Warrior Resiliency Program, Regional Health Command-Central, 7800 IH-10 West, Suite 300, San Antonio, TX, 78230, USA.
Department of Family Medicine, Madigan Army Medical Center, Tacoma, WA, 98431, USA.
Curr Psychiatry Rep. 2018 Oct 11;20(12):108. doi: 10.1007/s11920-018-0971-2.
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.
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.
创伤后梦魇（PTN）是创伤后应激障碍（PTSD）和其他临床表现患者的常见且持久的问题。PTN 会引起明显的痛苦，与高昂的成本相关，并且是自杀的独立风险因素。目前存在针对 PTN 的药理学和非药理学治疗选择。本刊之前的一篇综述表明，α 受体阻滞剂普萘洛尔是治疗 PTN 的首选药理学治疗方法，意象重述治疗（IRT）是首选的非药理学治疗方法。自那时以来，新的重要研究结果表明需要进行更新的综述。
根据《新英格兰医学杂志》上的一项最新研究结果，普萘洛尔已被美国睡眠医学学会（AASM）和退伍军人事务部/国防部（VA/DoD）降级，不再推荐用于治疗 PTN。在加拿大，合成大麻素纳布隆似乎很有前途。最近很少有研究发表关于 PTN 的非药理学干预措施；然而，最近的数据可用于住院患者使用 IRT、德国战斗退伍军人以及使用虚拟技术。最近的证据支持使用暴露、放松和重述治疗（ERRT）治疗儿童和患有共病双相情感障碍和 PTN 的个体。AASM 和 VA/DoD 不再将普萘洛尔视为治疗 PTN 的一线药理学干预措施。然而，在缺乏合适替代方案的情况下，它可能仍然是开处方者的首选。IRT 和 ERRT 仍然是治疗 PTN 的首选非药理学治疗方法。将失眠认知行为疗法（CBT-I）与 IRT 或 ERRT 相结合可能会带来更好的结果。
