Psychotic symptoms and comorbid psychiatric disorders in Croatian combat-related posttraumatic stress disorder patients

Aim. To investigate the prevalence rate of post-traumatic stress disorder (PTSD) comorbid psychiatric disorders and to explore psychotic symptoms in patients with combat-related current PTSD. Method. The sample included Croatian war veterans (N=41) who were hospitalized at the University Department of Psychiatry of the Vrapce Psychiatric Hospital during the 1995-1996 period and fulfilled the DSM-TV criteria for the current and chronic PTSD. The Schedule for Affective Disorder and Schizophrenia (SADS-L) was applied for the assessment of current and lifetime psychiatric disorders. Only three subjects had a prewar Axis I psychiatric disorder. One third of the patients met the criteria for a personality disorder. Results. After severe combat trauma, the majority of PTSD patients (33/41) had at least one comorbid psychiatric diagnosis on Axis I. In those with personality disorders the most frequent was alcohol dependence, whereas in those without personality disorders it was major depressive disorder. Psychotic symptoms occurred in 8 out of 41 PTSD patients. None of them had a primary psychotic disorder or a personality disorder. In all patients the psychotic symptoms were different from flashbacks. They were symbolically related to the trauma and resistant to antipsychotic treatment. Psychotic symptoms were associated with depression in 5 out of 8 patients with psychotic symptoms. Conclusion. Severe and prolonged combat trauma may be followed by the co-occurrence of PTSD and psychotic symptoms, forming an atypical clinical picture of PTSD.