Journal of the Korean Academy of Child and Adolescent Psychiatry

Korean Academy of Child and Adolescent Psychiatry (대한소아청소년정신의학회)
권호 표지
DOI QR코드

DOI QR Code

Pharmacologic Considerations for Youth with Posttraumatic Stress Disorder

  • Keeshin, Brooks (Department of Pediatrics, University of Utah) ;
  • Strawn, Jeffrey R. (Department of Psychiatry, University of Cincinnati)
  • Received : 2016.10.16
  • Accepted : 2016.11.15
  • Published : 2017.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Children exposed to potentially traumatic events are at risk of developing posttraumatic stress disorder (PTSD). However, the subsequent developmental course of posttraumatic stress symptoms appears to vary considerably. In this regard, some PTSD symptoms resolve without significant interventions, while for many children and adolescents, they persist until the patient receives appropriate treatment specifically designed to address PTSD and other trauma related symptoms. Evidence-based psychotherapies represent the standard of care for children with PTSD and, while psychopharmacologic interventions are utilized for many youth with posttraumatic stress symptoms and PTSD, there is little data available to guide the use of these medications in this population. However, given the structural challenges involved in disseminating and delivering evidence-based psychotherapies in all settings, prescribing clinicians should be aware of the medications whose use in children with pediatric PTSD has been studied. Herein, we review the PTSD assessment modalities, as well as the use of pharmacologic interventions in PTSD, including antiadrenergic agents, selective serotonin reuptake inhibitors and other medications.

