Nosological Implications of Psychotic Symptoms in Patients with Established Posttraumatic Stress Disorder

Objective: We describe three patients with chronic posttraumatic stress disorder (PTSD) who later developed psychotic symptoms. The nosological implications are discussed. Clinical picture: All three patients had no prior history of psychotic illness. The content of the psychotic symptoms was restricted to core features of the traumatic experiences which initially led to PTSD. Treatment: The patients received low-dose antipsychotic medications in addition to other treatments for PTSD and/or depression. Outcome: All three patients developed severe extrapyramidal side effects, particularly akathisia, and discontinued drug treatment. Conclusion: Psychotic symptoms occasionally can complicate chronic PTSD, but uncertainty remains about their aetiology and nosological status.