engleski

Biological background and pharmacotherapy of psychotic posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a serious psychiatric disorder. Biological basis of PTSD involves alterations in serotonin (5-HT), noradrenalin, and dopamine, and in genes controlling the activity of the corresponding proteins. Psychotic symptoms, which frequently occur in combat related PTSD, complicate the clinical picture and the treatment response. The aim of the study was to determine biomarkers and treatment response in male Croatian war veterans with current and chronic combat related PTSD (SCID and DSM-IV) with psychotic symptoms. Platelet biochemical markers (platelet monoamine oxidase (MAO-B) activity, and platelet 5-HT concentration), proposed to be related to particular symptoms or disorders, were found to be significantly higher in psychotic compared to non-psychotic veterans with PTSD. Plasma dopamine-beta-hydroxylase (DBH) activity did not differ between psychotic and non-psychotic PTSD veterans. The allele and genotype distribution of the catechol-O-methyl-transferase, brain derived neurotrophic factor, MAO-B, and DBH was similar, while the allele and genotype distribution of the 5-HT transporter gene-linked polymorphic region (5-HTTLPR) was significantly different between psychotic or non-psychotic veterans with PTSD. Our data show a biological distinction (in platelet 5-HT and platelet MAO-B, and different distribution of 5-HTT genotypes) in veterans with psychotic compared to non-psychotic PTSD. As some veterans with psychotic PTSD were refractory to usual treatment strategies, we studied the treatment response (reduction in the total and subscales scores in PTSD interview, Clinician-Administered PTSD Scale and Positive and Negative Syndrome Scale (PANSS) after 6 weeks monotherapy with typical (fluphenazine) or atypical (olanzapine, risperidone, quetiapine) antipsychotics. All antipsychotics reduced significantly the PTSD and psychotic symptoms (i.e. scores listed in trauma re-experiencing, avoidance, and hyper-arousal subscales of the CAPS, and total and subscales scores listed in positive, negative, general psychopathology, and supplementary items of the PANSS). Our results suggest that monotherapy with atypical antipsychotics improve clinical symptoms in treatment-resistant veterans with psychotic subtype of PTSD.

Posttraumatic stress disorder; platelet monoamine oxidase; platelet serotonin; plasma dopamine-beta-hydroxylase; catechol-O-methyl-transferase; brain derived neurotrophic factor; allele; genotype; 5-HTTLPR; psychotic PTSD; typical and atypical antipsychotics

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