Original scientific paper

https://doi.org/10.24869/psyd.2022.245

QUETIAPINE ADD-ON THERAPY MAY IMPROVE PERSISTENT SLEEP DISTURBANCES IN PATIENTS WITH PTSD ON STABILE COMBINED SSRI AND BENZODIAZEPINE COMBINATION: A ONE-GROUP PRETEST-POSTTEST STUDY

Maja Vilibić ; Department of Psychiatry, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia ; School of Medicine, Catholic University of Croatia, Zagreb, Croatia
Vjekoslav Peitl ; Department of Psychiatry, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia ; School of Medicine, Catholic University of Croatia, Zagreb, Croatia
Maja Živković ; School of Medicine, University of Zagreb, Zagreb,Croatia ; Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Suzana Vlatković ; Department for Psychotic Disorders, University Psychiatric Hospital Vrapče, Zagreb, Croatia
Ivana Ljubičić Bistrović ; Department of Psychiatry, Clinical Hospital Centre of Rijeka, Rijeka, Croatia ; School of Medicine, University of Rijeka, Rijeka, Croat
Rudolf Ljubičić ; Department of Psychiatry, Clinical Hospital Centre of Rijeka, Rijeka, Croatia
Ana Matošić ; Department of Psychiatry, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Zagreb, Croatia
Dalibor Karlović ; Department of Psychiatry, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia ; School of Medicine, Catholic University of Croatia, Zagreb, Croatia

Abstract

Background: To assess potential benefits of quetiapine for persistent sleep disturbances in patients with posttraumatic stress
disorder (PTSD) on stable combined SSRI and benzodiazepine therapy, who previously failed to respond to various benzodiazepine
and non-benzodiazepine hypnotic adjuvant treatment as well as to first-generation antipsychotic add-on treatment.
Subjects and methods: Fifty-two male PTSD outpatients on stable combination treatment with SSRI and benzodiazepines, with
persistent sleep disturbances not responding to prescription of zolpidem, flurazepam, nitrazepam, promazine, and levopromazine,
were assessed for sleep disturbances improvements after prescription of quetiapine in the evening. Each patient met both ICD-10
and DSM-IV criteria for PTSD. Psychiatric comorbidity and premorbidity were excluded using the Mini-International Neuropsychiatric
Interview (MINI). Improvement on the CAPS recurrent distressing dream item, reduction in the amount of time needed to
fall asleep, prolongation of sleep duration, and reduction in average number of arousals per night in the last 7 days before the
assessment period were used as efficacy measures.
Results: All sleep-related parameters improved significantly at the end of a five-week follow-up: sleep duration increased by one
hour (p<0.001), sleep latency decreased by 52.5 minutes (p<0.001), median number of arousals per night decreased from two to one
(p<0.001), CAPS recurrent distressing dream item median decreased from five to four (p<0.001), and the number of patients
dissatisfied with their sleep quality and quantity decreased from 45 to two (p<0.001).
Conclusion: Quetiapine prescribed in the evening may be successful therapy for persistent sleep disturbances in patients with
PTSD and generally good response to an SSRI and benzodiazepine combination, who previously failed to respond to some of the usual
hypnotic medication or addition of first-generation antipsychotics: zolpidem, flurazepam, nitrazepam, promazine, and levopromazine.

Keywords

posttraumatic stress disorder; insomnia; quetiapine; sleep; nightmares

Hrčak ID:

280016

URI

https://hrcak.srce.hr/280016

Publication date:

5.7.2022.

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