engleski

Olanzapine or fluphenazine in patients with psychotic combat-related posttraumatic stress disorder

Background: Combat-related posttraumatic stress disorder (CR-PTSD) is frequently associated with psychotic symptoms. Aim Comparison of the effects of olanzapine and fluphenazine in patients with psychotic PTSD. Methods: The study included 55 male war veterans (28 treated with olanzapine and 27 with fluphenazine, 5-10 mg/day dose range) who met criteria for PTSD with psychotic symptoms (DSM-IV ctiteria). Patients were evaluated at baseline and after 21 days of treatment using Watson's PTSD scale, PANSS scale, Clinical Global Impression Severity Scale (CGI-S). After 21 days, symptoms were determined with Clinical Global Impression Improvement Scale (CGI-I), Patient Global Impression Improvement Scale (PGI-I) and Drug Induced Extra-Pyramidal Symptoms Scale (DIEPSS). Results: At baseline there was no differences in age, duration of combat experience and all scales between groups. After 21 days, both neuroleptic-treated patients showed improvement on most of the measurement instruments used. However, olanzapine was significantly more efficacious than fluphenazine in reducing symptoms in PANSS subscales (negative, general psychopathology, supplementary items), Watson's PTSD subscales (avoidance, increased arousal), CGI-S, CGI-I, and PGI-I scale. There was no difference in PANSS positive subscale and Watson's trauma re-experiencing subscale between treatments. Fluphenazine, in contrast to olanzapine, induced more extrapyramidal symptoms. Conclusion: Psychotic PTSD patients treated for 3 weeks with olanzapine or fluphenazine showed improvement on most of the measurement instruments used. Olanzapine was better than fluphenazine in reducing negative symptoms, general psychopathology, symptoms of avoidance and increased arousal, and was better tolerated in psychotic PTSD patients. Our data suggest that olanzapine should be used in the treatment of psychotic CR-PTSD.

Olanzapine; fluphenazine; PTSD

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