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Olanzapine versus fluphenazine in an open trial in patients with psychotic combat-related post-traumatic stress disorder

Abstract

Rationale

Combat-related post-traumatic stress disorder (PTSD) is often complicated with other psychiatric comorbidities, and is refractory to treatment.

Objective

The aim of an open, comparative 6-week study was to compare olanzapine and fluphenazine, as a monotherapy, for treating psychotic combat-related PTSD.

Method

Fifty-five male war veterans with psychotic PTSD (DSM-IV criteria) were treated for 6 weeks with olanzapine (n=28) or fluphenazine (n=27) in a 5–10 mg/day dose range, once or twice daily. Patients were evaluated at baseline, 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

At baseline, patient’s data (age, duration of combat experience and scores in all measurement instruments) did not differ. After 3 and 6 weeks of treatment, olanzapine was significantly more efficacious than fluphenazine in reducing symptoms in PANSS (negative, general psychopathology subscale, supplementary items), Watson’s PTSD (avoidance, increased arousal) subscales, CGI-S, CGI-I, and PGI-I scale. Both treatments affected similarly the symptoms listed in PANSS positive and Watson’s trauma re-experiencing subscales. Fluphenazine induced more extrapyramidal symptoms. Prolongation of the treatment for 3 additional weeks did not affect the efficacy of either drug.

Conclusions

Our data indicate that both fluphenazine and olanzapine were effective for particular symptom profile in psychotic combat-related PTSD. Olanzapine was better than fluphenazine in reducing most of the psychotic and PTSD symptoms, and was better tolerated in psychotic PTSD patients.

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Acknowledgements

Thanks are due to the staff of the National Centre for Psychotrauma, Department of Psychiatry, Dubrava University Hospital, Zagreb, Croatia.

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Correspondence to Nela Pivac.

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Pivac, N., Kozaric-Kovacic, D. & Muck-Seler, D. Olanzapine versus fluphenazine in an open trial in patients with psychotic combat-related post-traumatic stress disorder. Psychopharmacology 175, 451–456 (2004). https://doi.org/10.1007/s00213-004-1849-z

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  • DOI: https://doi.org/10.1007/s00213-004-1849-z

Keywords

  • Combat-related post-traumatic stress disorder
  • Psychotic symptoms
  • Olanzapine
  • Fluphenazine