engleski

The use of atypical antipsychotics in the pharmacotherapy of treatment-resistant combat-related posttraumatic stress disorder with psychotic features

Background: Combat-related posttraumatic stress disorder (PTSD) comorbid with psychotic features is usually refractory to treatment. The comorbid psychotic symptoms complicate its pharmacotherapy and implicate the use of other therapeutic approaches such as typical or atypical antipsychotics. Methods: Eighty-one male war veterans with combat-related PTSD participated in the open labeled 6-weeks study: 27 patients were treated with fluphenazine, 28 patients received olanzapine (5-10 mg/day), and 26 patients were treated with risperidone (2-4 mg/day), as a monotherapy. The diagnosis of current and chronic combat-related PTSD was done according to structured clinical interview (APA 1995). All patients were evaluated before and after 6 weeks of treatment using Positive and Negative Syndrome Scale (PANSS) as a primary outcome measure. Secondary outcome measures were Watson's PTSD scale, Clinical Global Impression Severity Scale (CGI-S), Clinical Global Impression Improvement Scale (CGI-I), Patient Global Impression Improvement Scale (PGI-I) and Drug Induced Extra-Pyramidal Symptoms Scale (DIEPSS). Results: Before the treatment the age of the patients, duration of combat experience and scores in all measurement instruments were similar among veterans with combat-related PTSD receiving fluphenazine, olanzapine or risperidone treatment. After 6 weeks of treatment, all three antipsychotics: fluphenazine, olanzapine or risperidone, decreased significantly and in a similar manner, the symptoms listed in PANSS positive and Watson's trauma re-experiencing subscales. However, treatment with olanzapine or risperidone induced greater scores reductions in PANSS negative, general psychopathology and supplementary items subscales than fluphenazine treatment. In addition, olanzapine or risperidone reduced more the scores in Watson's avoidance and increased arousal subscales, and in scores in CGI-S, CGI-I, and PGI-I, than fluphenazine treatment. Fluphenazine induced more extrapyramidal symptoms than olanzapine or risperidone treatment. Conclusion: Treatment with atypical antipsychotic olanzapine or risperidone for 6 weeks improved significantly most of the PTSD and psychotic symptoms in war veterans with combat-related PTSD. Olanzapine and risperidone showed similar efficacy and tolerability and induced fewer side effects than fluphenazine. Our data suggest that atypical antipsychotics might have beneficial effects in war veterans with treatment-resistant psychotic combat-related PTSD.

war veterans; combat-related PTSD; fluphenazine; olanzapine; risperidone

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