RESUMO
BACKGROUND: Posttraumatic stress disorder (PTSD) is a highly prevalent and often chronic disorder among combat veterans, persisting in as many as 15% of Vietnam veterans for at least 20 years. Treatment response in veterans with combat-related PTSD has been disappointing. Although anxiolytics, anticonvulsants, antipsychotics, and antidepressants have been tried, none has been consistently associated with improvement in all primary symptom domains (i.e., intrusive recollections, avoidance/numbing, and hyperarousal). This open-label study evaluated the use of nefazodone in a group of Vietnam veterans with chronic, treatment-refractory symptoms of PTSD. METHOD: Male outpatients with DSM-IV PTSD who had failed a minimum of 3 previous medication trials were eligible for the study. Nineteen Vietnam combat veterans entered the study and were treated with nefazodone, 100-600 mg/day, for 12 weeks. PTSD symptoms, anxiety, depression, sleep, sexual functioning, and adverse events were assessed weekly. RESULTS: Severity of depression lessened, as did PTSD symptoms of intrusive recollections, avoidance, and hyperarousal. Depressive symptom severity as measured by the Beck Depression Inventory decreased by a mean of 30%. Similarly, there was an overall drop in the intensity of PTSD symptoms as measured by the Clinician Administered PTSD Scale of 32% with a 26% improvement for symptoms of intrusion, 33% for avoidance, and 28% for arousal. In addition, improvements in sleep and sexual functioning were reported. The mean daily dose of nefazodone after 12 weeks was 430 mg (range, 200-600 mg/day). The most frequently reported side effects were headaches (53%), dry mouth (42%), and diarrhea (42%), but side effects tended to be mild and transient. CONCLUSION: In this group of Vietnam veterans with chronic treatment-refractory PTSD and multiple comorbid Axis I psychiatric disorders, nefazodone was well tolerated and effective. Larger, controlled studies are warranted.
Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Triazóis/uso terapêutico , Assistência Ambulatorial , Doença Crônica , Ritmo Circadiano/fisiologia , Distúrbios de Guerra/tratamento farmacológico , Distúrbios de Guerra/epidemiologia , Distúrbios de Guerra/psicologia , Comorbidade , Esquema de Medicação , Resistência a Medicamentos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Piperazinas , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Índice de Gravidade de Doença , Comportamento Sexual , Sono/fisiologia , Ajustamento Social , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologiaAssuntos
1-Naftilamina/análogos & derivados , Transtorno Depressivo/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , 1-Naftilamina/uso terapêutico , Adulto , Comorbidade , Transtorno Depressivo/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sertralina , Transtornos de Estresse Pós-Traumáticos/epidemiologiaRESUMO
The phenomenon of vivid flashbacks elicited by olfactory stimuli is described in two combat veterans with posttraumatic stress disorder (PTSD). Although many sensory and cognitive cues can elicit flashback phenomena, smell has distinctive characteristics that make evocation of vivid olfactory memories particularly likely. It is recommended that clinicians inquire specifically about olfactory precipitants when evaluating combat veterans disabled by PTSD flashbacks.
