A Case of Comorbid PTSD and Posttraumatic OCD Treated with Sertraline-Aripiprazole Augmentation

Rossi, Rodolfo; Niolu, Cinzia; Siracusano, Alberto; Rossi, Alessandro; Lorenzo, Giorgio Di

doi:10.1155/2020/2616492

Cited by 4 publications

(3 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the structure of chronic PTSD, the avoidance cluster is often accompanied by symptoms of obsessive-compulsive disorder. There is clinical evidence that augmentation of sertraline with aripiprazole is much more effective than sertraline monotherapy in the treatment of post-traumatic OCD [19].…”

Section: Resultsmentioning

confidence: 99%

Experience using aripiprazole in the complex treatment of PTSD due to the war in Ukraine

Pustovoyt,

Krasnopolska,

Panchyshyn

et al. 2023

PMGP

View full text Add to dashboard Cite

Relevance. Our country has fully experienced the incomprehensibility and fragility of the modern world with the beginning of the anti-terrorist operation in eastern Ukraine, later going through the COVID-19 pandemic with all its devastating consequences, and finally suffering a treacherous attack from a neighboring state that until recently positioned itself as “fraternal”.It is understandable that all of this has significantly influenced the overall anxiety, fear of the future, and lack of trust of the population as a whole, subjecting large segments of the population to an increased risk of developing post-traumatic stress disorder (PTSD) associated with being in a combat zone, among military personnel and war veterans, among forced migrants, and among those who have experienced violence and torture. Obtaining effective treatment is crucial for reducing disorder symptoms and improving functioning. Modern treatment options for PTSD include both psychological and pharmacological interventions. Since we currently have a large influx of patients with post-traumatic stress disorders, both as a result of combat stress and other mass stressors, it is necessary to review approaches to the treatment of such patients and choose the most effective and accessible ones for the majority of specialists. Of course, the effectiveness of trauma-focused psychotherapeutic methods is difficult to overestimate, and most of our professionals have undergone or are undergoing training in their application. However, one should not forget about the vast arsenal of available and effective medications that can effectively prepare a patient for psychotherapeutic treatment or serve as a complement to psychotherapy. Objective. The objective of our study was to investigate the effectiveness of the atypical antipsychotic aripiprazole in the comprehensive treatment of PTSD and its mechanisms of influence on different clusters of PTSD, as well as comorbid disorders. Materials and Methods. A literature analysis was conducted on the effectiveness of various PTSD therapy methods, including chronic complex PTSD and PTSD with comorbid psychiatric disorders and addictions. Our own clinical studies are being carried out on patients with PTSD undergoing inpatient and outpatient treatment at the “Prykarpatskyi Regional Clinical Mental Health Center of the Ivano-Frankivsk Regional Council” and the First Volunteer Surgical Hospital of the “BRASS” clinic. The group primarily consisted of males aged 21 to 45 with PTSD related to military actions and verified according to contemporary diagnostic criteria. Clinical-psychopathological examination and psychodiagnostic methods were used, including the Clinical-Administered PTSD Scale (CAPS) for clinical diagnosis of PTSD, the Hospital Anxiety and Depression Scale (HADS), the Dissociative Experiences Scale (DES), Richard Lazarus' Psychological Diagnosis of Coping Behavior Strategy, the Quality of Life Assessment Scale (Chaban O.S., 2008), and others. A follow-up method was also employed to assess the results of the comprehensive treatment program. It should be noted that this article serves as a preliminary report, and the statistically analyzed results of the study will be reported in our future publications. Results. Aripiprazole can be considered one of the most promising antipsychotic agents for the treatment of post-traumatic stress disorders in a comprehensive approach alongside psychotherapy, and in certain cases, as monotherapy, considering its broad spectrum of action and minimal side effects. The key to successful treatment is the establishment of trusting and collaborative relationships with the patient when prescribing medication. Psychological preparation of patients regarding side effects, necessary dosages, treatment duration, and compliance can significantly improve outcomes. It is necessary to consider and discuss side effects, as well as weigh the risks and benefits of continued treatment. It is important to discuss treatment response and coordinate efforts. The doctor should engage in an ongoing dialogue with the patient regarding the effects of the medications and the presence of side effects. It is also crucial for the patient to actively participate in the treatment process rather than feeling like a passive recipient of medication to alleviate symptoms. Conclusions. Trauma-focused psychotherapy is certainly the main method for treating PTSD, and in cases of recent uncomplicated PTSD, it may be the sole treatment method. However, considering the fact that we are increasingly encountering complex PTSD with psychotic dissociative symptoms, significant disruptions in the affective domain, and anticipating an increase in such cases in the future, we understand that psychotherapy may be ineffective or entirely unattainable in such situations. Currently, pharmacotherapy for post-traumatic stress disorders primarily focuses on SSRI/H antidepressants, adrenergic blockers, and short courses of benzodiazepines. Previous attempts at antipsychotic pharmacotherapy for post-traumatic stress disorders were mainly focused on the “dones” and “pines” groups, whose side effects (sedation, cardiometabolic effects, dyskinesia) hindered successful treatment. The new generation antipsychotic, “doublepipe-rip” aripiprazole, demonstrates effectiveness in influencing all clusters of PTSD: intrusive, avoidance, hyperarousal, and additionally shows efficacy in treating complex PTSD and comorbid disorders with PTSD, supported by numerous studies and practical experience. It makes sense to take a closer look at the role of antipsychotic medications in the treatment of PTSD, considering the specific characteristics of aripiprazole and possibly other newer antipsychotics, and consider them as effective agents for augmentation, and sometimes even monotherapy, in the treatment of PTSD and complex PTSD.

