Administration of Prazosin to Prevent PTSD in Adult Women After Sexual Assault

Administration of Prazosin to Prevent PTSD After Sexual Assault

This study plans to learn more about whether taking the medication, Prazosin, immediately and during the weeks immediately following a traumatic event can help to reduce the risk of developing posttraumatic stress disorder (PTSD). Early post traumatic event sleep disturbance predicts the later development of PTSD. Prazosin has shown some effectiveness in reducing trauma related nightmares and sleep disturbance. We hypothesize that regulating sleep immediately after a sexual assault will reduce PTSD and diminish symptoms.

This study plans to learn more about whether taking the medication, Prazosin, in the weeks immediately following a traumatic event can help to reduce the risk of developing posttraumatic stress disorder (PTSD).

Specific Aim 1: Test the efficacy of the drug prazosin in decreasing PTSD symptom severity as compared to placebo at 3 months post rape as measured by the Clinician-Administered PTSD Scale version 5 (CAPS-5, primary outcome) as well as associated secondary outcomes (PTSD diagnosis rate, sleep scores, and depression symptoms) at 3 months.

Hypotheses:

1a: Severity score on the CAPS-5 will be significantly lower in rape victims randomized to receive prazosin within 24 hours of at the University of Colorado Hospital (UCH) Emergency Department and continue on a titrated dose for one month compared to the control group at 3 months post rape. Secondarily, PTSD diagnosis rate will be lower in the prazosin group versus the control group at 3 months.

1b: Participants randomized to receive prazosin will have better sleep scores as measured by the Pittsburgh Sleep Quality Index (PSQI) and PSQI Trauma addendum at 3 months post rape as compared to the control group.

1c: Severity scores for major depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9) will be significantly lower in rape victims randomized to receive prazosin as compared to the control group at 3 months post rape.

1d: Sleep scores as measured by the PSQI and PSQI Trauma addendum will be positively correlated with PTSD symptom severity as measured by the CAPS-5 such that higher (worse) sleep scores are associated with more PTSD symptoms.

Rationale: Many studies have shown that sleep disturbances and nightmares that occur directly after a traumatic event are a good predictor of the development of PTSD. Prazosin has been shown to improve PTSD-related sleep disturbance, including nightmares. If prazosin can effectively treat sleep disturbance in the weeks immediately following a traumatic experience and decrease the rate of PTSD and the severity of symptoms, then it could possibly become the standard of care for individuals exposed to a traumatizing event.

Brief overview of methods: Females between the ages of 18 and 50 years will be recruited directly from the ED at University of Colorado Hospital with the assistance of the Forensic Nurse Examiners. Those who elect to take part in this study and complete the informed consent process will be randomized to receive either prazosin or placebo. This is a double-blind study, so neither the participant nor the study doctor/team will know whether a participant is in the treatment (prazosin) or control (placebo) group. Participants will receive three 2mg tabs and three 1mg tbs for titration purposes (prazosin or placebo equivalent) before they leave the hospital, with instructions to take the first dose (2 mg) 1 hour before bed, the first night after being seen in the ED. Study staff will follow up the next day to inquire about the participant's general condition, possible side-effects, sleep, and to schedule the first study visit (at ~72 hours after treatment in ED). PTSD and posttraumatic stress symptoms, symptoms of depression, suicidality, medication compliance, side-effects and adverse events will be monitored and assessed by study personnel at weekly study visits for the duration of the med trial (~6 weeks; 3 weeks on medication and 2-3 weeks of tapering off of medication) and again at 3-months post. However, participants will be instructed to report any changes or concerns as needed. Each participant will also complete a daily sleep log for the duration of their participation in the study.

Inclusion Criteria:

• Female patients between the ages of 18 years and 50 years
• Victim of sexual assault/rape
• Able to understand consent procedure
• Discharged to home

Exclusion Criteria:

• Admitted to inpatient unit
• Previous diagnosis of PTSD
• Contra-indications to prazosin: orthostatic hypotension, right heart failure, use of anti-hypertensive medication, 5-phosphodiesterase inhibitors (sildenafil) or diuretic, history of syncope or severe unexplained faintness, known hypersensitivity to quinazolines
• Hemodynamically unstable
• Current use of over the counter, prescribed, or use of other drugs for insomnia
• Dependence on alcohol, opiates or other illegal drugs
• History of psychotic disorder
• Suicidal risk defined by a positive response on the 3-item assessment, standard protocol in the ED
• Current use of morphine or methadone
• Pregnant or breastfeeding
• Known hepatic dysfunction
• Cardiac or vascular history including coronary artery disease
• Narcolepsy
• History of sleep apnea
• Returning to chronic domestic abuse situation