Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder

Background: Psychotic symptoms may be present in up to 40% of patients with combat-related posttraumatic stress disorder (PTSD). In this study, we hyp othesized that severity of psychotic symptoms would also reflect severity o f PTSD symptoms in patients with well-defined psychotic features. Methods: Forty-five Vietnam combat veterans with PTSD but without a primary psychotic disorder diagnosis underwent a Structured Clinical Interview for DSM-III-R with Psychotic Screen, and the Clinician Administered PTSD Scale (CAPS). Patients identified as having psychotic features (PTSD-P), (n = 22 ) also received the Positive and Negative Syndrome Scale (PANSS) and the Ha milton Depression Rating Scale (HDRS). Results: There was a significant positive correlation between the Caps and PANSS global ratings (p < .001) and the HDRS and PANSS (p < .03) in the PTS D-P patients. Many CAPS and PANSS subscales also demonstrated significant i ntercorrelations; however, the CAPS-B subscale (reexperiencing) and the PAN SS positive symptom scale were not correlated, suggesting that psychotic fe atures may not necessarily be influenced or accounted for by more severe re experiencing symptoms. Fifteen (68%) of the PTSD-P patients had major depre ssion (MDD). Both CAPs and PANSS ratings were significantly higher in the P TSD-P patients with comorbid MDD. Conclusions: As postulated, patients with more severe psychosis ratings are likely to have more severe PTSD disease burden if psychotic features are p resent. This study further documents the occurrence of psychotic features i n PTSD that are not necessarily due to a primary psychotic disorder, sugges ting that this may be a distinct subtype; however, a significant interactio n likely exists between PTSD, depression, and psychotic features. (C) 1999 Society of Biological Psychiatry.