Psychotropic Polypharmacy in Australian Vietnam War Veterans with Post-Traumatic Stress Disorder: A Descriptive Cohort Study.

Background: Pharmacological management of complex psychological conditions and physical comorbidities in Vietnam veterans can be challenging, particularly when there are multiple prescribing clinicians. Purpose: To investigate the incidence of psychotropic polypharmacy in a cohort of Australian Vietnam veterans with post-traumatic stress disorder (PTSD). Methods: Subanalysis of data from a cross-sectional study of Vietnam veterans conducted at Gallipoli Medical Research Foundation from 2014-2015. Relationships between psychotropic polypharmacy and health outcomes were assessed, and anticholinergic burden scores calculated. Results: Of 160 participants with PTSD, 107 (66.9%) were treated with psychotropic medications, with 53 (33.1%) prescribed two or more. The most common combination was antidepressants with anxiolytics (21.5% of those treated). Polypharmacy was significantly associated with PTSD symptom severity (p<0.01), comorbid depression (p<0.05) and current suicidality (p<0.01). Anticholinergic burden scores ranged from 0--7, with 37.5% of participants classed as medium risk (score = 1--2) and 16-9% as high risk (≥3). Conclusion: Psychotropic polypharmacy prevalence in Australian Vietnam veterans with PTSD is high. This condition is commonly refractory to pharmacotherapeutic intervention, often leading to trials of combination therapy without supportive scientific evidence. Further research would be beneficial in evaluating potential efficacy versus harm of combination therapies to assist in rationalising prescription of multiple medications. Conflict of Interest: No conflicts of interest to declare. [ABSTRACT FROM AUTHOR]