Rosh Psychiatry Board Practice Exam

Which medication is effective for decreasing nightmares in post-traumatic stress disorder?

1. Amlodipine

2. Clonidine

3. Hydralazine

4. Prazosin

The correct answer is: Prazosin

Prazosin is recognized as an effective medication for reducing nightmares associated with post-traumatic stress disorder (PTSD). This adrenergic antagonist specifically works by blocking alpha-1 adrenergic receptors, which helps mitigate the sympathetic nervous system's overactivity that can contribute to sleep disturbances and vivid nightmares. Research has shown that prazosin can improve sleep quality and decrease the frequency and intensity of nightmares in individuals with PTSD, enhancing overall sleep architecture by minimizing wakefulness caused by distressing dreams. The effectiveness of prazosin in treating trauma-related nightmares is widely supported in clinical practice and various studies, making it a preferred choice in this situation. Sleep disturbances are a significant aspect of PTSD, and addressing nightmares through pharmacotherapy can greatly enhance the overall management of the disorder. In contrast, medications like amlodipine, clonidine, and hydralazine do not have strong evidence supporting their use for nightmare reduction in PTSD and are primarily indicated for other conditions such as hypertension. Clonidine may have some sedative properties, but it is not specifically targeted for the management of PTSD nightmares. Therefore, prazosin stands out as the best treatment option in this context.