Management of nightmares in patients with posttraumatic stress disorder: current perspectives

Ali A El-Solh1–4 1Research Department, VA Western New York Healthcare System, Buffalo, NY, USA; 2Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA; 3Department of Epid...

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Autor principal:	El-Solh AA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	nightmares posttraumatic stress disorder cognitive behavioral therapy pharmacotherapy Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
Acceso en línea:	https://doaj.org/article/807eedf7dc6e4d669867f253ed99cfa6
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spelling	oai:doaj.org-article:807eedf7dc6e4d669867f253ed99cfa62021-12-02T04:03:11ZManagement of nightmares in patients with posttraumatic stress disorder: current perspectives1179-1608https://doaj.org/article/807eedf7dc6e4d669867f253ed99cfa62018-11-01T00:00:00Zhttps://www.dovepress.com/management-of-nightmares-in-patients-with-posttraumatic-stress-disorde-peer-reviewed-article-NSShttps://doaj.org/toc/1179-1608Ali A El-Solh1–4 1Research Department, VA Western New York Healthcare System, Buffalo, NY, USA; 2Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA; 3Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA; 4Department of Community and Health Behavior, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA Abstract: Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD). Although the characteristics of these distressing dreams may vary with the type of traumatic event, the pathophysiology exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in noradrenergic, dopaminergic, and serotonin pathways. Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. The efficacy of existing pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, has been undermined by methodological limitations and absence of large randomized controlled trials. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. Given the intricate relationship between PTSD and nightmares, future clinical trials have to adopt a more pragmatic approach focused not only on efficacy of novel interventions but also on adjunctive iteration of existing therapies tailored to individual socio-cultural background. Keywords: nightmares, posttraumatic stress disorder, cognitive-behavioral therapy, pharmacotherapy, image rehearsal therapy, prazosin, cannabisEl-Solh AADove Medical Pressarticlenightmaresposttraumatic stress disordercognitive behavioral therapypharmacotherapyPsychiatryRC435-571Neurophysiology and neuropsychologyQP351-495ENNature and Science of Sleep, Vol Volume 10, Pp 409-420 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	nightmares posttraumatic stress disorder cognitive behavioral therapy pharmacotherapy Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
spellingShingle	nightmares posttraumatic stress disorder cognitive behavioral therapy pharmacotherapy Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495 El-Solh AA Management of nightmares in patients with posttraumatic stress disorder: current perspectives
description	Ali A El-Solh1–4 1Research Department, VA Western New York Healthcare System, Buffalo, NY, USA; 2Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA; 3Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA; 4Department of Community and Health Behavior, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA Abstract: Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD). Although the characteristics of these distressing dreams may vary with the type of traumatic event, the pathophysiology exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in noradrenergic, dopaminergic, and serotonin pathways. Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. The efficacy of existing pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, has been undermined by methodological limitations and absence of large randomized controlled trials. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. Given the intricate relationship between PTSD and nightmares, future clinical trials have to adopt a more pragmatic approach focused not only on efficacy of novel interventions but also on adjunctive iteration of existing therapies tailored to individual socio-cultural background. Keywords: nightmares, posttraumatic stress disorder, cognitive-behavioral therapy, pharmacotherapy, image rehearsal therapy, prazosin, cannabis
format	article
author	El-Solh AA
author_facet	El-Solh AA
author_sort	El-Solh AA
title	Management of nightmares in patients with posttraumatic stress disorder: current perspectives
title_short	Management of nightmares in patients with posttraumatic stress disorder: current perspectives
title_full	Management of nightmares in patients with posttraumatic stress disorder: current perspectives
title_fullStr	Management of nightmares in patients with posttraumatic stress disorder: current perspectives
title_full_unstemmed	Management of nightmares in patients with posttraumatic stress disorder: current perspectives
title_sort	management of nightmares in patients with posttraumatic stress disorder: current perspectives
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/807eedf7dc6e4d669867f253ed99cfa6
work_keys_str_mv	AT elsolhaa managementofnightmaresinpatientswithposttraumaticstressdisordercurrentperspectives
_version_	1718401440750239744

Management of nightmares in patients with posttraumatic stress disorder: current perspectives

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