Use of Prazosin for Pediatric Post-Traumatic Stress Disorder With Nightmares and/or Sleep Disorder: Case Series of 18 Patients Prospectively Assessed

Vladimir Ferrafiat (1) , Maryam Soleimani (2) , Boris Chaumette (3, 4, 5, 6) , Audrey Martinez (7) , Jean-Marc Guile (8, 9) , Brooks Keeshin (10) , Priscille Gerardin (1, 11)

1 Hôpital Charles Nicolle [Rouen]
2 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
3 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
4 GHU Paris Psychiatrie et Neurosciences
5 GDR Psychiatrie (3557) - Groupement de recherche en Psychiatrie
6 Department of Psychiatry [Montréal]
7 IMN - Institut des Maladies Neurodégénératives [Bordeaux]
8 CHU Amiens-Picardie
9 GRAMFC - Groupe de Recherche sur l'Analyse Multimodale de la Fonction Cérébrale - UMR INSERM_S 1105
10 University of Utah
11 CRFDP - Centre de Recherches sur les Fonctionnements et Dysfonctionnements Psychologiques

Objectives Few studies have investigated pharmacologic treatment for pediatric post-traumatic stress disorder (PTSD). Prazosin, an alpha-1 adrenergic receptor antagonist, has been studied and demonstrated to be efficacious in an adult population for PTSD related sleep disturbances; however, in the pediatric population, data is limited to case reports and retrospective case series. This study prospectively assessed the safety and effects of Prazosin on PTSD symptoms in a pediatric sample. Methods Since 2016, 18 patients with PSTD under the age of 15 admitted in a child and adolescent psychiatric unit were challenged with prazosin as part of a treatment protocol. PTSD symptoms and adverse effects were collected weekly and prospectively assessed each month with validated clinical scales. All data were retrospectively analyzed. This treatment protocol and the evaluation of clinical data were approved by our Ethical committee for research on preexisting data at the University Teaching Hospital of Rouen. Results Among the 18 patients (10 girls and 8 boys), 13 (72%) had experienced sexual abuse and 5 (28%) family violence. After 1 month of treatment with a mean prazosin dose of 2.16 ( +/- 0.6) mg/day, the CGI-S score significantly decreased from 5.3 ( +/- 0.9) to 2.9 ( +/- 0.7) (improvement of 43%). The mean total UCLA-PTSD-RI score significantly decreased 11.4 points ( +/- 5.4) during the first week and 37.9 ( +/- 16) during the first month, leading to an improvement of 20% and 67%, respectively. The improvement was significant irrespective of trauma exposure or sex. No adverse effects were reported except for one patient (hypotension). Conclusion Consistent with prior case reports and retrospective reviews, our retrospective analysis of data prospectively and systematically assessed among 18 patients suggests that prazosin is well-tolerated and associated with improvement in symptoms for pediatric PTSD.

Mots clés: nightmares; post-traumatic stress disorder; prazosin; sleep disorder; youth

Domaines: Sciences du Vivant [q-bio]

Vladimir Ferrafiat, Maryam Soleimani, Boris Chaumette, Audrey Martinez, Jean-Marc Guile, et al.. Use of Prazosin for Pediatric Post-Traumatic Stress Disorder With Nightmares and/or Sleep Disorder: Case Series of 18 Patients Prospectively Assessed. Frontiers in Psychiatry, 2020, 11, ⟨10.3389/fpsyt.2020.00724⟩. ⟨hal-03604176⟩