show abstract

Section: Resultsmentioning

confidence: 99%

Experience using aripiprazole in the complex treatment of PTSD due to the war in Ukraine

Pustovoyt,

Krasnopolska,

Panchyshyn

et al. 2023

PMGP

View full text Add to dashboard Cite

show abstract

“…Такий одночасний підхід з подвійним спрямуванням виглядає доречним. Також було показано, що обидва захворювання реагують на селективні інгібітори захоплення серотоніну (Rossi, Niolu, Siracusano, Rossi, & Di Lorenzo, 2020).…”

Section: посттравматичний стресовий розлад у військовослужбовців: тео...unclassified

Post-Traumatic Stress Disorder for Military Servants: Theory, Research and Treatment

Kovalenko,

Berezan,

Pomohaibo

2023

ПІO

View full text Add to dashboard Cite

Military service is associated with exposure to traumatic stressors, including war zone hazards, accidents, and other occupational hazards, which may place military personnel at increased risk for the developing post-traumatic stress disorder (PTSD). The overall lifetime prevalence of PTSD among the world’s population varies between 10.0-11.3% for women and 5.0-6.0% for men. Among military veterans, the lifetime prevalence of the disorder is 13.4% and 7.7% for women and men, respectively. The United States Department of Veterans Affairs and the United States Department of Defense recommend a clinical methodology for the treatment of PTSD, which includes the following components: a diagnosis based on the criteria of the “Diagnostic and Statistical Manual of Mental Disorders” of the American Psychiatric Association; the presence of a high risk of harming oneself or others; functional status including duty and level of work responsibility; risk and protective factors; treatment history; medical history of the patient and his family. At the same time, joint decision-making with the patient is assumed, the key components of which are taking into account the patient’s preferences, educating the patient and his relatives with the concept of psychological trauma and the peculiarities of the course of PTSD, joint consideration with the patient of the advantages and disadvantages of available treatment options. The PTSD treatment process necessarily must be trauma-oriented and include the following types of psychotherapy: prolonged exposure, cognitive processing therapy, cognitive-behavioral therapy, brief eclectic psychotherapy, narrative exposure therapy, eye movement desensitization and reprocessing, and written exposure therapy. For situations where clinicians are not trained in trauma-focused psychotherapy or when patients refuse to initiate treatment, pharmacotherapy or non-trauma-focused manualized psychotherapy that includes stress resistance training, life-focused therapy, and interpersonal psychotherapy is recommended. Despite certain successes in the treatment of PTSD, important questions remain unsolved. First of all, there is a lack of clinical research to compare the effectiveness of the many available psychological treatments in general and for active-duty military personnel in particular. It is necessary to continue research in the field of precision medicine, which will make it possible to choose the most effective treatment for PTSD for each serviceman individually. To resolve these and similar issues, further long-term, consistent studies conducted on representative samples are needed.

show abstract

“…Some researchers have also distinguished in a case series that an integrated treatment approach to address both OCD and PTSD symp-toms through a cognitive-behavioral system (cognitive restructuring to modify trauma-related beliefs paired with exposure and prevention therapy for OCD symptoms) may be effective when there is a functional connection between both entities (Van Kirk et al, 2018). Lastly, a recent case study reported an apparent successful treatment approach with aripiprazole augmentation of sertraline (Rossi, Niolu, Siracusano, Rossi, & Di Lorenzo, 2020).…”

Section: Treatment Approaches (N = 3)mentioning

confidence: 99%

Overlap of obsessive and posttraumatic symptoms: A systematic review

Rodríguez

Villegas

2022

Salud Ment

View full text Add to dashboard Cite

Background. Current medical literature suggests a symptomatic overlap between posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), which makes understanding their impact on the treatment process a challenging undertaking. Objective. The key aim of this work was to deliver a comprehensive overview of empirical and observational studies concerning the overlap between both psychopathologies. Method. Two independent authors searched PubMed, PsycINFO, and Web of Science databases between April and July 2020 utilizing relevant MeSH terms. Subsequently, a systematic scoping review was undertaken according to the PRISMA-ScR Statement to identify all relevant publications concerning the overlap of OCD and PTSD symptomatology. We included peer reviewed studies published in any language that contributed quantitative or qualitative data that addressed the relationship between OCD and PTSD symptoms as the main aim or outcome of the study. Non-peer-reviewed articles, studies that did not address this phenomenon of interest, and gray literature documents were excluded. This review was not registered into the International Prospective Register of Systematic Reviews, since, according to the National Institute of Health Research, scoping reviews are ineligible for registration into PROSPERO. Results. Twenty-five relevant studies were included (11 cross-sectional studies, 5 longitudinal-prospective studies, 4 case series, 4 case studies and 1 retrospective study). We did not conduct any statistical analysis due to the diversity of the included studies, thus proceeding to realize a thematic synthesis of the obtained data. Discussion and conclusion. A symptomatic overlap exists between both comorbidities in some clinical populations, and this relationship may hamper treatment outcomes.

show abstract

A Case of Comorbid PTSD and Posttraumatic OCD Treated with Sertraline-Aripiprazole Augmentation

Cited by 4 publications

References 25 publications

Experience using aripiprazole in the complex treatment of PTSD due to the war in Ukraine

Experience using aripiprazole in the complex treatment of PTSD due to the war in Ukraine

Post-Traumatic Stress Disorder for Military Servants: Theory, Research and Treatment

Overlap of obsessive and posttraumatic symptoms: A systematic review

Contact Info

Product

Resources

About