Psychopharmakotherapie der Posttraumatischen Belastungsstörung und der Depression: Ergebnisse aus dem Projekt Arzneimittelsicherheit in der Psychiatrie

Reinhard, Matthias Alexander (2022): Psychopharmakotherapie der Posttraumatischen Belastungsstörung und der Depression: Ergebnisse aus dem Projekt Arzneimittelsicherheit in der Psychiatrie. Dissertation, LMU München: Medizinische Fakultät

Abstract

Psychopharmacotherapy plays a major role in the treatment of psychiatric disorders such as posttraumatic stress disorders (PTSD) and depressive disorders that are a common reason for psychiatric inpatient admission. Guidelines have been developed for both disorders that formulate specific treatment recommendations regarding psychopharmacotherapy. However, data on real-life prescription of different psychotropic drugs in psychiatric inpatients are limited and may show discrepancies to guideline recommendations due to a lack of recommendations and/or due to specific needs of the inpatient setting. Therefore, utilization rates of psychotropic drugs were analyzed in two studies for patients with (1) PTSD or (2) major depressive disorder. Data stemmed from the program “Drug safety in Psychiatry” (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) that was developed to assess drug prescription and severe side effects in psychiatric hospitals. For study 1, N = 1,044 patients with PTSD were found in the AMSP database. For study 2, data of N = 43,868 with depressive disorder was analyzed according to depression severity. To summarize, both studies found high utilization rates of psychotropic drugs in both patient groups with discrepancies of observed prescription rates and guidelines recommendations. These discrepancies suggest that specific needs of the psychiatric inpatient setting are not sufficiently met by existing guidelines and/or that specific recommendations are lacking. For instance, results suggest a specific need of PTSD inpatients for treatment of hyperarousal and sleep disorders. However, only a negative recommendation for benzodiazepines exists. Further, evidence- based recommendations for treatment-resistant PTSD and treatment-resistant depressive disorders are lacking due to an insufficient number of randomized-controlled trials or diverging results of the existing literature. Therefore, both studies suggest that future research should specifically focus on recommendations for the psychiatric inpatient setting. Randomized-controlled trials comparing competing treatment options in case of treatment-resistance or regarding combination therapies of psychopharmacotherapy and psychotherapy are necessary. Further, future research may focus on personalized recommendations for specific clinical and biological phenotypes of PTSD and depressive disorders to be incorporated in guidelines.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: Psychopharmakotherapie, Depression, Posttraumatische Belastungsstörung
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Deutsch
• Datum der mündlichen Prüfung: 18. November 2022
• 1. Bericht­erstatter:in: Padberg, Frank