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Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study

Authors
  • Baig, Muhammad R.1, 2, 3
  • Beck, Robert D.1, 2
  • Wilson, Jennifer L.1, 2
  • Lemmer, Jennifer A.1, 2
  • Meraj, Adeel1
  • Meyer, Eric C.4, 5, 6
  • Mintz, Jim3, 3
  • Peterson, Alan L.1, 3, 7
  • Roache, John D.3, 3
  • 1 Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA , San Antonio (United States)
  • 2 Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA , San Antonio (United States)
  • 3 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA , San Antonio (United States)
  • 4 Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA , Waco (United States)
  • 5 Central Texas Veterans Healthcare System, Waco, TX, USA , Waco (United States)
  • 6 Baylor University, Waco, TX, USA , Waco (United States)
  • 7 University of Texas at San Antonio, San Antonio, USA , San Antonio (United States)
Type
Published Article
Journal
Military Medical Research
Publisher
Springer Nature
Publication Date
Oct 08, 2020
Volume
7
Issue
1
Identifiers
DOI: 10.1186/s40779-020-00278-0
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundSelective serotonergic reuptake inhibitors (SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder (PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury (mTBI) is problematic since SSRIs could exacerbate post-concussion syndrome (PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy.MethodsWe report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of mTBI.DiscussionWe expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full- scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.Trial registrationNCT04280965.

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