Pharmacotherapy of treatment-resistant combat-related posttraumatic stress disorder with psychotic features.
OBJECTIVE
To assess retrospectively the clinical effects of typical (fluphenazine) or atypical (olanzapine, risperidone, quetiapine) antipsychotics in three open clinical trials in male Croatian war veterans with chronic combat-related posttraumatic stress disorder (PTSD) with psychotic features, resistant to previous antidepressant treatment.


METHODS
Inpatients with combat-related PTSD were treated for 6 weeks with fluphenazine (n=27), olanzapine (n=28), risperidone (n=26), or quetiapine (n=53) as a monotherapy. Treatment response was assessed by the reduction in total and subscales scores in the clinical scales measuring PTSD (PTSD interview and Clinician-administered PTSD Scale) and psychotic symptoms (Positive and Negative Syndrome Scale).


RESULTS
After 6 weeks of treatment, monotherapy with fluphenazine, olanzapine, risperidone, or quetiapine in patients with PTSD significantly decreased the scores listed in trauma reexperiencing, avoidance, and hyperarousal subscales in the clinical scales measuring PTSD, and total and subscales scores listed in positive, negative, general psychopathology, and supplementary items of the Positive and Negative Syndrome Scale subscales, respectively (P<0.001).


CONCLUSIONS
PTSD and psychotic symptoms were significantly reduced after monotherapy with typical or atypical antipsychotics. As psychotic symptoms commonly occur in combat-related PTSD, the use of antipsychotic medication seems to offer another approach to treat a psychotic subtype of combat-related PTSD resistant to previous antidepressant treatment.
Pivac
Nela
N
Division of Molecular Medicine, Rudjer Bosković Institute,Zagreb, Croatia. npivac@irb.hr
Kozarić-Kovacić
Dragica
D
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D017523:Croatia; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000188:drug therapy*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D014857:Warfare
D014150:Antipsychotic Agents