{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T14:31:16Z","timestamp":1792161076632,"version":"4.4.0"},"reference-count":7,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"3","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"},{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n Posttraumatic stress disorder (PTSD) in children and adolescents has a high prevalence of accompanying sleep disturbances. Currently, pediatric treatment of PTSD-related nightmares is extrapolated from adult studies. This study aims to determine the effectiveness and safety of clonidine and guanfacine compared with prazosin for the treatment of PTSD-related nightmares.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a retrospective, single-center, medical record review of patients 5 to 17 years old admitted to an inpatient psychiatric unit from January 2015 to September 2021. Patients with a new initiation of an alpha-2 agonist (clonidine or guanfacine) or an alpha-1 antagonist (prazosin) with a diagnosis of PTSD, other trauma- or stressor-related disorder or unspecified anxiety disorder were included. The primary endpoint was the percentage of patients with a decrease in the frequency of nightmares.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 59 patients were included in the study: 37 in the alpha-2 agonist group and 22 in the alpha-1 antagonist group. There was no statistically significant difference in reduction of nightmares with both groups having a high percentage of patients showing response (alpha-2 agonist: 91.9%, alpha-1 antagonist: 86.4%). Time to decrease in nightmares was comparable between groups with a relatively quick onset. Within the alpha-2 agonist group, clonidine (1.59\u2009\u00b1\u20091.06 days) compared with guanfacine (3.18\u2009\u00b1\u20091.74 days) had a statistically significant faster time to reduction in nightmares (\n p<\/jats:italic>\n \u2009=\u2009.005).\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Both pharmacologic classes of medications were effective treatment options for pediatric PTSD-associated nightmares with a low incidence of adverse effects. There was a quick time to onset seen with all agents.<\/jats:p>\n <\/jats:sec>","DOI":"10.9740\/mhc.2024.06.199","type":"journal-article","created":{"date-parts":[[2024,6,2]],"date-time":"2024-06-02T20:01:13Z","timestamp":1717358473000},"page":"199-203","source":"Crossref","is-referenced-by-count":5,"title":["Comparison of alpha-2 agonist versus alpha-1 antagonist for post-traumatic stress disorder\u2013associated nightmares in pediatric patients"],"prefix":"10.9740","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8195-1033","authenticated-orcid":true,"given":"Seher","family":"Khalid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2658-2905","authenticated-orcid":true,"given":"Sandra","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Specialist, Child and Adolescent Psychiatry, Virginia Commonwealth University Health System Department, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6932-0702","authenticated-orcid":true,"given":"Cheryl","family":"Al-Mateen","sequence":"additional","affiliation":[{"name":"Child and Adolescent Psychiatrist, Virginia Commonwealth University Health System Department of Psychiatry, Division of Child and Adolescent Psychiatry, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4719","reference":[{"key":"i2168-9709-14-3-199-b01","article-title":"Post-traumatic stress disorder [cited 2022 Jun 13]","author":"National Institute of Mental Health","unstructured":"National Institute of Mental Health\n . Post-traumatic stress disorder [cited 2022 Jun 13]. Available from: https:\/\/www.nimh.nih.gov\/health\/statistics\/post-traumatic-stress-disorder-ptsd"},{"key":"i2168-9709-14-3-199-b02","series-title":"Diagnostic and Statistical Manual of Mental Disorders","article-title":"Trauma- and Stressor-Related Disorders","author":"American Psychiatric Association.","year":"2022","unstructured":"American Psychiatric Association.\n \n Trauma- and Stressor-Related Disorders. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. 2022."},{"issue":"2","key":"i2168-9709-14-3-199-b03","series-title":"J Child Adolesc Trauma","first-page":"249","article-title":"Nightmares in treatment-seeking youth: the role of cumulative trauma exposure","volume":"13","author":"Secrist","year":"2019","unstructured":"Secrist\n ME,\n \n \n John\n SG,\n \n \n Harper\n SL,\n \n \n Conners Edge\n NA,\n \n \n Sigel\n BA,\n \n \n Sievers\n C,\n \n et al.\n \n Nightmares in treatment-seeking youth: the role of cumulative trauma exposure. J Child Adolesc Trauma. 2019 Jun 18;13(2):249-56. DOI: 10.1007\/s40653-019-00268-y"},{"issue":"5","key":"i2168-9709-14-3-199-b04","series-title":"J Clin Sleep Med","first-page":"501","article-title":"Sleep disturbance in pediatric PTSD: current findings and future directions","volume":"9","author":"Kovachy","year":"2013","unstructured":"Kovachy\n B,\n \n \n O\u2019Hara\n R,\n \n \n Hawkins\n N,\n \n \n Gershon\n A,\n \n \n Primeau\n MM,\n \n \n Madej\n J,\n \n et al.\n \n Sleep disturbance in pediatric PTSD: current findings and future directions. J Clin Sleep Med. 2013 May 15;9(5):501-10. DOI: 10.5664\/jcsm.2678"},{"issue":"3","key":"i2168-9709-14-3-199-b05","series-title":"Child Psychiatry Hum Dev","first-page":"439","article-title":"Longitudinal study of nightmares in children: stability and effect of emotional symptoms","volume":"40","author":"Schredl","year":"2009","unstructured":"Schredl\n M,\n \n \n Fricke-Oerkermann\n L,\n \n \n Mitschke\n A,\n \n \n Wiater\n A,\n \n \n Lehmkuhl\n G.\n \n \n Longitudinal study of nightmares in children: stability and effect of emotional symptoms. Child Psychiatry Hum Dev. 2009 Sep;40(3):439-49. DOI: 10.1007\/s10578-009-0136-y"},{"issue":"3","key":"i2168-9709-14-3-199-b06","series-title":"Depress Anxiety","first-page":"260","article-title":"Noradrenergic dysfunction and the psychopharmacology of posttraumatic stress disorder","volume":"25","author":"Strawn","year":"2008","unstructured":"Strawn\n JR,\n \n \n Geracioti\n TD\n Jr\n \n . Noradrenergic dysfunction and the psychopharmacology of posttraumatic stress disorder. Depress Anxiety. 2008;25(3):260-71. DOI: 10.1002\/da.20292"},{"issue":"4","key":"i2168-9709-14-3-199-b07","series-title":"J Am Acad Child Adolesc Psychiatry","first-page":"414","article-title":"AACAP work group on quality issues: practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder","volume":"49","author":"Cohen","year":"2010","unstructured":"Cohen\n JA,\n \n \n Bukstein\n O,\n \n \n Walter\n H,\n \n \n Benson\n SR,\n \n \n Chrisman\n A,\n \n \n Farchione\n TR,\n \n et al.\n \n AACAP work group on quality issues: practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry. 2010 Apr;49(4):414-30. 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