engleski

The comparison of olanzapine and fluphenazine in the treatment of combat-related posttraumatic stress disorder with psychotic features

Combat-related posttraumatic stress disorder (PTSD) is a severe anxiety disorder, frequently associated with other psychiatric comorbidities. Combat-related PTSD with psychotic features is often resistant to treatment, and the presence of psychotic symptoms implicates the use of atypical antipsychotics. Methods: The study compared the effects of 3 and 6 weeks of treatment with olanzapine or fluphenazine in 55 male war veterans with psychotic combat-related PTSD (DSM-IV criteria). In an open, comparative, 6-weeks study, 28 patients received olanzapine and 27 fluphenazine (5-10 mg/day). Patients were evaluated before and after 3 and 6 weeks of treatment using Watson’ s PTSD scale, Positive and Negative Syndrome Scale (PANSS), 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 treatment patients receiving olanzapine or fluphenazine did not differ in age, duration of combat experience and scores in all measurement instruments used. After 3, or after 6 weeks of treatment, olanzapine or fluphenazine decreased significantly and similarly the symptoms listed in PANSS positive and Watson’ s trauma reexperiencing subscales. Patients treated with olanzapine for 3 or 6 weeks showed greater reductions in symptoms listed in PANSS negative, general psychopathology subscale, supplementary items subscales, in Watson’ s avoidance and increased arousal subscales, and in scores in CGI-S, CGI-I, and PGI-I scale than patients treated with fluphenazine. Fluphenazine induced more extrapyramidal symptoms. Prolongation of the treatment did not improve the response observed after 3 weeks of treatment. Conclusion: Treatment for 3 or 6 weeks with olanzapine induced greater improvement than fluphenazine, and reduced more psychotic and PTSD symptoms. Olanzapine was more efficacious and was better tolerated than fluphenazine, suggesting that olanzapine is a drug of choice for the treatment of psychotic combat-related PTSD.

psychotic PTSD; olanzapine; fluphenazine

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