Mahr Fauzia, Waschbusch Daniel A, Vgontzas Alexandros
Pediatrics and Eating Disorders, Penn State College of Medicine, Hershey, USA.
Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, USA.
Cureus. 2023 Jul 25;15(7):e42433. doi: 10.7759/cureus.42433. eCollection 2023 Jul.
Objectives Post-traumatic stress disorder (PTSD) symptoms are reported in over 36% of individuals with bulimia nervosa. To date, none of the clinical trials have examined nightmare reduction in this population. We evaluated the effectiveness of prazosin in bulimic females experiencing PTSD-related nightmares. We hypothesized that prazosin will decrease nightmares, normalize cortisol levels and secretory patterns, and improve sleep. Methods Our seven-week prospective, randomized, double-blind, placebo-controlled crossover pilot trial recruited eight adult women. Each participant received three weeks of prazosin and a placebo, separated by a one-week washout period. The order of treatment was counterbalanced across participants. Self-reports, clinician-administered scales, and salivary cortisol was collected to measure outcomes. Results A significant treatment effect was seen in nightmare intensity on the Clinician-Administered PTSD Scale (CAPS-I) (p=0.026) and a marginally significant effect on nightmare frequency (p=0.069). The only significant main effect of treatment on self-reported sleep parameters was on nightmares. Cortisol secretory patterns did not change, but on average, study participants had significantly higher cortisol levels compared to normative values. ANOVA showed a significant main effect of time for cortisol (F(4, 28) = 6.15, p=.001) but no within or between groups significant effects (ps>.179). Follow-up tests showed the effect of time was linear (F(1, 7) = 10.77, p=.013). Conclusion Prazosin significantly reduced intensity and marginally reduced the frequency of PTSD-related nightmares in bulimia nervosa but did not affect subjective sleep efficiency, quality, cortisol levels, or diurnal cortisol secretory pattern. Larger trials using objective sleep measures are warranted to replicate these findings.
超过36%的神经性贪食症患者报告有创伤后应激障碍（PTSD）症状。迄今为止，尚无临床试验研究该人群中噩梦减少的情况。我们评估了哌唑嗪对患有与PTSD相关噩梦的贪食症女性的有效性。我们假设哌唑嗪将减少噩梦，使皮质醇水平和分泌模式正常化，并改善睡眠。方法：我们进行了一项为期七周的前瞻性、随机、双盲、安慰剂对照交叉试点试验，招募了八名成年女性。每位参与者接受三周的哌唑嗪治疗和三周的安慰剂治疗，中间间隔一周的洗脱期。治疗顺序在参与者之间进行了平衡。收集自我报告、临床医生评定量表和唾液皮质醇以测量结果。结果：在临床医生评定的PTSD量表（CAPS-I）上，噩梦强度有显著的治疗效果（p = 0.026），对噩梦频率有边缘显著效果（p = 0.069）。治疗对自我报告的睡眠参数的唯一显著主要影响是对噩梦的影响。皮质醇分泌模式没有改变，但平均而言，研究参与者的皮质醇水平明显高于正常水平。方差分析显示皮质醇的时间主效应显著（F(4, 28) = 6.15，p = 0.001），但组内或组间没有显著效应（p > 0.179）。后续测试表明时间效应是线性的（F(1, 7) = 10.77，p = 0.013）。结论：哌唑嗪显著降低了神经性贪食症中与PTSD相关噩梦的强度，并略微降低了其频率，但未影响主观睡眠效率、质量、皮质醇水平或昼夜皮质醇分泌模式。有必要进行更大规模的试验，采用客观睡眠测量方法来重复这些发现。
