German-speaking countries

Cited by 5 publications

References 48 publications

Pharmacological treatment of major depressive disorder according to severity in psychiatric inpatients: results from the AMSP pharmacovigilance program from 2001–2017

Pharmacological treatment of major depressive disorder according to severity in psychiatric inpatients: results from the AMSP pharmacovigilance program from 2001–2017

Second-generation antipsychotic use during pregnancy and risk of congenital malformations

Quetiapine Treatment for Post-traumatic Stress Disorder: A Systematic Review of the Literature

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