The validity and psychometric properties of the DSM-5 version of the UCLA-PTSD-RI have been validated in the pediatric population. The UCLA-PTSD-RI is a self-report questionnaire that assesses trauma history and diagnostic criteria for PTSD based on frequency of symptoms. Symptoms are reported in five clusters: (1) intrusive symptoms such as unwanted upsetting memories, flashbacks, nightmares (cluster B); (2) avoidant symptoms such as avoidance of thoughts, feelings, or reminders (cluster C); (3) negative cognition/mood symptoms such as inability to recall the trauma, negative affect and thoughts, culpability, decreased interest (cluster D); (4) hyperarousal symptoms such as irritability, angry outbursts, risky behavior, hypervigilance (cluster E); and (5) dissociative symptoms such as depersonalization, derealization (cluster A). The scale has been validated for children over 6 years old. A cut-off was fixed at >=38. This cut-off showed the greatest sensitivity and specificity for detecting PTSD.
The sleep score is an added subscale to the UCLA-PTSD-RI to monitor for sleep problems, summing questions 10 and 21 from the UCLA-PTSD-RI, with a score range of 0 to 8.
The CGI provides a brief assessment of the clinician's view of the patient's global functioning prior to and after initiating a treatment. The CGI-S is a 7-point scale that requires the clinician to rate the severity of the patient's illness at the time of assessment: 1 = Normal, not at all ill; 2 = Borderline mentally ill; 3 = Mildly ill; 4 = Moderately ill; 5 = Markedly ill; 6 = Severely ill; 7 = Among the most extremely ill patients.
All assessments except UCLA-PTSD- RI (self-questionnaire) were performed and reviewed by senior child and adolescent psychiatrists (MS and VF) with expertise in pediatric PSTD.
Prazosin was initiated at 1 mg per day at bedtime, consistent with previous studies. The dosage was then increased by 1 mg every week until clinical improvement, as long as tolerance was acceptable. No other treatments targeting PSTD features besides prazosin were introduced during the trial. We defined the response to treatment by a reduction >=25% of the UCLA-PSTD-RI global score in accordance with other reports and the remission of PTSD could be considered from a score less than 38 (UCLA-PTSD index cut off). As prazosin has been reported to have a significant effect on symptoms during the first weeks in adults, the duration of the study was 4 weeks. For clinical purpose, maintenance treatment was proposed to patients at the end of the study in cases of significant improvement. Most of our admitted patients were admitted while taking others agents such as antidepressants, antipsychotics and psychostimulants for comorbid psychiatric disorders (MDD, anxiety disorders, ADHD) or symptoms of PTSD. As part of the treatment protocol, we maintained treatments without changing dosage at the time of initiating prazosin and during prazosin dosage adjustment.
Common side effects associated with prazosin therapy include: i) dizziness, drowsiness, headache, faintness, and syncope for the nervous system; ii), palpitations, hypotension (reported as rare) for the cardiac-vascular system; iii) constipation, diarrhea, dry mouth, nausea, vomiting for the gastrointestinal system; iv) urinary frequency for the renal and urinary system; and v) reduced response to environmental allergens for the immune system. Blood pressure (BP) and heart rate were manually monitored, measured, and recorded on a daily basis twice a day during the first week of treatment and during the week after each dose increase. BP was manually measured in two positions, first in supine position and after in seated still position in a quite nursing room, in order to capture orthostatic hypotension. Heart rate was manually measured following seated BP. After initial close monitoring, BP, and heart rate were manually measured once a week in the morning until the end of the hospitalization. All other known adverse events (headache, enuresis, hypotension, ...) were systematically evaluated and, when present, monitored by senior physicians through a checklist (part of the medical file) on a weekly basis through a general clinical work up and a full side effect clinical interview. Any new side effect that could be imputable to prazosin was recorded and reported to pharmacology-toxicology department, as our standard procedure requires.
Statistical analyses were conducted using SPSS software (IBM SPSS Statistics for Windows, Version 24, IBM Corp., Armonk, NY). Kolmogorov Smirnov tests identified that changes in the UCLA and sleep scores did not follow a normal distribution. Due to the small number of participants and the impossibility to assume a normal distribution, non-parametric tests were used. Differences in the mean of the clinical scores were compared to zero (null hypothesis) using a Wilcoxon's test. Comparisons between two groups were tested using a Fisher's exact test and tests between more than two groups were examined with a Kruskal-Wallis's test. Correlations were tested using both Pearson's and Spearman's tests. A bilateral alpha-risk of 0.05 was assumed. Graphical representations were done using SPSS.