The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An Update on Posttraumatic Stress Disorder

Bajor, Laura; Ticlea, Ana Nectara; Osser, David N.

doi:10.3109/10673229.2011.614483

Cited by 68 publications

(41 citation statements)

References 111 publications

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“…Upcoming results from 2 large clinical trials of use of prazosin to treat PTSD symptoms (a 13-site VA study of 320 veterans and a single-site study of 120 soldiers on active duty), expected to be completed in late 2012, will add greatly to our knowledge. 38 There are several limitations to the present literature review. One is the relatively small number of studies and total number of patients.…”

Section: Discussionmentioning

confidence: 91%

“…[38][39][40][41][42] We used a method that would be reproducible for future updates, and we assessed the risk of bias for the randomized studies. Already, our review includes 2 recent studies from 2010 and 2012 that other recent reviews were unable to include, and the significance is that one of these studies reported a negative finding and the other study reported less impressive results than the earlier studies.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Nightmares With Prazosin: A Systematic Review

Kung

Espinel

Lapid

2012

Mayo Clinic Proceedings

252

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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: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Treatment of Nightmares With Prazosin: A Systematic Review

Kung

Espinel

Lapid

2012

Mayo Clinic Proceedings

252

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“…This algorithm update is one of several recently published by the PAPHSS (1,(8)(9)(10)(11) and available in condensed format for access on smart phone devices on the website www.psychopharm.mobi. The methods of producing these algorithms have been described in the previous publications.…”

Section: Methodsmentioning

confidence: 99%

The psychopharmacology algorithm project at the harvard south shore program: 2012 update on psychotic depression

Tang¹,

Osser²

2012

JMOOD

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Bulgular: Algoritmada küçük değişiklikler yapıldı, önceki önerilerin çoğu desteklendi. Elektrokonvulsif tedavi (EKT), hastaneye yatırılmış, ağır psikotik depresyon hastaları için en etkin tedavi olmaya devam etmektedir. EKT mevcut olmadığında veyadüşünülmediğindetercihedilenfarmakolojikyöntemise halenbirantidepresan(trisiklik[TSA],seçiciserotoningeri-alım engelleyici[SSGE]veyaserotonin-norepinefringeri-alımengelleyici [SNGE]) ile bir antipsikotiğin birlikte kullanımıdır. Son güncellemedenitibarenyenikanıtlar,ilkseçenekantidepresan olarak bir SNGE olan venlafaksin ER kullanımını destekleme eğilimindedir. Antipsikotikler ele alındığında, hem olanzapinin hem de ketiapinin etkililiğini gösteren yeni veriler mevcuttur. Ancak daha iyi huylu güvenlik profillerine sahip diğer atipik antipsikotiklerin(örn.ziprasidon,aripiprazol)ilkseçenekantipsikotik olarak denenmesinin daha akıllıca olacağı tavsiye edilmektedir.Yeniverilerayrıcaenazdörtaylıkidametedavisinin de etkin olduğunu önermektedir. Eğer ilk antidepresan-antipsikotik birlikte kullanımı tatminkar bir sonuç vermezse ve EKT halaulaşılabilirveyauygundeğilseikincifarmakolojikgirişim, 2008 algoritmasında da önerildiği gibi, antidepresanda değişiklikyapmakolabilir.İkibirleştirmegirişimibaşarısızolduktan sonra (ve yine EKT tercihler arasında yoksa) algoritma, lityum eklenmesini önermeye devam etmektedir. Sınırlı miktarda kanıt,klozapinteklitedavisinegeçmeyidetavsiyeetmektedir. Çok küçük miktardaki kanıta dayanan metilfenidat eklenmesi ise son dönemde bahsedilen, olası bir seçenektir. Kanıtlar, birleştirmetedavisitercihedilmediğinde,TSAileteklitedavinin SSGE ile veya SNGE ile tekli tedaviden daha etkin olduğunu önermektedir.Ancak,güvenlikkonularıvepsikozalevlenmesi riskinde olası artış, TSA tekli tedavisi için olumsuz etkenlerdir. Antidepresanteklitedavisibaşarısızolursa,EKTveyabirantipsikotikeklenmesiyenidendeğerlendirilmelidir. Sonuç:Bugözdengeçirme,psikotikdepresyonunfarmakolojik tedavisi için mevcut olan kanıtların önceki PAPHSS analizini yeniden değerlendirmektedir. Sonuçların geçerliliği, mevcut literatürün nicelik ve niteliği açısından kısıtlıdır. Psikotik depresyondabirebirkarşılaştırmalıileriyedönükçalışmalarhalen göreceazmiktardadır.Ancakbualgoritma,psikotikdepresyon tedavisi için hekimlere bir rehber olarak hizmet edebilir.

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“…For these reasons it is useful to treat insomnia first. 22 Sleep disturbances in PTSD are thought to be related to hyperarousal and increased adrenergic activity, which may lead to related symptoms such as nightmares, difficulty initiating sleep, and frequent awakenings. Two medications that decrease nightmares and improve sleep quality are prazosin, and trazodone.…”

Section: Preferred Pharmacologic Management Of Ptsd Symptoms Sleepmentioning

confidence: 99%

Posttraumatic Stress in Older Adults

Moye

Rouse

2014

Clinics in Geriatric Medicine

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The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An Update on Posttraumatic Stress Disorder

Abstract: This heuristic may be helpful in producing faster symptom resolution, fewer side effects, and increased compliance.

Cited by 68 publications

References 111 publications

Treatment of Nightmares With Prazosin: A Systematic Review

Treatment of Nightmares With Prazosin: A Systematic Review

The psychopharmacology algorithm project at the harvard south shore program: 2012 update on psychotic depression

Posttraumatic Stress in Older Adults

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