- Email: [email protected]
4.53 Prazosin in Children and Adolescents With Posttraumatic Stress Disorder Who Have Nightmares: A Case Series
NEW RESEARCH POSTERS 4.53 — 4.55
Results: A significant inverse correlation between CDI and Clinical Global Impression (CGI) Scale of ACE symptoms was noted (r2¼ 0.61, P ¼ 0.001). CDI was significantly lower in subjects with ACE compared with those without ACE (3.1 0.2 vs. 4.6 0.2, P ¼ 0.001). Regression analyses revealed that ACE is independently associated with adulthood PTSD (likelihood ratio: 18.9, 95% CI 8.5–42.2, P ¼ 0.001). The likelihood of adulthood PTSD in ACE without preserved CDI was 10.6-fold (95% CI 5.4–25.6, P ¼ 0.001) higher compared with ACE with preserved CDI. The likelihood of adulthood PTSD was less in ACE with preserved CDI compared with ACE without preserved CDI (6 vs. 45%, P ¼ 0.001), which was comparable to those without ACE (3.5%; P > 0.05). Conclusions: Preserved CDI is strongly associated with the reduced adulthood PTSD in subjects with ACE. This highlights the important role of early intervention and preserving CDI in identifying individuals with ACE at risk for MACE.
PRE http://dx.doi.org/10.1016/j.jaac.2017.09.268
4.53 PRAZOSIN IN CHILDREN AND ADOLESCENTS WITH POSTTRAUMATIC STRESS DISORDER WHO HAVE NIGHTMARES: A CASE SERIES Adefolake Akinsanya, MD, MetroHealth Medical Center, [email protected]; Raman Marwaha, MD, Case Western Reserve University School of Medicine and MetroHealth Medical Center, [email protected]; Florence V. Kimbo, MD, MetroHealth Medical Center, fl[email protected] Objectives: The aim of this retrospective chart review is to identify patients who have been prescribed prazosin for PTSD-related nightmares and review benefits and outcomes from the use of prazosin. Methods: A retrospective chart review was conducted by reviewing medical records on EPIC over the last 20 years in the child psychiatry departments’ patient population. Information on age, sex, medication dosage, diagnosis, and outcome was gathered. Information gathered was limited to just one facility. Inclusion criteria include the following: patients between the ages of 0 and 18 years; diagnosis of PTSD; nightmares; and prescription of prazosin. There was no discrimination between race, sex, or socioeconomic status. Exclusion criteria included diagnosis of PTSD with no nightmares and no prescription of prazosin, as well as ages > 18 years. Results: A total of 25 patient records were identified. Of this population, 22 patients showed significant improvement in frequency of nightmares with administration of prazosin, one patient did not follow up after initiation of prazosin, and two patients had no significant improvement and also reported side effect of sedation. Of the 22 patients with significant improvement, five of them also had improved irritability and two of them had return of nightmares after stopping prazosin use and improvement when prazosin was resumed. The dose administered ranged from a total of one to three milligrams daily, with either nighttime dosing or twice-a-day dosing. Conclusions: Nightmares associated with PTSD have considerable comorbidity. Currently, there are no US Food and Drug Administrationapproved medications for treatment of nightmares associated with PTSD in children and adolescents. Our case series highlights that prazosin helps with pediatric PTSD-related nightmares. This positive outcome gives room for consideration of this medication in the treatment of children and adolescents with PTSD-related nightmares. Given that there are no RCTs in children, we recommend that RCTs be conducted to assess efficacy and safety of prazosin.
