A Parallel Group Placebo Controlled Study of Prazosin for Trauma Nightmares and Sleep Disturbance in Combat Veterans with Post-Traumatic Stress Disorder

Raskind, Murray A.; Peskind, Elaine R.; Hoff, David J.; Hart, Kimberly; Holmes, Hollie; Warren, Daniel; Shofer, Jane B.; O’Connell, James; Taylor, Fletcher B.; Gross, Christopher; Rohde, Kirsten; McFall, Miles

doi:10.1016/j.biopsych.2006.06.032

Cited by 481 publications

(358 citation statements)

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“…4,16,17 Patients in these 3 studies had a diagnosis of PTSD, with a CAPS minimum severity score for item B2, and active substance use within 3 to 6 months was excluded. Concurrent psychotropic medications were continued unchanged.…”

Section: Randomized Placebo-controlled Trialsmentioning

confidence: 99%

“…12 For the randomization categories, only 2 studies mentioned the method of sequence generation. 4,18 None of the studies described the details of the allocation concealment sufficient for assessment. All of the studies seemed to use adequate blinding techniques, eg, with how the placebos were provided.…”

Section: Article Highlightsmentioning

confidence: 99%

“…1-3 They can be a contributing factor to alcohol and substance abuse, suicidal ideation, or completed suicide. 4 Trauma-related nightmares in PTSD are more severe than non-trauma-related nightmares in terms of increased frequency and association with more frequent awakenings and worse sleep maintenance. 5,6 In the National Comorbidity Survey Replication of American adults, the lifetime prevalence of PTSD was 6.8%.…”

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confidence: 99%

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Treatment of Nightmares With Prazosin: A Systematic Review

Kung

Espinel

Lapid

2012

Mayo Clinic Proceedings

247

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Nightmares, frequently associated with posttraumatic stress disorder and clinically relevant in today's world of violence, are difficult to treat, with few pharmacologic options. We performed a systematic review to evaluate the evidence for the use of prazosin in the treatment of nightmares. A comprehensive search was performed using the databases EMBASE, Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews, from their inception to March 9, 2012, using keywords prazosin and nightmares/PTSD or associated terms (see text). Two authors independently reviewed titles and abstracts and selected relevant studies. Descriptive data and outcomes of interest from eligible studies were extracted by 1 author, and checked by 2 others. The risk of bias of randomized controlled trials (RCTs) was assessed independently by 2 reviewers. Articles met criteria for inclusion if prazosin was used to treat nightmares, and outcome measures included nightmares or related symptoms of sleep disorders. Our search yielded 21 studies, consisting of 4 RCTs, 4 open-label studies, 4 retrospective chart reviews, and 9 single case reports. The prazosin dose ranged from 1 to 16 mg/d. Results were mixed for the 4 RCTs: 3 reported significant improvement in the number of nightmares, and 1 found no reduction in the number of nightmares. Reduced nightmare severity with use of prazosin was consistently reported in the open-label trials, retrospective chart reviews, and single case reports.

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Section: Randomized Placebo-controlled Trialsmentioning

confidence: 99%

Section: Article Highlightsmentioning

confidence: 99%

mentioning

confidence: 99%

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Treatment of Nightmares With Prazosin: A Systematic Review

Kung

Espinel

Lapid

2012

Mayo Clinic Proceedings

247

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“…14e17 However, more studies are needed to determine whether this is a primary pharmacologic effect or secondary to improved sleep at night. 18 This report highlights the importance of obtaining a history of traumatic exposure in nursing home residents. Although the patient's presentation was suggestive of depression or complicated grief reaction, the primary problem was nightmares due to recurrent PTSD.…”

Section: Discussionmentioning

confidence: 87%

“…6 Low-dose prazosin is the recommended treatment for PTSDrelated nightmares, 7 even for patients taking SSRIs and other psychotropic medications. 8,9 Although low-dose prazosin is well tolerated in the geriatric population, even among those with other medical conditions and taking other blood pressure medications, there are some safety concerns. A common adverse effect of prazosin is orthostatic hypotension, especially after the first dose administration.…”

Section: Discussionmentioning

confidence: 99%

Re-emergence of Posttraumatic Stress Disorder Nightmares With Nursing Home Admission: Treatment With Prazosin

Johnson

Rosen

2013

Journal of the American Medical Directors Association

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a b s t r a c tSeniors with a history of emotional trauma decades earlier can experience a recurrence of posttraumatic stress disorder symptoms when transitioning to a nursing home. We present the case of an 86-year-old male Holocaust survivor admitted to a nursing home for physical therapy and rehabilitation 6 weeks after the death of his wife; the patient was expressing a persistent death wish. Despite the multiple risk factors for depression, his distress was specifically related to the reemergence of nightly posttraumatic nightmares. Over the course of 1 week of treatment with 1 mg prazosin at bedtime, his nightmares and his death wish completely resolved. He achieved his rehabilitation goals and was discharged to a community setting. This report highlights the importance of considering posttraumatic stress disorder in nursing home residents with a history of emotional trauma, and understanding how to address these symptoms pharmacologically and nonpharmacologically.Published by Elsevier Inc. on behalf of the American Medical Directors Association, Inc.Posttraumatic stress disorder (PTSD) symptoms can reemerge even decades later as seniors face challenges associated with aging. 1 Nursing home placement, although stressful for most seniors, can be particularly trying for survivors of involuntary incarceration, such as concentration camps, prisoner of war camps, or prison. Although these seniors may present with symptoms suggestive of depression, they also can present with symptoms specific to PTSD. 2 In some cases, this distinction will change the treatment approach. Case ReportAn 86-year-old male Holocaust survivor was admitted to a nursing facility for physical therapy after a humerus fracture sustained in a fall. His wife of 60 years had died after a long illness 6 weeks earlier.At the nursing home, he verbalized to the nursing staff on several occasions that he had "nothing to live for." The primary care physician in the nursing facility requested psychiatric consultation for evaluation of depression.The patient's history is significant for PTSD resulting from concentration camp imprisonment from ages 12 to 17. His parents, siblings, and more than 30 other relatives perished. After liberation, he married another survivor and moved to the United States, where he raised 3 children and worked as a plumber. He described vivid nightmares of his concentration camp experiences for several years after liberation, but over time, these became infrequent, occurring no more than once or twice per year.According to the patient's community primary care physician, he was "adjusting to his wife's death well," and his mood was good before his fall. He continued taking 50 mg sertraline daily, which had been initiated by his primary care physician during his wife's illness.Arriving at the nursing facility, the patient voiced renewed distress over his wife's death, reporting feelings of hopelessness and helplessness, passive death wish, and severe sleep disturbance. Despite these complaints, he was progressing well in physic...

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