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Posttraumatic Stress Disorder in Children and Adolescents: A Review of Psychopharmacological Treatment

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Abstract

PTSD in children and adolescents differs from the adult disease. Therapeutic approaches involve both psychotherapy and psychopharmacotherapy. Objectives: The current paper aims at reviewing studies on psychopharmacological treatment of childhood and adolescent PTSD. Additionally, developmental frameworks for PTSD diagnosis and research along with an experimental model of quenching and kindling in the context of stress exposure are presented. We conducted an extensive literature search of reviews on psychopharmacotherapy as well as studies on psychopharmacological treatment for PTSD among children and adolescents. We used the database PubMed and focused on the time period of the last 10 years up to January 2009. Pertinent earlier papers were also included.There are a limited number of studies specifically assessing the psychopharmacological treatment of PTSD in children and adolescents. The vast majority of them lack verification in RCTs. Only the use of imipramine, divalproex sodium and sertraline were already evaluated in RCTs. Future studies should take into account developmental approaches to the diagnosis and treatment of PTSD in children and adolescents. In this context, different underlying neurobiological patterns, which are reflected in distinct clinical symptomatology, require a precise investigation and a symptom-orientated psychopharmacological approach.

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References

  1. American Psychiatric Association (2008) Diagnostic and statistical manual of mental disorders—DSM-IV. American Psychiatric Association Press, Washington

    Google Scholar 

  2. Copeland WE, Keeler G, Angold A, Costello EJ (2007) Traumatic events and posttraumatic stress in childhood. Arch Gen Psychiatry 64(5):577–584

    Article  PubMed  Google Scholar 

  3. Berman SL, Kurtines WM, Silverman WK (1996) The impact of exposure to crime and violence on urban youth. Am J Orthopsychiatry 3(66):329–336

    Article  Google Scholar 

  4. Cauffman E, Feldman SS, Waterman J, Steiner H (1998) Posttraumatic stress disorder among incarcerated females. J Am Acad Child Adolesc Psychiatry 37(11):1209–1216

    Article  PubMed  Google Scholar 

  5. Steiner H, Garcia IG, Matthews Z (1997) Posttraumatic stress disorder in incarcerated juvenile delinquents. J Am Acad Child Adolesc Psychiatry 36(3):357–365

    Article  PubMed  Google Scholar 

  6. McLeer SV, Deblinger EB, Henry D (1992) Sexually abused children at high risk for post-traumatic stress disorder. J Am Acad Child Adolesc Psychiatry 31(5):875–879

    Article  PubMed  Google Scholar 

  7. Famularo R, Terence Fenton, Augustyn M (1996) Persistence of pediatric posttraumatic stress disorder after 2 years. Child Abuse Negl 20(12):1245–1248

    Article  PubMed  Google Scholar 

  8. Layne CM, Olsen JA, Baker A, Legerski JP, Isakson B, Pašalić A, Duraković-Belko E, Djapo N, Ćampara N, Arslanagić B, Saltzman WR, Pynoos RS (2010) Unpacking trauma exposure risk factors and differential pathways of influence: predicting post-war mental distress in Bosnian adolescents. http://www.srcd.org/index.php?option=com_content&task=view&id=247&Itemid=510 (Society for Research in Child Development)

  9. Fairbank JA (2008) The epidemiology of trauma and trauma related disorders in children and youth. PTSD Res Q 19(1):1–3

    Google Scholar 

  10. Rogan MT, Leon KS, Perez DL, Kandel ER (2005) Distinct neural signatures for safety and danger in the amygdala and striatum of the mouse. Neuron 46(2):309–320

    Article  PubMed  Google Scholar 

  11. Yehuda R, Antelman SM (1993) Criteria for rationally evaluating animal models of posttraumatic stress disorder. Biol Psychiatry 33:479–486

    Article  PubMed  Google Scholar 

  12. Post RM, Weiss SRB, Smith M, Li H, McCann U (1997) Kindling vs. quenching: implications for the evolution, treatment of PTSD. Ann N Y Acad Sci 821:285–295

