Pharmacotherapy treatment of PTSD and comorbid disorders.
Comorbity is very high in posttraumatic stress disorder (PTSD) patients. PTSD is very often complicated with depressive disorder, substance abuse, other anxiety disorders, personality disorders, psychotic features, etc. There have been few pharmacotherapy studies in this complicated field. In the past few years the literature on pharmacotherapy treatment for PTSD and comorbidity has arisen. From empirical evidence (level A) exist three sertraline studies in PTSD comorbid with: 1) anxiety, 2) depression, and 3) anxiety and depression, and one risperidone study in PTSD comorbid with psychotic symptoms. From empirical evidence (level B) exist two disulfiram, naltrexone, and their combination studies in patients with PTSD comorbid with alcohol dependence and one paroxetine or bupropion versus cognitive behavioral therapy (CBT) versus community mental health referral study in PTSD women outpatients with major depressive disorder. The results from our label trials in the Croatian war veterans with chronic PTSD comorbid with psychotic features treated with novel antipsychotics (olanzapine, risperidone, or quetiapine) are promising. In the future more rigorously designed, comparative studies are needed to determine the usefulness, efficacy, tolerability, and safety of particular psychopharmaceutical drugs in the treatment of this therapeutically and functionally challenging disorder, especially the trials from level A.
Department of Psychiatry, Dubrava University Hospital, Referral Center for Stress-related Disorders of the Croatian Ministry of Health and Social Welfare, Regional Center for Psychotrauma, 10000 Zagreb, Croatia. dkozaric_kovacic@yahoo.com
Dragica
D
Kozarić-Kovacić
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015928:Cognitive Behavioral Therapy; D003130:Combat Disorders / Q000188:drug therapy / Q000453:epidemiology; D003131:Combined Modality Therapy; D015897:Comorbidity; D017523:Croatia; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000453:epidemiology*; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D011619:Psychotropic Drugs