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Chronic Sleep Disruption and the Reexperiencing Cluster of Posttraumatic Stress Disorder Symptoms Are Improved by Olanzapine: Brief Review of the Literature and a Case-Based Series

Primary Care Companion J Clin Psychiatry 2003;5(2):74-79
10.4088/PCC.v05n0203

Background: Posttraumatic stress disorder (PTSD) is one of the most prevalent psychiatric disorders in young adults. Early diagnosis and treatment of PTSD are essential to avoid possible long-term neuropsychiatric changes in brain physiology and function. A cardinal symptom of PTSD is chronic sleep disruption, often with recurring nightmares. If untreated, PTSD symptoms often contribute to substance abuse and the development of other comorbid psychiatric disorders. Once PTSD is diagnosed, drug treatment should begin with antidepressant therapy. If antidepressants do not correct the sleep disruption, adjunctive treatment with the atypical antipsychotic olanzapine or other agents should be considered.

Method: This case series reviews 7 cases of patients with PTSD (DSM-IV criteria) seen in primary care clinics who were successfully treated with olanzapine. In most cases, olanzapine therapy was adjunctive and followed failed treatment with antidepressant monotherapy for sleep disturbances.

Results:
All patients reported improved sleep with decreased or absent nightmares, as well as improvements in other PTSD symptom clusters.

Conclusion: Further controlled studies are needed to better characterize and validate this therapeutic indication.