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Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013.
Curr Psychiatry Rep 2018; 20(12):108CP

Abstract

PURPOSE OF REVIEW

Post-traumatic nightmares (PTN) are a common and enduring problem for individuals with post-traumatic stress disorder (PTSD) and other clinical presentations. PTN cause significant distress, are associated with large costs, and are an independent risk factor for suicide. Pharmacological and non-pharmacological treatment options for PTN exist. A previous review in this journal demonstrated that Prazosin, an alpha blocker, was a preferred pharmacological treatment for PTN and imagery rescripting therapy (IRT) was a preferred non-pharmacological treatment. Since that time, new and important research findings create the need for an updated review.

RECENT FINDINGS

Based on the results of a recent study in the New England Journal of Medicine, Prazosin has been downgraded by both the American Academy of Sleep Medicine (AASM) and the Veterans Health Administration/Department of Defense (VA/DoD) for PTN. In Canada, Nabilone, a synthetic cannabinoid, appears to be promising. Few recent studies have been published on non-pharmacological interventions for PTN; however, recent data is available with regard to using IRT on an inpatient setting, with German combat veterans, and through the use of virtual technology. Recent evidence supports the use of exposure, relaxation, and rescripting therapy (ERRT) with children and individuals with comorbid bipolar disorder and PTN. Prazosin is no longer considered a first-line pharmacological intervention for PTN by AASM and VA/DoD. However, in the absence of a suitable alternative, it will likely remain the preferred option of prescribers. IRT and ERRT remain preferred non-pharmacological treatments of PTN. Combining cognitive behavior therapy for insomnia (CBT-I) with IRT or ERRT may lead to improved outcomes.

Authors+Show Affiliations

Warrior Resiliency Program, Regional Health Command-Central, 7800 IH-10 West, Suite 300, San Antonio, TX, 78230, USA. scott.h.waltman.civ@mail.mil.Department of Family Medicine, Madigan Army Medical Center, Tacoma, WA, 98431, USA.Warrior Resiliency Program, Regional Health Command-Central, 7800 IH-10 West, Suite 300, San Antonio, TX, 78230, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30306339

Citation

Waltman, Scott H., et al. "Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013." Current Psychiatry Reports, vol. 20, no. 12, 2018, p. 108.
Waltman SH, Shearer D, Moore BA. Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013. Curr Psychiatry Rep. 2018;20(12):108.
Waltman, S. H., Shearer, D., & Moore, B. A. (2018). Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013. Current Psychiatry Reports, 20(12), p. 108. doi:10.1007/s11920-018-0971-2.
Waltman SH, Shearer D, Moore BA. Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013. Curr Psychiatry Rep. 2018 10 11;20(12):108. PubMed PMID: 30306339.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013. AU - Waltman,Scott H, AU - Shearer,David, AU - Moore,Bret A, Y1 - 2018/10/11/ PY - 2018/10/12/entrez PY - 2018/10/12/pubmed PY - 2019/9/27/medline KW - Imagery rehearsal therapy KW - Nightmares KW - PTSD KW - Prazosin KW - Trauma KW - Trauma nightmare KW - Traumatic SP - 108 EP - 108 JF - Current psychiatry reports JO - Curr Psychiatry Rep VL - 20 IS - 12 N2 - PURPOSE OF REVIEW: Post-traumatic nightmares (PTN) are a common and enduring problem for individuals with post-traumatic stress disorder (PTSD) and other clinical presentations. PTN cause significant distress, are associated with large costs, and are an independent risk factor for suicide. Pharmacological and non-pharmacological treatment options for PTN exist. A previous review in this journal demonstrated that Prazosin, an alpha blocker, was a preferred pharmacological treatment for PTN and imagery rescripting therapy (IRT) was a preferred non-pharmacological treatment. Since that time, new and important research findings create the need for an updated review. RECENT FINDINGS: Based on the results of a recent study in the New England Journal of Medicine, Prazosin has been downgraded by both the American Academy of Sleep Medicine (AASM) and the Veterans Health Administration/Department of Defense (VA/DoD) for PTN. In Canada, Nabilone, a synthetic cannabinoid, appears to be promising. Few recent studies have been published on non-pharmacological interventions for PTN; however, recent data is available with regard to using IRT on an inpatient setting, with German combat veterans, and through the use of virtual technology. Recent evidence supports the use of exposure, relaxation, and rescripting therapy (ERRT) with children and individuals with comorbid bipolar disorder and PTN. Prazosin is no longer considered a first-line pharmacological intervention for PTN by AASM and VA/DoD. However, in the absence of a suitable alternative, it will likely remain the preferred option of prescribers. IRT and ERRT remain preferred non-pharmacological treatments of PTN. Combining cognitive behavior therapy for insomnia (CBT-I) with IRT or ERRT may lead to improved outcomes. SN - 1535-1645 UR - https://www.unboundmedicine.com/medline/citation/30306339/Management_of_Post_Traumatic_Nightmares:_a_Review_of_Pharmacologic_and_Nonpharmacologic_Treatments_Since_2013_ L2 - https://dx.doi.org/10.1007/s11920-018-0971-2 DB - PRIME DP - Unbound Medicine ER -