Keywords

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Arlington: American Psychiatric Publishing;2013.
  2. Nemeroff CB, Weinberger D, Rutter M, MacMillan HL, Bryant RA, Wessely S, et al. DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions. BMC Med 2013;11:202. https://doi.org/10.1186/1741-7015-11-202
  3. Scheeringa MS. Developmental considerations for diagnosing PTSD and acute stress disorder in preschool and school-age children. Am J Psychiatry 2008;165:1237-1239. https://doi.org/10.1176/appi.ajp.2008.08070974
  4. Hafstad GS, Dyb G, Jensen TK, Steinberg AM, Pynoos RS. PTSD prevalence and symptom structure of DSM-5 criteria in adolescents and young adults surviving the 2011 shooting in Norway. J Affect Disord 2014;169:40-46. https://doi.org/10.1016/j.jad.2014.06.055
  5. Finkelhor D, Turner HA, Shattuck A, Hamby SL. Prevalence of childhood exposure to violence, crime, and abuse: results from the national survey of children's exposure to violence. JAMA Pediatr 2015;169:746-754. https://doi.org/10.1001/jamapediatrics.2015.0676
  6. Scheeringa MS, Wright MJ, Hunt JP, Zeanah CH. Factors affecting the diagnosis and prediction of PTSD symptomatology in children and adolescents. Am J Psychiatry 2006;163:644-651. https://doi.org/10.1176/ajp.2006.163.4.644
  7. Daviss WB, Mooney D, Racusin R, Ford JD, Fleischer A, McHugo GJ. Predicting posttraumatic stress after hospitalization for pediatric injury. J Am Acad Child Adolesc Psychiatry 2000;39:576-583. https://doi.org/10.1097/00004583-200005000-00011
  8. Stallard P, Velleman R, Baldwin S. Prospective study of post-traumatic stress disorder in children involved in road traffic accidents. BMJ 1998;317:1619-1623. https://doi.org/10.1136/bmj.317.7173.1619
  9. Keeshin BR, Strawn JR. Psychological and pharmacologic treatment of youth with posttraumatic stress disorder: an evidence-based review. Child Adolesc Psychiatr Clin N Am 2014;23:399-411, x. https://doi.org/10.1016/j.chc.2013.12.002
  10. Morina N, Koerssen R, Pollet TV. Interventions for children and adolescents with posttraumatic stress disorder: a meta-analysis of comparative outcome studies. Clin Psychol Rev 2016;47:41-54. https://doi.org/10.1016/j.cpr.2016.05.006
  11. Cohen JA, Kelleher KJ, Mannarino AP. Identifying, treating, and referring traumatized children: the role of pediatric providers. Arch Pediatr Adolesc Med 2008;162:447-452. https://doi.org/10.1001/archpedi.162.5.447
  12. Pine DS, Cohen JA. Trauma in children and adolescents: risk and treatment of psychiatric sequelae. Biol Psychiatry 2002;51:519-531. https://doi.org/10.1016/S0006-3223(01)01352-X
  13. Foa EB, McLean CP, Capaldi S, Rosenfield D. Prolonged exposure vs supportive counseling for sexual abuse-related PTSD in adolescent girls: a randomized clinical trial. JAMA 2013;310:2650-2657. https://doi.org/10.1001/jama.2013.282829
  14. Sadowski CM, Friedrich WN. Psychometric properties of the trauma symptom checklist for children (TSCC) with psychiatrically hospitalized adolescents. Child Maltreat 2000;5:364-372. https://doi.org/10.1177/1077559500005004008
  15. Chung US. The Korean version of the trauma symptom checklist for children: psychometric properties and the connection to trauma among Korean children and adolescents. J Korean Med Sci 2014;29:837-845. https://doi.org/10.3346/jkms.2014.29.6.837
  16. Strawn JR, Geracioti TD Jr. Noradrenergic dysfunction and the psychopharmacology of posttraumatic stress disorder. Depress Anxiety 2008;25:260-271. https://doi.org/10.1002/da.20292
  17. Keeshin BR, Strawn JR, Out D, Granger DA, Putnam FW. Elevated salivary alpha amylase in adolescent sexual abuse survivors with posttraumatic stress disorder symptoms. J Child Adolesc Psychopharmacol 2015;25:344-350. https://doi.org/10.1089/cap.2014.0034
  18. Famularo R, Kinscherff R, Fenton T. Propranolol treatment for childhood posttraumatic stress disorder, acute type. A pilot study. Am J Dis Child 1988;142:1244-1247. https://doi.org/10.1001/archpedi.1988.02150110122036
  19. Nugent NR, Christopher NC, Crow JP, Browne L, Ostrowski S, Delahanty DL. The efficacy of early propranolol administration at reducing PTSD symptoms in pediatric injury patients: a pilot study. J Trauma Stress 2010;23:282-287.
  20. Raskind MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D, et al. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry 2007;61:928-934. https://doi.org/10.1016/j.biopsych.2006.06.032
  21. Raskind MA, Thompson C, Petrie EC, Dobie DJ, Rein RJ, Hoff DJ, et al. Prazosin reduces nightmares in combat veterans with posttraumatic stress disorder. J Clin Psychiatry 2002;63:565-568. https://doi.org/10.4088/JCP.v63n0705
  22. Byers MG, Allison KM, Wendel CS, Lee JK. Prazosin versus quetiapine for nighttime posttraumatic stress disorder symptoms in veterans: an assessment of long-term comparative effectiveness and safety. J Clin Psychopharmacol 2010;30:225-229. https://doi.org/10.1097/JCP.0b013e3181dac52f
  23. Brkanac Z, Pastor JF, Storck M. Prazosin in PTSD. J Am Acad Child Adolesc Psychiatry 2003;42:384-385. https://doi.org/10.1097/01.CHI.0000052509.98293.97
  24. Oluwabusi OO, Sedky K, Bennett DS. Prazosin treatment of nightmares and sleep disturbances associated with posttraumatic stress disorder: two adolescent cases. J Child Adolesc Psychopharmacol 2012;22:399-402. https://doi.org/10.1089/cap.2012.0035
  25. Strawn JR, Delbello MP, Geracioti TD. Prazosin treatment of an adolescent with posttraumatic stress disorder. J Child Adolesc Psychopharmacol 2009;19:599-600. https://doi.org/10.1089/cap.2009.0043
