1. 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

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

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

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

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

6. 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

7. Next Video: Management of Non-Response to Initial SSRI Trial