    Article  PubMed  Google Scholar 

  13. Cohen J, Mannarino A, Rogal S (2001) Treatment practices for childhood posttraumatic stress disorder. Child Abuse Negl 25:123–135

    Article  PubMed  Google Scholar 

  14. Stoddard FJ, Usher CT, Abrams AN (2006) Psychopharmacology in pediatric critical care. Child Adolesc Psychiatr Clin N Am 15(3):611–655

    Article  PubMed  Google Scholar 

  15. Reinblatt SP, Riddle MA (2007) The pharmacological management of childhood anxiety disorders: a review. Psychopharmacology 191(1):67–86

    Article  PubMed  Google Scholar 

  16. Pervanidou P (2008) Biology of post-traumatic stress disorder in childhood and adolescence. J Neuroendocrinol 20(5):632–638

    Article  PubMed  Google Scholar 

  17. Taylor TL, Chemtob CM (2004) Efficacy of treatment for child and adolescent traumatic stress. Arch Pediatr Adolesc Med 158(8):786–791

    Article  PubMed  Google Scholar 

  18. Lustig SL, Botelho C, Lynch L, Nelson SV, Eichelberger WJ, Vaughan BL (2002) Implementing a randomized clinical trial on a pediatric psychiatric inpatient unit at a children’s hospital: the case of clonidine for post-traumatic stress. Gen Hosp Psychiatry 24(6):422–429

    Article  PubMed  Google Scholar 

  19. Najjar F, Weller RA, Weisbrot J, Weller EB (2008) Post-traumatic stress disorder and its treatment in children and adolescents. Curr Psychiatry Rep 10(2):104–108

    Article  PubMed  Google Scholar 

  20. Nikulina V, Hergenrother JM, Brown EJ, Doyle ME, Filton BJ, Carson GS (2008) From efficacy to effectiveness: the trajectory of the treatment literature for children with PTSD. Expert Rev Neurother 8(8):1233–1246

    Article  PubMed  Google Scholar 

  21. Wethington HR, Hahn RA, Fuqua-Whitley DS, Sipe TA, Crosby AE, Johnson RL, Liberman AM, Mościcki E, Price LN, Tuma FK, Kalra G, Chattopadhyay SK (2008) The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review. Am J Prev Med 35(3):287–313

    Article  PubMed  Google Scholar 

  22. Tareen A, Elena Garralda M, Hodes M (2007) Post-traumatic stress disorder in childhood. Arch Dis Child Educ Pract Ed 92(1):1–6

    Article  Google Scholar 

  23. Reinblatt SP, Walkup JT (2005) Psychopharmacologic treatment of pediatric anxiety disorders. Child Adolesc Psychiatr Clin N Am 14(4):877–908

    Article  PubMed  Google Scholar 

  24. De Bellis MD, Van Dillen T (2005) Childhood post-traumatic stress disorder: an overview. Child Adolesc Psychiatr Clin N Am 14(4):745–772

    Article  PubMed  Google Scholar 

  25. Cohen JA (2005) Treating traumatized children: current status and future directions. J Trauma Dissoc 6(2):109–121

    Article  Google Scholar 

  26. Brown EJ (2005) Clinical characteristics and efficacious treatment of posttraumatic stress disorder in children and adolescents. Pediatr Ann 34(2):138–146

    PubMed  Google Scholar 

  27. Scott RW, Mughelli K, Deas D (2005) An overview of controlled studies of anxiety disorders treatment in children and adolescents. J Natl Med Assoc 97(1):13–24

    PubMed  Google Scholar 

  28. Silva RR, Cloitre M, Davis L, Levitt J, Gomez S, Ngai I, Brown E (2003) Early intervention with traumatized children. Psychiatr Q 74(4):333–347

    Article  PubMed  Google Scholar 

  29. Cohen J (1998) Practice parameters for the assessment and treatment of children and adolescents with post traumatic stress disorder. J Am Acad Child Adolesc Psychiatry 37(9):997–1001

    Article  Google Scholar 

  30. Cohen JA, Mannarino AP, Zhitova AC, Capone ME (2003) Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abuse Negl 27(12):1345–1365

