Best practice guide for the treatment of nightmare disorder in adults

Mount Sinai Medical Center, New York, NY, USA.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine (Impact Factor: 3.05). 08/2010; 6(4):389-401.
Source: PubMed

ABSTRACT Prazosin is recommended for treatment of Posttraumatic Stress Disorder (PTSD)-associated nightmares. Level A. Image Rehearsal Therapy (IRT) is recommended for treatment of nightmare disorder. Level A. Systematic Desensitization and Progressive Deep Muscle Relaxation training are suggested for treatment of idiopathic nightmares. Level B. Venlafaxine is not suggested for treatment of PTSD-associated nightmares. Level B. Clonidine may be considered for treatment of PTSD-associated nightmares. Level C. The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Nefazodone is not recommended as first line therapy for nightmare disorder because of the increased risk of hepatotoxicity. Level C. The following behavioral therapies may be considered for treatment of PTSD-associated nightmares based on low-grade evidence: Exposure, Relaxation, and Rescripting Therapy (ERRT); Sleep Dynamic Therapy; Hypnosis; Eye-Movement Desensitization and Reprocessing (EMDR); and the Testimony Method. Level C. The following behavioral therapies may be considered for treatment of nightmare disorder based on low-grade evidence: Lucid Dreaming Therapy and Self-Exposure Therapy. Level C No recommendation is made regarding clonazepam and individual psychotherapy because of sparse data.

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Available from: Susmita Chowdhuri, Dec 23, 2013
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    • "Relative reduction of anxiety and depression symptoms may have also been a result of pharmacotherapy. The choice of medication prescribed was motivated by the authors' clinical experience and recent literature (Aurora et al., 2010; Stein, Ipser, & McAnda, 2009). Further, performed advocacy activities aiming at reducing the effect of resettlement stressors on asylum seekers' and refugees' mental health may also have caused a reduction of anxiety and depression symptoms. "
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    ABSTRACT: To examine sustainability of symptom outcomes of a 1-year phase-based trauma-focused, multimodal, and multicomponent group therapy in a day treatment program for posttraumatic stress disorder (PTSD) over an average period of 7 years. Iranian and Afghan patients (N = 69) were assessed with self-rated symptom checklists for PTSD, anxiety, and depression symptoms before (T1), after (T2), and up to 11 years upon completion of the treatment (T3). A series of mixed model regression analyses was applied to determine the course of the measured symptoms over time. At T2, all symptoms were reduced, but PTSD symptoms showed the strongest reduction. The trend of symptom reduction continued up to 5 years posttreatment and was similar for all the examined symptoms. After 5 years, all symptoms started to worsen, but remained under baseline levels at T3. The applied treatment appears to improve mental health of the studied sample on both the short and longer term.
    Journal of Clinical Psychology 04/2014; 70(4). DOI:10.1002/jclp.22035 · 2.12 Impact Factor
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    • "Pharmacological (Germain et al., 2012; Raskind et al., 2007) and psychological sleep-focused interventions (Forbes et al., 2003; Krakow et al., 2001b; Moore & Krakow, 2010) have been shown to improve both nocturnal and daytime PTSD symptoms concurrently (e.g., Augedal, Hansen, Kronhaug, Harvey, & Pallesen, 2013; Escamilla, LaVoy, Moore, & Krakow, 2012). As such, prazosin (an a-1 adrenergic antagonist) and imagery rehearsal therapy (IRT) have been recommended as the treatment of choice (level A) for posttraumatic nightmares by the American Association Sleep Medicine commissioned task force (Aurora et al., 2010). While successful implementation and further examination of the efficacy of these treatments are necessary worldwide, to date, there are no instruments measuring trauma-related sleep disturbances validated in French. "
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    ABSTRACT: Sleep disturbances are one of the main complaints of patients with trauma-related disorders. The original Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A) is self-report instrument developed to evaluate posttraumatic stress disorder (PTSD)-specific sleep disturbances in trauma-exposed individuals. However, to date, the PSQI-A has not yet been translated nor validated in French. THE PRESENT STUDY AIMS TO: a) translate the PSQI-A into French, and b) examine its psychometric properties. Seventy-three adult patients (mean age=40.3 [SD=15.0], 75% females) evaluated in a specialized psychotraumatology unit completed the French versions of the PSQI-A, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), and Impact Event Scale-Revised (IES-R). The French version of the PSQI-A showed satisfactory internal consistency, inter-item correlations, item correlations with the total score, convergent validity with PTSD and anxiety measures, and divergent validity with a depression measure. Our findings support the use of the French version of the PSQI-A for both clinical care and research. The French version of the PSQI-A is an important addition to the currently available instruments that can be used to examine trauma-related sleep disturbances among French-speaking individuals.
    European Journal of Psychotraumatology 09/2013; 4. DOI:10.3402/ejpt.v4i0.19298 · 2.40 Impact Factor
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    • "Patients with depression also have important sleep disturbances and recurrent nightmares, which are associated with suicidality [103] [104] [105]. Psychotherapies based on inducing LD could be an effective way of treating patients with recurrent nightmares [106] [107] [108] [109] [110] [111]. We believe the ability of becoming lucid during nightmare could bring about three outcomes, which are all beneficial. "
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    ABSTRACT: Several lines of evidence converge to the idea that rapid eye movement sleep (REMS) is a good model to foster our understanding of psychosis. Both REMS and psychosis course with internally generated perceptions and lack of rational judgment, which is attributed to a hyperlimbic activity along with hypofrontality. Interestingly, some individuals can become aware of dreaming during REMS, a particular experience known as lucid dreaming (LD), whose neurobiological basis is still controversial. Since the frontal lobe plays a role in self-consciousness, working memory and attention, here we hypothesize that LD is associated with increased frontal activity during REMS. A possible way to test this hypothesis is to check whether transcranial magnetic or electric stimulation of the frontal region during REMS triggers LD. We further suggest that psychosis and LD are opposite phenomena: LD as a physiological awakening while dreaming due to frontal activity, and psychosis as a pathological intrusion of dream features during wake state due to hypofrontality. We further suggest that LD research may have three main clinical implications. First, LD could be important to the study of consciousness, including its pathologies and other altered states. Second, LD could be used as a therapy for recurrent nightmares, a common symptom of depression and post-traumatic stress disorder. Finally, LD may allow for motor imagery during dreaming with possible improvement of physical rehabilitation. In all, we believe that LD research may clarify multiple aspects of brain functioning in its physiological, altered and pathological states.
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