Prazosin (an alpha-1 adrenergic blocker) is used in PTSD specifically to treat which symptom cluster?
- A Intrusive flashbacks and re-experiencing symptoms during waking hours
- B Emotional numbing and avoidance of trauma reminders
- C Trauma-related nightmares and sleep disturbance ✓
- D Hypervigilance and exaggerated startle response
Correct answer: C. Trauma-related nightmares and sleep disturbance
Explanation
Prazosin's alpha-1 adrenergic blockade in the CNS (particularly prefrontal cortex and locus coeruleus) reduces noradrenergic-driven arousal during sleep, thereby diminishing trauma-related nightmares — the target symptom for which prazosin has the strongest evidence base in PTSD. It is typically given at bedtime. Prazosin has less robust evidence for daytime re-experiencing or avoidance/numbing symptoms. SSRIs and trauma-focused therapy address broader PTSD symptom clusters.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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