Adjunctive risperidone in the treatment of chronic combat-related posttraumatic stress disorder

Background: The efficacy and safety of risperidone was evaluated in veteran patients with chronic combat-related postraumatic stress disorder (PTSD) who were referred to a residential treatment program. Methods. Seventy-three subjects volunteered to participate in this double-blind. placebo-controlled study, which comprised of a 5 week residential program followed by a 3-month outpatient follow-up. Risperidone was added to a stable psychotropic medication regimen in 92% of subjects. Primary outcome measures were the Clinician-Administered PTSD scale (CAPS-total) and its three subscales; B (Re-experiencing), C(Avoidance) and D (Arousal). Secondary outcome measures were the Hamilton Anxiety (HAM-A) and Depression (HAM-D) scales, and the Positive and Negative Syndrome Scale, Positive Subscale (PANSS-P). Results: Sixty-five subjects were randomized and 48 completed the 4-month study. Significantly greater improvement in symptoms was observed in subjects receiving risperidone compared to placebo on the CAPS-total and CAPS-D subscale scores and also on HAM-A and PANSS-P. Numerically greater improvements in all the remaining measures were noted with risperidone, but the differences did not reach statistical significance. Risperidone was well tolerated. Conclusions. These results suggest that adjunctive risperidone improved a broad range of pychiatric symptoms in patients with chronic combat-related PTSD. The data support the concept that a typical antipsychotic medications may have a wider therapeutic spectrum that goes beyond the treatment of psychosis.