Emerging roles for atypical antipsychotics in chronic post-traumatic stress disorder.

Department of Psychiatry, Ralph H Johnson Department of Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, SC 29401, USA.
Expert Review of Neurotherapeutics (Impact Factor: 2.83). 04/2005; 5(2):267-75. DOI: 10.1586/14737175.5.2.267
Source: PubMed

ABSTRACT Post-traumatic stress disorder is an anxiety disorder that may occur after the individual is exposed to severe psychologic trauma such as combat, sexual assault, or childhood physical or sexual abuse. Chronic post-traumatic stress disorder may result in considerable psychologic pain and suffering for the individual in addition to significant functional impairment. In addition to the heterogeneity of symptoms that occur in post-traumatic stress disorder, there may also be extensive comorbidity with other anxiety disorders, mood disorders, psychotic disorders, and other psychiatric disorders. This complicates the treatment picture. Currently, accepted treatments for post-traumatic stress disorder include psychotherapy, in particular cognitive behavioral-based approaches and antidepressant medication. However, many patients are refractory to these initial treatments or have only a partial response. In light of this, may clinicians combine additional classes of psychotropic agents and different psychotherapeutic approaches to enhance treatment response. This article reviews the literature on the use of atypical antipsychotics in the treatment of post-traumatic stress disorder. Most of the research to date has involved combat veterans partially responsive or refractory to treatment, namely with antidepressants. Studies have shown improvement across post-traumatic stress disorder symptom clusters, as well as improvement in comorbid psychotic symptoms or disorders. More research is needed to confirm these recent findings and further delineate the role of atypical antipsychotics in the treatment of post-traumatic stress disorder. Currently, possible indications for their use include treatment-resistant post-traumatic stress disorder and post-traumatic stress disorder with comorbid psychotic features.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background As some evidences demonstrated that atypical antipsychotics (AA) may be efficacious in treating post-traumatic stress disorder (PTSD), we preformed a meta-analysis of randomized, double-blind, placebo-controlled clinical trials (RCTs) of AAs for the treatment of PTSD. Methods 251 articles were searched and screened. Eight RCTs met the inclusion criteria. Results AAs may be superior to placebo in the treatment of PTSD, as indicated by the changes in Clinician Administered PTSD Scale (CAPS) total scores (weighted mean differences (WMD)=-5.89, 95% confidence interval (CI) [-9.21, −2.56], P=0.0005) and also in CAPS subscale intrusion (WMD=-2.58, 95% CI[-3.83, -1.33], P<0.0001 ) and subscale hyperarousal (WMD=−2.94, 95% CI[−5.45, -0.43], P=0.02). The acceptability measured by dropout rates between AAs and placebo showed no statistical difference (OR=1.24, 95%CI [0.78, 1.97], P=0.36). Conclusion TSD symptom cluster, especially in intrusion and hyperarousal. However, we should be careful to generalize the conclusion because of the small number of included trails. We expect more RCTs will be done in the future so as to clarify the specific value of AAs for PTSD.
    Psychiatry Research 11/2014; 219(3). DOI:10.1016/j.psychres.2014.05.027 · 2.68 Impact Factor
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study reviewed extant published articles on the efficacy and safety of atypical antipsychotics for the treatment of posttraumatic stress disorder (PTSD). We performed a literature search using PubMed, EMBASE, and the Cochrane database in January 2013. Selection criteria for this review included prospective, controlled studies using validated rating scales of PTSD symptoms in the management of PTSD. A total of 12 prospective, controlled studies were included in this review. This review found that atypical antipsychotics are effective and safe in treating PTSD, although there were some negative findings. In particular, atypical antipsychotics also seem to be effective in treating anxiety, depression, and psychotic symptoms frequently accompanied by PTSD. This review found that atypical antipsychotics seemed to be effective and tolerable in the management of PTSD, although the evidence was limited.
    Clinical neuropharmacology 11/2013; 36(6). DOI:10.1097/WNF.0b013e3182aa365f · 1.84 Impact Factor