Sleep disturbance in chronic military-related PTSD: Clinical impact and response to adjunctive risperidone in the veterans affairs cooperative study #504

Veterans Affairs Cooperative Study #504 Group

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: Sleep disturbances are common among veterans with chronic military-related posttraumatic stress disorder (PTSD). This article reports the results of a multicenter clinical trial that explored the clinical correlates of reported sleep impairment in these veterans and tested the impact of the second-generation antipsychotic risperidone upon these symptoms. Method: This article reports secondary analyses of a 24-week multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD symptoms (n = 267, 97% male) who were symptomatic despite treatment with antidepressants and other medications. The study was conducted between February 2007 and February 2010. DSM-IV PTSD diagnoses were made by using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Nonpatient Edition. Sleep disturbances were assessed principally by using the Pittsburgh Sleep Quality Index (PSQI) (primary outcome measure). Analyses were conducted using bivariate correlations and longitudinal mixed model regressions. Results: Eighty-eight percent of the patients in this study had clinically significantly impaired sleep on the PSQI. Severity of sleep disturbances correlated with PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS) and reductions in multiple measures of quality of life (Veterans RAND 36-item Health Survey [SF-36 V] subscales, Boston Life Satisfaction Index). Risperidone produced small but statistically significant effects on total PSQI scores (main effect of drug: F1,228 = 4.57, P = .034; drug-by-time interaction: F2,421 = 4.32, P = .014) and severity of nightmares as assessed by the CAPS (main effect of drug: F1,248 = 4.60, P = .033). The improvements in sleep quality produced by risperidone correlated with reductions in PTSD symptom severity and improvement in the mental health subscale of the SF-36 V. Conclusions: This study highlighted the near universality and significant negative impact of severe disturbances in sleep quality in veterans with chronic militaryrelated PTSD who were partial responders to standard pharmacotherapies. The modest improvements in sleep quality produced by adjunctive risperidone were correlated with limited reductions in PTSD severity and improvements in quality of life.

Original languageEnglish (US)
Pages (from-to)483-491
Number of pages9
JournalJournal of Clinical Psychiatry
Volume77
Issue number4
DOIs
StatePublished - Apr 1 2016

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Risperidone
Veterans
Post-Traumatic Stress Disorders
Sleep
Diagnostic and Statistical Manual of Mental Disorders
Quality of Life
Health Surveys
Drug Interactions
Pharmaceutical Preparations
Antidepressive Agents
Antipsychotic Agents
Multicenter Studies
Mental Health
Randomized Controlled Trials
Placebos
Outcome Assessment (Health Care)
Clinical Trials
Interviews

ASJC Scopus subject areas

  • Psychiatry and Mental health

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Sleep disturbance in chronic military-related PTSD : Clinical impact and response to adjunctive risperidone in the veterans affairs cooperative study #504. / Veterans Affairs Cooperative Study #504 Group.

In: Journal of Clinical Psychiatry, Vol. 77, No. 4, 01.04.2016, p. 483-491.

Research output: Contribution to journalArticle

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title = "Sleep disturbance in chronic military-related PTSD: Clinical impact and response to adjunctive risperidone in the veterans affairs cooperative study #504",
abstract = "Objective: Sleep disturbances are common among veterans with chronic military-related posttraumatic stress disorder (PTSD). This article reports the results of a multicenter clinical trial that explored the clinical correlates of reported sleep impairment in these veterans and tested the impact of the second-generation antipsychotic risperidone upon these symptoms. Method: This article reports secondary analyses of a 24-week multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD symptoms (n = 267, 97{\%} male) who were symptomatic despite treatment with antidepressants and other medications. The study was conducted between February 2007 and February 2010. DSM-IV PTSD diagnoses were made by using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Nonpatient Edition. Sleep disturbances were assessed principally by using the Pittsburgh Sleep Quality Index (PSQI) (primary outcome measure). Analyses were conducted using bivariate correlations and longitudinal mixed model regressions. Results: Eighty-eight percent of the patients in this study had clinically significantly impaired sleep on the PSQI. Severity of sleep disturbances correlated with PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS) and reductions in multiple measures of quality of life (Veterans RAND 36-item Health Survey [SF-36 V] subscales, Boston Life Satisfaction Index). Risperidone produced small but statistically significant effects on total PSQI scores (main effect of drug: F1,228 = 4.57, P = .034; drug-by-time interaction: F2,421 = 4.32, P = .014) and severity of nightmares as assessed by the CAPS (main effect of drug: F1,248 = 4.60, P = .033). The improvements in sleep quality produced by risperidone correlated with reductions in PTSD symptom severity and improvement in the mental health subscale of the SF-36 V. Conclusions: This study highlighted the near universality and significant negative impact of severe disturbances in sleep quality in veterans with chronic militaryrelated PTSD who were partial responders to standard pharmacotherapies. The modest improvements in sleep quality produced by adjunctive risperidone were correlated with limited reductions in PTSD severity and improvements in quality of life.",
author = "{Veterans Affairs Cooperative Study #504 Group} and Krystal, {John H.} and Pietrzak, {Robert H.} and Rosenheck, {Robert A.} and Cramer, {Joyce A.} and Jennifer Vessicchio and Jones, {Karen M.} and Huang, {Grant D.} and Vertrees, {Julia E.} and Joseph Collins and Krystal, {Andrew D.} and J. Canive and L. Calais and A. Smith and E. Nye and E. Duncan and K. Skelton and R. Bradley-Davino and K. Tabb and T. Sergent and M. Daugherty and E. Russ and N. Denny and K. Arnemann and J. Lauren-Rusnack and J. Schillac and S. Batten and L. Dixon and A. Santanello and L. Bell and J. Duncan and S. Carney and G. Kavanagh and P. Parker and K. McCall and S. Rathmell and D. Kaloupek and G. Aguayo and D. Ryngala and A. Collins and M. Hamner and D. Agbor-Tabi and M. Timmerman and M. Brown and S. Robert and S. Coleman and P. Fore and T. Teppen and J. Yount and E. Konicki and Daniella David",
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T1 - Sleep disturbance in chronic military-related PTSD

T2 - Clinical impact and response to adjunctive risperidone in the veterans affairs cooperative study #504

AU - Veterans Affairs Cooperative Study #504 Group

AU - Krystal, John H.