    Article  PubMed  Google Scholar 

  31. Cohen JA (2003) Treating acute posttraumatic reactions in children and adolescents. Biol Psychiatry 53(9):827–833

    Article  PubMed  Google Scholar 

  32. Donnelly CL (2003) Pharmacologic treatment approaches for children and adolescents with posttraumatic stress disorder. Child Adolesc Psychiatr Clin N Am 12(2):251–269

    Article  PubMed  Google Scholar 

  33. Pine DS, Cohen JA (2002) Trauma in children and adolescents: risk and treatment of psychiatric sequelae. Biol Psychiatry 51(7):519–531

    Article  PubMed  Google Scholar 

  34. Donnelly CL, Amaya-Jackson L (2002) Post-traumatic stress disorder in children and adolescents: epidemiology, diagnosis and treatment options. Paediatr Drugs 4(3):159–170

    PubMed  Google Scholar 

  35. Perrin S, Smith P, Yule W (2000) The assessment and treatment of post-traumatic stress disorder in children and adolescents. J Child Psychol Psychiatry 41(3):277–289

    Article  PubMed  Google Scholar 

  36. Donnelly CL, Amaya-Jackson L, March JS (1999) Psychopharmacology of pediatric posttraumatic stress disorder. J Child Adolesc Psychopharmacol 9(3):203–220

    Article  PubMed  Google Scholar 

  37. Marmar CR, Neylan TC, Schoenfeld FB (2002) New directions in the pharmacotherapy of posttraumatic stress disorder. Psychiatr Q 73(4):259–270

    Article  PubMed  Google Scholar 

  38. Perry BD, Azad I (1999) Posttraumatic stress disorders in children and adolescents. Curr Opin Pediatr 11(4):310–316

    Article  PubMed  Google Scholar 

  39. Cohen JA, Berliner L, Mannarino AP (2003) Psychosocial and pharmacological interventions for child crime victims. J Trauma Stress 16(2):175–186

    Article  PubMed  Google Scholar 

  40. Murphy TK, Bengtson MA, Tan JY, Carbonell E, Levin GM (2000) Selective serotonin reuptake inhibitors in the treatment of paediatric anxiety disorders: a review. Int Clin Psychopharmacol 15(2):47–63

    Google Scholar 

  41. Weller EB, Weller RA, Davis GP (2000) Use of venlafaxine in children and adolescents: a review of current literature. Depress Anxiety 12(1):85–89

    Article  PubMed  Google Scholar 

  42. Steiner H, Saxena KS, Carrion V, Khanzode LA, Silverman M, Chang K (2007) Divalproex sodium for the treatment of PTSD and conduct disordered youth: a pilot randomized controlled clinical trial. Child Psychiatry Hum Dev 38(3):183–193

    Article  PubMed  Google Scholar 

  43. Cohen JA, Mannarino AP, Perel JM, Staron V (2007) A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms. J Am Acad Child Adolesc Psychiatry 46(7):811–819

    Article  PubMed  Google Scholar 

  44. Stathis S, Martin G, McKenna JG (2005) A preliminary case series on the use of quetiapine for posttraumatic stress disorder in juveniles within a youth detention center. J Clin Psychopharmacol 25(6):539–544

    Article  PubMed  Google Scholar 

  45. Meighen KG, Hines LA, Lagges AM (2007) Risperidone treatment of preschool children with thermal burns and acute stress disorder. J Child Adolesc Psychopharmacol 17(2):223–232

    Article  PubMed  Google Scholar 

  46. Staller JA (2007) Psychopharmacologic treatment of aggressive preschoolers: a chart review. Prog Neuropsychopharmacol Biol Psychiatry 31:131–135

    Article  PubMed  Google Scholar 

  47. Kant R, Chalansani R, Chengappa KN, Dieringer MF (2004) The off-label use of clozapine in adolescents with bipolar disorder, intermittent explosive disorder, or posttraumatic stress disorder. J Child Adolesc Psychopharmacol 14(1):57–63

    Article  PubMed  Google Scholar 

  48. Seedat S, Stein DJ, Ziervogel C, Middleton T, Kaminer D, Emsley RA, Rossouw W (2002) Comparison of response to a selective serotonin reuptake inhibitor in children, adolescents, and adults with posttraumatic stress disorder. J Child Adolesc Psychopharmacol 12(1):37–46

