Management of Psychotic Symptoms in PTSD (Node 3a)

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Management of Psychotic Symptoms in PTSD (Node 3a) David N. Osser, MD, Associate Professor of Psychiatry Harvard Medical School Brockton Division of the VA Boston Healthcare System

PTSD-related psychosis Phenomena related to original trauma Hearing soldiers scream Visual hallucinations of attacker

Other psychotic symptoms Paranoid delusions Can be related to PTSD Non-bizarre, not associated with disorganized thought or flat affect Comorbid psychotic disorder

PTSD-related psychosis SSRI PTSD-related psychosis Try an SSRI alone

PTSD-related psychosis SSRI PTSD-related psychosis Try an SSRI alone Try an antipsychotic

Second-generation antipsychotics Risperidone Best evidence Quetiapine, Olanzapine Open label studies Rothbaum BO, Killeen TK, Davidson JR, Brady KT, Connor KM, Heekin MH. Placebo-controlled trial of risperidone augmentation for selective serotonin reuptake inhibitor resistant civilian posttraumatic stress disorder. J Clin Psychiatry 2008;69:520–5. 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 (Berl) 2004;175:451–6

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