  26. Strawn JR, Keeshin BR. Successful treatment of posttraumatic stress disorder with prazosin in a young child. Ann Pharmacother 2011;45:1590-1591. https://doi.org/10.1345/aph.1Q548
  27. De Bellis MD, Baum AS, Birmaher B, Ryan ND. Urinary catecholamine excretion in childhood overanxious and posttraumatic stress disorders. Ann N Y Acad Sci 1997;821:451-455. https://doi.org/10.1111/j.1749-6632.1997.tb48303.x
  28. Pervanidou P. Biology of post-traumatic stress disorder in childhood and adolescence. J Neuroendocrinol 2008;20:632-638. https://doi.org/10.1111/j.1365-2826.2008.01701.x
  29. Bloch MH, Panza KE, Landeros-Weisenberger A, Leckman JF. Meta-analysis: treatment of attention-deficit/hyperactivity disorder in children with comorbid tic disorders. J Am Acad Child Adolesc Psychiatry 2009;48:884-893. https://doi.org/10.1097/CHI.0b013e3181b26e9f
  30. Harmon RJ, Riggs PD. Clonidine for posttraumatic stress disorder in preschool children. J Am Acad Child Adolesc Psychiatry 1996;35:1247-1249. https://doi.org/10.1097/00004583-199609000-00022
  31. Porter DM, Bell CC. The use of clonidine in post-traumatic stress disorder. J Natl Med Assoc 1999;91:475-477.
  32. Horrigan JP, Barnhill LJ. The suppression of nightmares with guanfacine. J Clin Psychiatry 1996;57:371.
  33. Connor DF, Grasso DJ, Slivinsky MD, Pearson GS, Banga A. An open-label study of guanfacine extended release for traumatic stress related symptoms in children and adolescents. J Child Adolesc Psychopharmacol 2013;23:244-251. https://doi.org/10.1089/cap.2012.0119
  34. Sallee FR, Lyne A, Wigal T, McGough JJ. Long-term safety and efficacy of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2009;19:215-226. https://doi.org/10.1089/cap.2008.0080
  35. Strawn JR, Keeshin BR, DelBello MP, Geracioti TD Jr, Putnam FW. Psychopharmacologic treatment of posttraumatic stress disorder in children and adolescents: a review. J Clin Psychiatry 2010;71:932-941. https://doi.org/10.4088/JCP.09r05446blu
  36. Seedat S, Lockhat R, Kaminer D, Zungu-Dirwayi N, Stein DJ. An open trial of citalopram in adolescents with post-traumatic stress disorder. Int Clin Psychopharmacol 2001;16:21-25. https://doi.org/10.1097/00004850-200101000-00002
  37. Seedat S, Stein DJ, Ziervogel C, Middleton T, Kaminer D, Emsley RA, et al. Comparison of response to a selective serotonin reuptake inhibitor in children, adolescents, and adults with posttraumatic stress disorder. J Child Adolesc Psychopharmacol 2002;12:37-46. https://doi.org/10.1089/10445460252943551
  38. Cohen JA, Mannarino AP, Perel JM, Staron V. A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms. J Am Acad Child Adolesc Psychiatry 2007;46:811-819. https://doi.org/10.1097/chi.0b013e3180547105
  39. Robb AS, Cueva JE, Sporn J, Yang R, Vanderburg DG. Sertraline treatment of children and adolescents with posttraumatic stress disorder: a double-blind, placebo-controlled trial. J Child Adolesc Psychopharmacol 2010;20:463-471. https://doi.org/10.1089/cap.2009.0115
  40. Stathis S, Martin G, McKenna JG. A preliminary case series on the use of quetiapine for posttraumatic stress disorder in juveniles within a youth detention center. J Clin Psychopharmacol 2005;25:539-544. https://doi.org/10.1097/01.jcp.0000186901.79861.e2
  41. Meighen KG, Hines LA, Lagges AM. Risperidone treatment of preschool children with thermal burns and acute stress disorder. J Child Adolesc Psychopharmacol 2007;17:223-232. https://doi.org/10.1089/cap.2006.0121
  42. Keeshin BR, Strawn JR. Risperidone treatment of an adolescent with severe posttraumatic stress disorder. Ann Pharmacother 2009;43:1374.
  43. Looff D, Grimley P, Kuller F, Martin A, Shonfield L. Carbamazepine for PTSD. J Am Acad Child Adolesc Psychiatry 1995;34:703-704. https://doi.org/10.1097/00004583-199506000-00008
  44. Steiner H, Saxena KS, Carrion V, Khanzode LA, Silverman M, Chang K. Divalproex sodium for the treatment of PTSD and conduct disordered youth: a pilot randomized controlled clinical trial. Child Psychiatry Hum Dev 2007;38:183-193. https://doi.org/10.1007/s10578-007-0055-8
  45. Staller JA, Kunwar A, Simionescu M. Oxcarbazepine in the treatment of child psychiatric disorders: a retrospective chart review. J Child Adolesc Psychopharmacol 2005;15:964-969. https://doi.org/10.1089/cap.2005.15.964
  46. Cohen JA, Bukstein O, Walter H, Benson SR, Chrisman A, Farchione TR, et al. Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry 2010;49:414-430.
  47. Cohen JA, Mannarino AP, Iyengar S. Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial. Arch Pediatr Adolesc Med 2011;165:16-21.
  48. Berkowitz SJ, Stover CS, Marans SR. The Child and Family Traumatic Stress Intervention: secondary prevention for youth at risk of developing PTSD. J Child Psychol Psychiatry 2011;52:676-685. https://doi.org/10.1111/j.1469-7610.2010.02321.x
  49. Finkelhor D, Browne A. The traumatic impact of child sexual abuse: a conceptualization. Am J Orthopsychiatry 1985;55:530-541. https://doi.org/10.1111/j.1939-0025.1985.tb02703.x
  50. Connor DF, Ford JD, Arnsten AF, Greene CA. An update on posttraumatic stress disorder in children and adolescents. Clin Pediatr (Phila) 2015;54:517-528. https://doi.org/10.1177/0009922814540793
  51. Deblinger E, Mannarino AP, Cohen JA, Runyon MK, Steer RA. Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length. Depress Anxiety 2011;28:67-75. https://doi.org/10.1002/da.20744

Cited by

  1. Violence and Abuse: What Child Psychiatrists Need to Know vol.28, pp.1, 2017, https://doi.org/10.5765/jkacap.2017.28.1.2
  2. Pediatrician's Practical Approach to Sleep Disturbances in Children Who Have Experienced Trauma vol.48, pp.7, 2019, https://doi.org/10.3928/19382359-20190610-01