(126) A case series of the effectiveness of prazosin for managing acute stress disorder

Abstract:

Background:

Improving quality of sleep is important for patients with posttraumatic stress disorder (PTSD) and acute stress disorder (ASD). The presence of ASD risks progression to PTSD. Nighttime reexperiencing symptoms in PTSD is often treated with α1-blocker prazosin. Consultation-liaison psychiatrists often manage ASD in medically ill patients, including ICU patients (1). Besides trauma-focused CBT, no pharmacologically accepted therapy that prevents the progression of ASD to PTSD is in routine use (2). Although hydrocortisone has been found to be moderately efficacious in preventing PTSD, limited evidence and its adverse effects currently preclude routine use (3). Limited evidence exists regarding prazosin's efficacy in reducing nightmares and flashbacks in ASD (4). We report on prazosin’s efficacy in managing ASD in medically ill patients utilizing a case series format.



Case

A retrospective chart review covering a 4 month period identified 3 hospitalized patients experiencing ASD symptoms who were started on prazosin by the psychiatric consultation service.



Patient 1 was a 39-year-old male admitted for multiple fractures following a motor vehicle accident. After starting bedtime prazosin 1 mg, anxiety, nightmares, and sleep improved within 2 days. Patient 2 was a 27-year-old male admitted with multiple injuries following a gunshot wound. Within 5 days of bedtime prazosin, titrated to 2 mg, he noticed improvements in nightmares and quality of sleep. Patient 3 was a 20-year-old male admitted for multiple fractures following a motor vehicle accident. Within 1 day of initiating bedtime prazosin 1 mg, patient reported a decrease in intrusive images and flashbacks.

All 3 patients reported improvement in sleep with resolution of nightmares, flashbacks, and improved mood within 5 days of starting prazosin. Prazosin was well-tolerated without any adverse effects.



Discussion

This case series suggests that prazosin may be effective in preventing nightmares and flashbacks in ASD. Early recognition and treatment of patients with in-hospital ASD can improve long-term outcomes and limit progression to PTSD.



Conclusion

Prazosin may be effective in treating ASD symptoms and may play a role in inhibiting the progression of ASD to PTSD. Further studies should be conducted to determine the effectiveness of prazosin in those with ASD.

1. 
   Parker AM, et al. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Critical Care Medicine. 2015;43(5):1121-9.
   
   


2. 
   Kornør H, et al. Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms: a systematic review and meta-analysis. BMC Psychiatry. 2008;19(8):81.
   
   


3. 
   Astill Wright, L. et al. Pharmacological prevention and early treatment of post-traumatic stress disorder and acute stress disorder: a systematic review and meta-analysis. Translational Psychiatry 2019;9: 334.
   
   


4. 
   Srivastava AA, Opler DJ. Clinical Use of Prazosin in a Patient With Acute Stress Disorder: A Case Report. Journal of Psychiatric Practice. 2020;26(3):246-248.