Cheung Lap Kei
Pennine Care NHS Foundation Trust, Lancashire, United Kingdom.
J Korean Acad Child Adolesc Psychiatry. 2025 Apr 1;36(2):78-82. doi: 10.5765/jkacap.240037.
Complex post-traumatic stress disorder (Complex PTSD) in pediatric patients is challenging to manage, particularly when conventional therapeutic approaches are insufficient. We report the case of Miss A, a 15-year-old girl with a history of severe neglect and abuse, adopted at age 5, who presented with frequent reliving of trauma memories, significant emotional dysregulation, dissociative episodes, recurrent self-harm, and aggression. Her treatment was complicated by comorbid mild-grade learning disability and suspected autism spectrum disorder. Initial management with promethazine, melatonin, and lorazepam, and later aripiprazole and fluoxetine provided limited relief. Following hospital readmission, guanfacine, an alpha-2 adrenergic agonist, was initiated. Miss A demonstrated a marked reduction in emotional dysregulation, self-harm, aggression, and suicidal thoughts, suggesting that guanfacine may offer significant benefits for managing Complex PTSD in such cases. This case underscores the difficulties in treating Complex PTSD with comorbid conditions, and highlights guanfacine as a potential adjunct therapy. However, further research is required to validate its efficacy and safety.
小儿复杂性创伤后应激障碍（Complex PTSD）的治疗颇具挑战性，尤其是在传统治疗方法效果不佳时。我们报告了A小姐的病例，她是一名15岁女孩，5岁时被收养，有严重忽视和虐待史，表现为创伤记忆频繁重现、明显的情绪失调、解离发作、反复自我伤害和攻击行为。她的治疗因合并轻度学习障碍和疑似自闭症谱系障碍而变得复杂。最初使用异丙嗪、褪黑素和劳拉西泮治疗，后来使用阿立哌唑和氟西汀，效果有限。再次入院后，开始使用α-2肾上腺素能激动剂胍法辛。A小姐的情绪失调、自我伤害、攻击行为和自杀念头明显减少，这表明胍法辛可能对此类病例的复杂性创伤后应激障碍的治疗有显著益处。该病例强调了治疗合并症的复杂性创伤后应激障碍的困难，并突出了胍法辛作为一种潜在辅助治疗方法的作用。然而，需要进一步研究来验证其疗效和安全性。
