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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV1138

Prescription medication use and polypharmacy following physical combat injury: the ADVANCE cohort study

PRESCRIPTION MEDICATION USE AND POLYPHARMACY FOLLOWING PHYSICAL COMBAT INJURY: THE ADVANCE COHORT STUDY

Injured personnel use more than twice as many prescription medications as their uninjured peers, with the highest use among those with deployment-related traumatic brain injury.

The study aimed to examine prescription medication use at a median of 11 years after injury, based on the premise that the long-term medication use required by complex physical trauma, particularly polypharmacy, may increase the risk of disease with aging. Within the ADVANCE cohort, a representative sample of personnel who sustained physical injuries in Afghanistan requiring medical evacuation (n=526; n=141 with limb loss) was compared with a frequency-matched uninjured group (n=525). Self-reported data were collected during a clinical interview with a research nurse, and medications were coded by indication and class using the Anatomical Therapeutic Chemical classification framework. In line with the literature, polypharmacy was defined as five or more medications overall, five or more central nervous system (CNS) medications, two or more psychotropic medications, or two or more analgesics. The incidence rate ratio (IRR) for prescription medication use was 2.15 (1.66 to 2.92) in the overall injured group, 2.13 (1.61 to 3.06) in those without limb loss, 2.20 (1.45 to 3.14) in those with limb loss, 1.51 (1.08 to 2.15) in those without deployment-related traumatic brain injury (TBI), and 3.03 (2.18 to 4.29) in those with TBI. For CNS medications, the IRR was reported as 2.67 (1.77 to 4.08) in the overall injured group, 2.69 (1.72 to 4.25) in those without limb loss, 2.64 (1.44 to 4.45) in those with limb loss, 1.70 (1.00 to 2.87) in those without TBI, and 3.95 (2.55 to 6.16) in those with TBI. For psychotropic medications, the IRR was 2.03 (1.27 to 3.25) in the overall injured group and 3.20 (1.88 to 5.42) in those with TBI, whereas for use for mental health indications, it was 1.54 (0.97 to 2.55) in the overall injured group, 1.67 (1.03 to 2.79) in those without limb loss, 1.20 (0.50 to 2.54) in those with limb loss, and 2.08 (1.27 to 3.58) in those with TBI. Overall polypharmacy rates were below 1% in the uninjured group, approximately 2.5% in injured personnel with or without limb loss, and 3.1% in those with TBI. Rates of CNS, psychotropic, and analgesic polypharmacy (0% to 4.4%) and opioid use (1.1% to 5.1%) were also relatively low but consistently highest in the TBI group. In conclusion, injured personnel use more prescription medications than their demographically similar peers, and increased psychotropic medication use among those with limb loss is driven more by pain, sleep, or other indications than by mental health indications. The failure of injury-specific guidelines to account for comorbidities fragments prescribing practices, and collaboration across specialist networks is needed for the long-term medication management of young adults with complex polytrauma.

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