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.

• Authors: Nela Pivac, Dragica Kozaric-Kovacic, Dorotea Muck-Seler
• Journal: Psychopharmacology (Psychopharmacology (Berl)) Vol. 175 Issue 4 Pg. 451-6 (Oct 2004) ISSN: 0033-3158 [Print] Germany
• PMID: 15064916 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article)

Chemical References

• Antipsychotic Agents
• Benzodiazepines
• Olanzapine
• Fluphenazine

Topics

• Adult
• Antipsychotic Agents (adverse effects, therapeutic use)
• Basal Ganglia Diseases (chemically induced, epidemiology)
• Benzodiazepines (adverse effects, therapeutic use)
• Dose-Response Relationship, Drug
• Fluphenazine (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Olanzapine
• Psychiatric Status Rating Scales
• Psychotic Disorders (drug therapy, psychology)
• Stress Disorders, Post-Traumatic (drug therapy, psychology)