Treatment of posttraumatic stress disorder: Focus on pharmacotherapy

Ehret, Megan J.

doi:10.9740/mhc.2019.11.373

Cited by 34 publications

(29 citation statements)

References 53 publications

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“…Only a handful of studies have been conducted on antipsychotics for the treatment of PTSD, and even fewer on the medications’ effect on SREs [ 33 ]. As discussed, the results of the limited studies do show promising efficacy for the treatment of PTSD with SGAs [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

Delapaz

Hor

Gilbert

et al. 2021

JPM

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Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

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Section: Discussionmentioning

confidence: 99%

An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

Delapaz

Hor

Gilbert

et al. 2021

JPM

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“…The subsequent therapeutic management of these symptoms must be adapted to each specific situation in the long term 34 . The presence of neuropathic symptoms with ‘sensory’ descriptors or allodynia could favour the use of antiepileptics, 35 while more affective items and the characterization of a PTSD would rather favour antidepressant treatment or psychotherapy 36,37 . This highlights the importance of careful clinical characterization of chronic pain syndrome in the context of SJS/TEN.…”

Section: Discussionmentioning

confidence: 99%

Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors

Lefaucheur

Valeyrie‐Allanore

Tin

et al. 2020

Acad Dermatol Venereol

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BackgroundStevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are associated with various sequelae. Chronic pain, one of these sequelae, has never been systematically evaluated.Objectives and methodsTo assess the persistence of pain in a single‐centre cohort of 113 consecutive patients with SJS/TEN. From this cohort, 81 patients were interviewed more than 1 year after the initial episode and included in the study. Data were collected according to standardized questionnaires.ResultsFrom the 81 interviewed patients, 52 patients (64%) were painless and 29 patients (36%) were painful. Chronic pain syndrome was associated with a more severe initial acute phase of the disease (larger extent of detachment, higher SCORTEN, increased rate of admission in ICU and complications, and longer hospital stay). Pain was mainly located at the level of eyes (55%), mouth and lower limbs (38–41%), with a moderate daily intensity on average (4.7/10). The ‘affective’ descriptors prevailed over the ‘sensory’ descriptors, with the exception of burning and itching sensations. Finally, regarding provoked pain, mechanical allodynia (to brushing and pressure) was more marked than thermal allodynia.DiscussionThe persistence of chronic pain after SJS/TEN is a common phenomenon. Sensory descriptors are consistent with sensitization of both small‐diameter nerve fibres (burning and itching sensations) and large‐diameter nerve fibres (mechanical allodynia), but the affective‐emotional components of pain largely predominate.ConclusionsComplex mechanisms lead to persistent pain as long‐term sequela of SJS/TEN, among which mechanisms, psychological factors related to post‐traumatic stress disorder probably play a key role.

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“…Concerning pharmacotherapy, the recent American Psychiatric Association (APA) and National Institute of Clinical Excellence (NICE) guidelines include antidepressants like the SSRIs fluoxetine, paroxetine, sertraline, and the SNRI venlafaxine, as well as the antipsychotics prazosin, olanzapine, and risperidone as first-and second-line agents for the treatment of PTSD [57]. Studies on the effectiveness of cannabinoids in the treatment of PTSD are small and disputed and better randomized clinical trials are needed [58] in order to corroborate the findings of the retrieved studies.…”

Section: Discussionmentioning

confidence: 99%

Neurobiological Trajectories Involving Social Isolation in PTSD: A Systematic Review

2020

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Social isolation (SI) stress has been recognized as a major risk factor of morbidity in humans and animals, exerting damaging effects at the physical and mental health levels. Posttraumatic stress disorder (PTSD), on the other hand, occurs as a result of experiencing serious, life-threatening, traumatic events and involves involuntary re-experiencing trauma (intrusion), avoidance symptoms, and distortions of cognition and emotional arousal. The literature shows that PTSD is affected by genetic predisposition and triggers a large neurocircuitry involving the amygdala, insula, hippocampus, anterior cingulate- and prefrontal-cortex, and affects the function of the neuroendocrine and immune systems. Social isolation seems to influence the predisposition, onset and outcome of PTSD in humans, whereas it constitutes a valid model of the disorder in animals. According to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) protocol, we systematically reviewed all original studies involving the neurobiological trajectories between SI and PTSD published till July 2019 (database: PubMed/Medline). Out of 274 studies, 10 met the inclusion criteria. We present the results of the retrieved studies in terms of hypothalamic-pituitary-adrenal (HPA)-axis and endocannabinoid system function, immune reactions, neuroplasticity, novel pharmacological targets, and shortening of telomere length, which confirm a synergistic effect on a neurobiological level between the two entities.

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Treatment of posttraumatic stress disorder: Focus on pharmacotherapy

Cited by 34 publications

References 53 publications

An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors

Neurobiological Trajectories Involving Social Isolation in PTSD: A Systematic Review

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