olanzapine and Combat-Disorders

Posttraumatic stress disorder (PTSD), particularly in combat veterans with chronic illness, is often refractory to standard pharmacological interventions. There is a need to test adjunctive treatments to boost response.. Subjects were 19 patients with PTSD who were minimally responsive to 12 weeks of treatment with a selective serotonin reuptake inhibitor (SSRI) at maximum tolerated dose. Outcomes were compared among subjects whose treatment was augmented with 8 weeks of double-blind olanzapine or placebo administration.. Olanzapine augmentation was associated with statistically significantly greater reduction than placebo in specific measures of posttraumatic stress, depressive, and sleep disorder symptoms. Clinician-rated global response rates did not, however, significantly differ between groups.. This is most likely the first double-blind, placebo-controlled study of an adjunct to SSRIs for PTSD. Despite the small group size, the findings suggest a role for olanzapine or other atypical antipsychotics in treating SSRI-resistant PTSD. Sleep symptoms may especially benefit.

Topics: Antipsychotic Agents; Benzodiazepines; Combat Disorders; Depressive Disorder; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Fluoxetine; Humans; Male; Middle Aged; Olanzapine; Paroxetine; Pirenzepine; Placebos; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Sertraline; Sleep Wake Disorders; Treatment Outcome

Huntington's disease (HD) is a neurodegenerative, autosomal dominant disease that manifests with a triad of symptom clusters including movement disorder, cognitive impairment and psychiatric symptoms. We present a patient with HD who, prior to developing neurological signs and symptoms, had been exposed to war trauma and had developed posttraumatic stress disorder. Fifteen years later he manifested with dysarthria, difficulties with swallowing and involuntary movement. What brought him to psychiatrist was a heteroanamnestically noticed change in personality with irritable mood, impulsivity, aggressive outbursts in behavior and delusional ideation. Therapy was stared with haloperidol, but patient developed severe extrapiramidal side effects. Subsequent treatment with olanzapine, diazepam and omega 3 fatty acids lead to mood stabilization and better impulse control with even some improvement in motoric symptoms. To our knowledge, this is the first case report on combat related PTSD as psychiatric disorder manifested prior to HD. We discuss a possible influence of psychological stress disorder on severity of psychiatric symptoms in the HD. The importance of personalized approach in both psychopharmacological and psychotherapeutical treatment of patients with HD is emphasized. If the influence of environmental stress on the psychiatric phenotype of the disease should be confirmed by clinical trials and further studies, both screening methods and interventions aimed to reduce psychological stress in carriers of Huntington gene could be considered.

Topics: Alleles; Antipsychotic Agents; Atrophy; Benzodiazepines; Cerebral Cortex; Chromosomes, Human, Pair 4; Combat Disorders; Combined Modality Therapy; Comorbidity; Diagnosis, Differential; Diazepam; Fatty Acids, Omega-3; Genetic Testing; Humans; Huntington Disease; Magnetic Resonance Imaging; Male; Medulla Oblongata; Middle Aged; Neurologic Examination; Olanzapine; Patient Care Team; Psychotherapy; Risk Factors; Social Environment; Stress Disorders, Post-Traumatic; Trinucleotide Repeats

Nightmares and insomnia in combat-related post-traumatic stress disorder (PTSD) might be resistant to treatment with selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines.. We describe five case reports of patients suffering from long-lasting and intractable nightmares and insomnia. They were given different psychotropic agents in past few years, with no improvement in their sleep disturbance. Olanzapine was added to the current treatment regimen.. Both nightmares and insomnia improved rapidly after olanzapine institution in all of five patients. No adverse events of olanzapine were reported.. Olanzapine augmentation might be useful in alleviating treatment-resistant nightmares and insomnia in patients with combat-related PTSD.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Combat Disorders; Dose-Response Relationship, Drug; Dreams; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Olanzapine; Pirenzepine; Selective Serotonin Reuptake Inhibitors; Sleep Initiation and Maintenance Disorders; Stress Disorders, Post-Traumatic; Time Factors; Treatment Outcome; Warfare

Topics: Antipsychotic Agents; Benzodiazepines; Combat Disorders; Dreams; Humans; Male; Middle Aged; Olanzapine; Pirenzepine; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Veterans