Combat-related posttraumatic stress disorder (PTSD) is a severe debilitating psychiatric illness associated with different comorbidities. When complicated with comorbid psychotic features, PTSD is usually refractory to treatment and requires the use of other pharmacotherapeutic strategies, i.e. typical or atypical antipsychotics. In 81 male war veterans with chronic combat related PTSD with psychotic features, treatment response, clinical symptoms and adverse events were assessed using Watson's PTSD questionnaire, Positive and Negative Syndrome Scale (PANSS), Hamilton Rating Scale for Depression (HAMD), Clinical Global Impression Severity Scale (CGI-S), CGI-Improvement (CGI-I), Patient Global Impression Improvement Scale (PGI-I) and Drug Induced Extra-Pyramidal Symptoms Scale (DIEPSS). War veterans were treated for 6 weeks with fluphenazine (27 patients), olanzapine (28 patients) in a dose range of 5-10 mg/day, or risperidone (26 patients) at a dose of 2-4 mg/day, as monotherapy. Treatment with the atypical antipsychotic olanzapine or risperidone for 6 weeks improved significantly most of the PTSD and psychotic symptoms in war veterans with combat-related chronic psychotic PTSD. Olanzapine and risperidone showed similar efficacy and tolerability and induced fewer side effects than fluphenazine, suggesting that atypical antipsychotics might have beneficial effects in war veterans with treatment-resistant psychotic PTSD. In an open study the effect of clozapine was evaluated in war veterans with combat-related PTSD complicated with severe insomnia and nightmares: 34 patients were treated for 7 days with clozapine, and 37 patients with sedatives. Clozapine was shown to be effective in veterans with PTSD as well as in severe sleep disorders and nightmares, due to its strong sedative and anxiolytic effect.