AU - Pietrzak, Robert H.

AU - Rosenheck, Robert A.

AU - Cramer, Joyce A.

AU - Vessicchio, Jennifer

AU - Jones, Karen M.

AU - Huang, Grant D.

AU - Vertrees, Julia E.

AU - Collins, Joseph

AU - Krystal, Andrew D.

AU - Canive, J.

AU - Calais, L.

AU - Smith, A.

AU - Nye, E.

AU - Duncan, E.

AU - Skelton, K.

AU - Bradley-Davino, R.

AU - Tabb, K.

AU - Sergent, T.

AU - Daugherty, M.

AU - Russ, E.

AU - Denny, N.

AU - Arnemann, K.

AU - Lauren-Rusnack, J.

AU - Schillac, J.

AU - Batten, S.

AU - Dixon, L.

AU - Santanello, A.

AU - Bell, L.

AU - Duncan, J.

AU - Carney, S.

AU - Kavanagh, G.

AU - Parker, P.

AU - McCall, K.

AU - Rathmell, S.

AU - Kaloupek, D.

AU - Aguayo, G.

AU - Ryngala, D.

AU - Collins, A.

AU - Hamner, M.

AU - Agbor-Tabi, D.

AU - Timmerman, M.

AU - Brown, M.

AU - Robert, S.

AU - Coleman, S.

AU - Fore, P.

AU - Teppen, T.

AU - Yount, J.

AU - Konicki, E.

AU - David, Daniella

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objective: Sleep disturbances are common among veterans with chronic military-related posttraumatic stress disorder (PTSD). This article reports the results of a multicenter clinical trial that explored the clinical correlates of reported sleep impairment in these veterans and tested the impact of the second-generation antipsychotic risperidone upon these symptoms. Method: This article reports secondary analyses of a 24-week multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD symptoms (n = 267, 97% male) who were symptomatic despite treatment with antidepressants and other medications. The study was conducted between February 2007 and February 2010. DSM-IV PTSD diagnoses were made by using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Nonpatient Edition. Sleep disturbances were assessed principally by using the Pittsburgh Sleep Quality Index (PSQI) (primary outcome measure). Analyses were conducted using bivariate correlations and longitudinal mixed model regressions. Results: Eighty-eight percent of the patients in this study had clinically significantly impaired sleep on the PSQI. Severity of sleep disturbances correlated with PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS) and reductions in multiple measures of quality of life (Veterans RAND 36-item Health Survey [SF-36 V] subscales, Boston Life Satisfaction Index). Risperidone produced small but statistically significant effects on total PSQI scores (main effect of drug: F1,228 = 4.57, P = .034; drug-by-time interaction: F2,421 = 4.32, P = .014) and severity of nightmares as assessed by the CAPS (main effect of drug: F1,248 = 4.60, P = .033). The improvements in sleep quality produced by risperidone correlated with reductions in PTSD symptom severity and improvement in the mental health subscale of the SF-36 V. Conclusions: This study highlighted the near universality and significant negative impact of severe disturbances in sleep quality in veterans with chronic militaryrelated PTSD who were partial responders to standard pharmacotherapies. The modest improvements in sleep quality produced by adjunctive risperidone were correlated with limited reductions in PTSD severity and improvements in quality of life.

AB - Objective: Sleep disturbances are common among veterans with chronic military-related posttraumatic stress disorder (PTSD). This article reports the results of a multicenter clinical trial that explored the clinical correlates of reported sleep impairment in these veterans and tested the impact of the second-generation antipsychotic risperidone upon these symptoms. Method: This article reports secondary analyses of a 24-week multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD symptoms (n = 267, 97% male) who were symptomatic despite treatment with antidepressants and other medications. The study was conducted between February 2007 and February 2010. DSM-IV PTSD diagnoses were made by using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Nonpatient Edition. Sleep disturbances were assessed principally by using the Pittsburgh Sleep Quality Index (PSQI) (primary outcome measure). Analyses were conducted using bivariate correlations and longitudinal mixed model regressions. Results: Eighty-eight percent of the patients in this study had clinically significantly impaired sleep on the PSQI. Severity of sleep disturbances correlated with PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS) and reductions in multiple measures of quality of life (Veterans RAND 36-item Health Survey [SF-36 V] subscales, Boston Life Satisfaction Index). Risperidone produced small but statistically significant effects on total PSQI scores (main effect of drug: F1,228 = 4.57, P = .034; drug-by-time interaction: F2,421 = 4.32, P = .014) and severity of nightmares as assessed by the CAPS (main effect of drug: F1,248 = 4.60, P = .033). The improvements in sleep quality produced by risperidone correlated with reductions in PTSD symptom severity and improvement in the mental health subscale of the SF-36 V. Conclusions: This study highlighted the near universality and significant negative impact of severe disturbances in sleep quality in veterans with chronic militaryrelated PTSD who were partial responders to standard pharmacotherapies. The modest improvements in sleep quality produced by adjunctive risperidone were correlated with limited reductions in PTSD severity and improvements in quality of life.

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