PPC, SLP http://dx.doi.org/10.1016/j.jaac.2017.09.269
4.54 INVESTIGATING THE PREVALENCE OF POSTTRAUMATIC SYMPTOMS IN CHILDREN AND ADOLESCENTS Monica Badillo, MD, Bronx-Lebanon Hospital Center at Icahn School of Medicine at Mount Sinai, [email protected];
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Aos Mohammed Ameen, MD, Bronx-Lebanon Hospital Center at Icahn School of Medicine at Mount Sinai, [email protected]; Viviana Chiappetta, MD, BronxLebanon Hospital Center, [email protected]; Luisa Gonzalez, MD, Bronx-Lebanon Hospital Center, [email protected]; Panagiota Korenis, MD, BronxLebanon Hospital Center and Albert Einstein College of Medicine, [email protected]; Michelle Kohut, LCSW, Bronx-Lebanon Hospital Center, [email protected]; Wen Gu, PhD, Bronx-Lebanon Hospital Center, WGu@ bronxleb.org Objectives: To appreciate and further understand what traumatic experience is most prevalent in the child and adolescent community, the goal is to improve detection, diagnosis, and management of posttraumatic pathologies. Methods: A performance improvement project was conducted in an urban inner city hospital on all newly admitted child and adolescent patients to inpatient psychiatry service over a two-month period. A total of 54 charts were screened and retrospectively reviewed, of which 42 patients had screened positive for trauma. Baseline data were collected using a modified Harvard screening questionnaire, which identified the prevalence of posttraumatic symptoms (PTS) and clinical characteristics of these young patients. Results: The overall prevalence of positive trauma history was 78 percent. The most prevalent trauma was physical abuse at 30 percent, sexual at 24 percent, emotional at 13 percent, and neglect at six percent. The most prevalent PTS were anger, sleep, detachment, and avoidance. Half of the patients screened resulted with anger symptoms associated with trauma. These symptoms primarily meet DSM-5 criteria B and C for PTSD. Of patients who screened positive for trauma, 83 percent of patients presented with a mood disorder, including bipolar disorder, major depressive disorder (MDD), and disruptive mood dysregulation disorder(DMDD). Based in our findings, there is a higher percentage of patients who present with substance abuse diagnosis, psychotic disorder, and reactive Attachment. Patient with the diagnosis of ADHD and conduct disorder (CD) had the same prevalence in the general population as the trauma population. Our findings indicated that there is a discrepancy in how PTS are treated in the inpatient unit. Only 19 percent of patients who were screened had prior treatment, and only 15 percent of patients’ PTS were addressed upon discharge. Caregiver support also played a major role in patients presenting symptoms. Conclusions: The prevalence of trauma in our population was high at 78 percent. Patients presenting with these symptoms can be treated with a combination of cognitive behavioral therapy and medications. Identifying trauma and addressing it on the in-patient Child and Adolescent unit may have future implications in preventing progression of psychiatric symptoms and improving quality of life.
R Supported by the Bronx Lebanon Hospital Center http://dx.doi.org/10.1016/j.jaac.2017.09.270
4.55 EFFECTS OF TRAUMA ON CHILDREN IN THE GREAT LAKES REGION OF AFRICA Kaitlin Budnik, MD, George Washington University, kaitlin. [email protected]; Suzan Song, MD, MPH, PhD, George Washington University Hospital, [email protected] Objectives: The Great Lakes Region of Africa, specifically Rwanda, The Democratic Republic of Congo, and Burundi, have endured years of conflict beginning with the genocide taking place in 1994 between the Hutus and Tutsis. During that time, estimates of up to one million Rwandese were killed and many were displaced. Studies at the time estimated that 94 percent of people in Rwanda experienced at least one genocide event (witnessing murder of family members, having property or homes destroyed, and having lives threatened). Children became soldiers, and many girls and women were raped. Children were often orphaned as a result of the fighting. HIV became a weapon of war across the region, causing many births of children with the disease. Studies began to emerge soon after demonstrating high prevalence rates of PTSD,
www.jaacap.org
S247
Results: A significant inverse correlation between CDI and Clinical Global Impression (CGI) Scale of ACE symptoms was noted (r2¼ 0.61, P ¼ 0.001). CDI was significantly lower in subjects with ACE compared with those without ACE (3.1 0.2 vs. 4.6 0.2, P ¼ 0.001). Regression analyses revealed that ACE is independently associated with adulthood PTSD (likelihood ratio: 18.9, 95% CI 8.5–42.2, P ¼ 0.001). The likelihood of adulthood PTSD in ACE without preserved CDI was 10.6-fold (95% CI 5.4–25.6, P ¼ 0.001) higher compared with ACE with preserved CDI. The likelihood of adulthood PTSD was less in ACE with preserved CDI compared with ACE without preserved CDI (6 vs. 45%, P ¼ 0.001), which was comparable to those without ACE (3.5%; P > 0.05). Conclusions: Preserved CDI is strongly associated with the reduced adulthood PTSD in subjects with ACE. This highlights the important role of early intervention and preserving CDI in identifying individuals with ACE at risk for MACE.
PRE http://dx.doi.org/10.1016/j.jaac.2017.09.268
4.53 PRAZOSIN IN CHILDREN AND ADOLESCENTS WITH POSTTRAUMATIC STRESS DISORDER WHO HAVE NIGHTMARES: A CASE SERIES Adefolake Akinsanya, MD, MetroHealth Medical Center, [email protected]; Raman Marwaha, MD, Case Western Reserve University School of Medicine and MetroHealth Medical Center, [email protected]; Florence V. Kimbo, MD, MetroHealth Medical Center, fl[email protected] Objectives: The aim of this retrospective chart review is to identify patients who have been prescribed prazosin for PTSD-related nightmares and review benefits and outcomes from the use of prazosin. Methods: A retrospective chart review was conducted by reviewing medical records on EPIC over the last 20 years in the child psychiatry departments’ patient population. Information on age, sex, medication dosage, diagnosis, and outcome was gathered. Information gathered was limited to just one facility. Inclusion criteria include the following: patients between the ages of 0 and 18 years; diagnosis of PTSD; nightmares; and prescription of prazosin. There was no discrimination between race, sex, or socioeconomic status. Exclusion criteria included diagnosis of PTSD with no nightmares and no prescription of prazosin, as well as ages > 18 years. Results: A total of 25 patient records were identified. Of this population, 22 patients showed significant improvement in frequency of nightmares with administration of prazosin, one patient did not follow up after initiation of prazosin, and two patients had no significant improvement and also reported side effect of sedation. Of the 22 patients with significant improvement, five of them also had improved irritability and two of them had return of nightmares after stopping prazosin use and improvement when prazosin was resumed. The dose administered ranged from a total of one to three milligrams daily, with either nighttime dosing or twice-a-day dosing. Conclusions: Nightmares associated with PTSD have considerable comorbidity. Currently, there are no US Food and Drug Administrationapproved medications for treatment of nightmares associated with PTSD in children and adolescents. Our case series highlights that prazosin helps with pediatric PTSD-related nightmares. This positive outcome gives room for consideration of this medication in the treatment of children and adolescents with PTSD-related nightmares. Given that there are no RCTs in children, we recommend that RCTs be conducted to assess efficacy and safety of prazosin.
