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Enhancing Completion of Cognitive Processing Therapy for Posttraumatic Stress Disorder with Quetiapine in Veterans with Mild Traumatic Brain Injury: a Case Series

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Abstract

To evaluate the outcomes of the antiarousal medications valproate, risperidone, and quetiapine on completion of treatment of cognitive processing therapy (CPT) for PTSD. A case series of fifty treatment-seeking adult (≥18 years) veterans with mild traumatic brain injury and combat-related PTSD who had unsuccessful trials of 2 or more first-line agents and previously declined treatment with trauma-focused therapy, seen at the psychiatric outpatient services of the local Polytrauma Rehabilitation Center from January 1, 2014, through December 31, 2017. Patients were prescribed valproate (n = 8), risperidone (n = 17), or quetiapine (n = 25) and were referred for individual weekly treatment with CPT. Outcome measurements of interest were measures of engagement and completion rate of CPT, PTSD Checklist total score (range, 0–80; higher scores indicate greater PTSD severity) and arousal subscale score (range, 0–24; higher scores indicate greater arousal severity), and clinical observations of sleep variables. Of the 50 patients included in the study, 48 (96%) were men; mean (SD) age was 36 (8) years. Eighteen (86%) patients initially receiving quetiapine and none taking valproate or risperidone became adequately engaged in and completed CPT. Among patients who completed CPT, the mean decrease in the PTSD Checklist score was 25 [95% CI, 30 to 20] and 9 (50%) patients no longer met criteria for PTSD. These preliminary findings support quetiapine as an adjunctive medication to facilitate CPT. A pragmatic trial is needed to evaluate the efficacy, safety, and feasibility of quetiapine to improve engagement in and completion rate of CPT.

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Authors and Affiliations

  1. Mental Health, South Texas Veterans Healthcare System, San Antonio, TX, USA

    Muhammad R. Baig, Jennifer L. Wilson, Jennifer A. Lemmer, Robert D. Beck & Alan L. Peterson

  2. Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA

    Muhammad R. Baig, Jennifer L. Wilson, Jennifer A. Lemmer & Robert D. Beck

  3. Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Muhammad R. Baig, Alan L. Peterson & John D. Roache

  4. Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA

    Alan L. Peterson

  5. Department of Pharmacology, University of Texas Health San Antonio, San Antonio, TX, USA

    John D. Roache

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  1. Muhammad R. Baig
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Correspondence to Muhammad R. Baig.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Baig, M.R., Wilson, J.L., Lemmer, J.A. et al. Enhancing Completion of Cognitive Processing Therapy for Posttraumatic Stress Disorder with Quetiapine in Veterans with Mild Traumatic Brain Injury: a Case Series. Psychiatr Q 90, 431–445 (2019). https://doi.org/10.1007/s11126-019-09638-z

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