Distinguishing Schizophrenia From PTSD With Psychosis
Prazosin, an alpha blocker, has been shown in several studies to have efficacy in decreasing nightmares associated with PTSD, as well as decreasing PTSD symptom severity overall. There has been some interest in looking at the use of prazosin in the treatment of psychosis as an augmenting agent, and prazosin has been shown to augment the effects of antipsychotics in an animal model.
Treatment of PTSD has seen changes in the past several years, with selective serotonin reuptake inhibitors (SSRIs), which were previously considered the first line being shown not to be as effective as initially thought. In addition, SSRIs have been reported in several case studies to cause hallucinations and delusions Thus, if psychotic symptoms are already present, the psychosis could be exacerbated by SSRIs rather than helped, particularly if there is misdiagnosis with schizophrenia. Furthermore, the diagnosis will be complicated by not being able to determine whether symptoms are because of an SSRI, PTSD or a primarily psychotic illness. Interestingly, treatment with antipsychotic medication is recommended for patients who are resistant to other medications including alpha blockers and SSRI/serotonin norepinephrine reuptake inhibitors. The available evidence for the treatment of PTSD with antipsychotic agents whether there are psychotic features or not is by no means convincing and mainly based on small observational studies (see Table 1). Interestingly, SSRIs have also been used to treat some patients in a prodrome for schizophrenia, but have not been shown to be clinically effective at improving the negative symptoms of schizophrenia or decreasing the progression to psychosis. SSRIs have not been shown to be effective in the treatment of insomnia in PTSD; however, their partial efficacy in decreasing overall symptoms in individual patients has been attributed to their effect of receptor downregulation and uncoupling in those who have the beta2AR gene, which has been associated with PTSD.
Antipsychotics are used in the treatment of refractory PTSD symptoms; however, there are no high-quality studies examining their effectiveness and no one antipsychotic medication has emerged as clearly effective in the treatment of psychosis in PTSD.
Sleep disturbance and in particular sleep fragmentation has been shown to play an important role in PTSD through fear conditioning and learning. There has been an association made between improving sleep and improving symptoms of PTSD and depression, and this effect of improving sleep on PTSD symptoms may account for the perceived efficacy of antipsychotic agents and other sedating medications in the treatment of PTSD. Schizophrenia has also been associated with disturbed sleep and in particular sleep latency and night time wakening, which has been demonstrated in PTSD.
Treatment of Posttraumatic Stress Disorder and Psychosis in the Same Individual
Prazosin, an alpha blocker, has been shown in several studies to have efficacy in decreasing nightmares associated with PTSD, as well as decreasing PTSD symptom severity overall. There has been some interest in looking at the use of prazosin in the treatment of psychosis as an augmenting agent, and prazosin has been shown to augment the effects of antipsychotics in an animal model.
Treatment of PTSD has seen changes in the past several years, with selective serotonin reuptake inhibitors (SSRIs), which were previously considered the first line being shown not to be as effective as initially thought. In addition, SSRIs have been reported in several case studies to cause hallucinations and delusions Thus, if psychotic symptoms are already present, the psychosis could be exacerbated by SSRIs rather than helped, particularly if there is misdiagnosis with schizophrenia. Furthermore, the diagnosis will be complicated by not being able to determine whether symptoms are because of an SSRI, PTSD or a primarily psychotic illness. Interestingly, treatment with antipsychotic medication is recommended for patients who are resistant to other medications including alpha blockers and SSRI/serotonin norepinephrine reuptake inhibitors. The available evidence for the treatment of PTSD with antipsychotic agents whether there are psychotic features or not is by no means convincing and mainly based on small observational studies (see Table 1). Interestingly, SSRIs have also been used to treat some patients in a prodrome for schizophrenia, but have not been shown to be clinically effective at improving the negative symptoms of schizophrenia or decreasing the progression to psychosis. SSRIs have not been shown to be effective in the treatment of insomnia in PTSD; however, their partial efficacy in decreasing overall symptoms in individual patients has been attributed to their effect of receptor downregulation and uncoupling in those who have the beta2AR gene, which has been associated with PTSD.
Antipsychotics are used in the treatment of refractory PTSD symptoms; however, there are no high-quality studies examining their effectiveness and no one antipsychotic medication has emerged as clearly effective in the treatment of psychosis in PTSD.
Sleep disturbance and in particular sleep fragmentation has been shown to play an important role in PTSD through fear conditioning and learning. There has been an association made between improving sleep and improving symptoms of PTSD and depression, and this effect of improving sleep on PTSD symptoms may account for the perceived efficacy of antipsychotic agents and other sedating medications in the treatment of PTSD. Schizophrenia has also been associated with disturbed sleep and in particular sleep latency and night time wakening, which has been demonstrated in PTSD.
Source...