PPC, SLP http://dx.doi.org/10.1016/j.jaac.2017.09.269
4.54 INVESTIGATING THE PREVALENCE OF POSTTRAUMATIC SYMPTOMS IN CHILDREN AND ADOLESCENTS Monica Badillo, MD, Bronx-Lebanon Hospital Center at Icahn School of Medicine at Mount Sinai, [email protected];
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Aos Mohammed Ameen, MD, Bronx-Lebanon Hospital Center at Icahn School of Medicine at Mount Sinai, [email protected]; Viviana Chiappetta, MD, BronxLebanon Hospital Center, [email protected]; Luisa Gonzalez, MD, Bronx-Lebanon Hospital Center, [email protected]; Panagiota Korenis, MD, BronxLebanon Hospital Center and Albert Einstein College of Medicine, [email protected]; Michelle Kohut, LCSW, Bronx-Lebanon Hospital Center, [email protected]; Wen Gu, PhD, Bronx-Lebanon Hospital Center, WGu@ bronxleb.org Objectives: To appreciate and further understand what traumatic experience is most prevalent in the child and adolescent community, the goal is to improve detection, diagnosis, and management of posttraumatic pathologies. Methods: A performance improvement project was conducted in an urban inner city hospital on all newly admitted child and adolescent patients to inpatient psychiatry service over a two-month period. A total of 54 charts were screened and retrospectively reviewed, of which 42 patients had screened positive for trauma. Baseline data were collected using a modified Harvard screening questionnaire, which identified the prevalence of posttraumatic symptoms (PTS) and clinical characteristics of these young patients. Results: The overall prevalence of positive trauma history was 78 percent. The most prevalent trauma was physical abuse at 30 percent, sexual at 24 percent, emotional at 13 percent, and neglect at six percent. The most prevalent PTS were anger, sleep, detachment, and avoidance. Half of the patients screened resulted with anger symptoms associated with trauma. These symptoms primarily meet DSM-5 criteria B and C for PTSD. Of patients who screened positive for trauma, 83 percent of patients presented with a mood disorder, including bipolar disorder, major depressive disorder (MDD), and disruptive mood dysregulation disorder(DMDD). Based in our findings, there is a higher percentage of patients who present with substance abuse diagnosis, psychotic disorder, and reactive Attachment. Patient with the diagnosis of ADHD and conduct disorder (CD) had the same prevalence in the general population as the trauma population. Our findings indicated that there is a discrepancy in how PTS are treated in the inpatient unit. Only 19 percent of patients who were screened had prior treatment, and only 15 percent of patients’ PTS were addressed upon discharge. Caregiver support also played a major role in patients presenting symptoms. Conclusions: The prevalence of trauma in our population was high at 78 percent. Patients presenting with these symptoms can be treated with a combination of cognitive behavioral therapy and medications. Identifying trauma and addressing it on the in-patient Child and Adolescent unit may have future implications in preventing progression of psychiatric symptoms and improving quality of life.
R Supported by the Bronx Lebanon Hospital Center http://dx.doi.org/10.1016/j.jaac.2017.09.270
4.55 EFFECTS OF TRAUMA ON CHILDREN IN THE GREAT LAKES REGION OF AFRICA Kaitlin Budnik, MD, George Washington University, kaitlin. [email protected]; Suzan Song, MD, MPH, PhD, George Washington University Hospital, [email protected] Objectives: The Great Lakes Region of Africa, specifically Rwanda, The Democratic Republic of Congo, and Burundi, have endured years of conflict beginning with the genocide taking place in 1994 between the Hutus and Tutsis. During that time, estimates of up to one million Rwandese were killed and many were displaced. Studies at the time estimated that 94 percent of people in Rwanda experienced at least one genocide event (witnessing murder of family members, having property or homes destroyed, and having lives threatened). Children became soldiers, and many girls and women were raped. Children were often orphaned as a result of the fighting. HIV became a weapon of war across the region, causing many births of children with the disease. Studies began to emerge soon after demonstrating high prevalence rates of PTSD,
www.jaacap.org
S247