Nefazodone in patients with treatment-refractory posttraumatic stress disorder.

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.

Psychopharmacists' role in neuroleptic therapy. A pharmaceutical care approach.

OBJECTIVE: To describe the roles of the psychopharmacist in the use of neuroleptic therapy. SETTING: A geriatric psychiatry ambulatory care clinic in a 400-bed Department of Veterans Affairs Medical Center, San Diego, California. CONCLUSIONS: In the pharmaceutical care model, the pharmacist is involved in several important roles in the provision of neuroleptic therapy. In the ambulatory care program, psychopharmacists provide important drug-related information to patients and consultation regarding potential neuroleptic-induced adverse effects. In addition, psychopharmacists serve as consultants to other clinicians concerning the risks associated with the use of neuroleptics and participate in neuroleptic-discontinuation clinics. Morbidity associated with neuroleptic-induced tardive dyskinesia has exposed healthcare providers to legal repercussions; therefore, pharmacy intervention may aid in the reduction of legal liability.