    Article  PubMed  Google Scholar 

  49. Seedat S, Lockhat R, Kaminer D, Zungu-Dirwayi N, Stein DJ (2001) An open trial of citalopram in adolescents with post-traumatic stress disorder. Int Clin Psychopharmacol 16(1):21–25

    Article  PubMed  Google Scholar 

  50. Saxe G, Stoddard F, Courtney D, Cunningham K, Chawla N, Sheridan R, King D, King L (2001) Relationship between acute morphine and the course of PTSD in children with burns. J Am Acad Child Adolesc Psychiatry 40(8):915–921

    Article  PubMed  Google Scholar 

  51. Robert R, Blakeney PE, Villarreal C, Rosenberg L, Meyer WJ 3rd (1999) Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder: a pilot study. J Am Acad Child Adolesc Psychiatry 38(7):873–882

    Article  PubMed  Google Scholar 

  52. Harmon RJ, Riggs PD (1996) Clonidine for posttraumatic stress disorder in preschool children. J Am Acad Child Adolesc Psychiatry 35(9):1247–1249

    Article  PubMed  Google Scholar 

  53. Loof D, Grimley P, Kuller F (1995) Carbamazepine found efficacious for some children, adolescents with PTSD. Special report: anxiety disorders. Psychiatr Times 12(2):23

    Google Scholar 

  54. Famularo R, Kinscherff R, Fenton T (1988) Propranolol treatment for childhood posttraumatic stress disorder, acute type. A pilot study. Am J Dis Child 142(11):1244–1247

    PubMed  Google Scholar 

  55. Pynoos RS, Steinberg AM, Layne CM, Briggs EC, Ostrowski SA, Fairbank JA (2010) DSM-V PTSD diagnostic criteria for children and adolescents: a developmental perspective and recommendations. J Trauma Stress 22(5):391–398

    Article  Google Scholar 

  56. De Bellis MD, Baum AS, Birmaher B, Keshavan MS, Eccard CH, Boring AM, Jenkins FJ, Ryan ND (1999) AE Bennett research award. Developmental traumatology. Part I: biological stress systems. Biol Psychiatry 45:1259–1270

    Article  PubMed  Google Scholar 

  57. McGaugh JL (2000) Memory-a century of consolidation. Science 287(5451):248–251

    Article  PubMed  Google Scholar 

  58. Liberzon I, Abelson JL, Flagel SB, Raz J, Young EA (1999) Neuroendocrine and psychophysiologic responses in PTSD: a symptom provocation study. Neuropsychopharmacology 21:40–50

    Article  PubMed  Google Scholar 

  59. Birnbaum S, Gobeske KT, Auerbach J, Taylor JR, Arnsten AF (1999) A role for norepinephrine in stress-induced cognitive deficits: alpha-1-adrenoceptor mediation in the prefrontal cortex. Biol Psychiatry 46(9):1266–1274

    Article  PubMed  Google Scholar 

  60. Southwick S, Morgan C, Charney D, High J (1999) Yohimbine use in a natural setting: effects on posttraumatic stress disorder. Biol Psychiatry 46:442–444

    Article  PubMed  Google Scholar 

  61. Eckhardt-Henn A, Hoffmann SO (2004) Dissoziative Bewußtseinsstörungen: theorie, symptomatik, therapie. Schattauer Verlag, Stuttgart

    Google Scholar 

  62. Depue RA, Spoont MR (1986) Conceptualizing a serotonin trait. A behavioral dimension of constraint. Ann N Y Acad Sci 487:47–62

    Article  PubMed  Google Scholar 

  63. Spivak B, Vered Y, Graff E, Blum I, Mester R, Weizman A (1999) Low plateletpoor plasma concentrations of serotonin in patients with combat-related posttraumatic stress disorder. Biol Psychiatry 45:840–845

    Article  PubMed  Google Scholar 

  64. Maes M, Lin AH, Verkerk R, Delmeire L, Van Gastel A, Van der Planken M, Scharpe S (1999) Serotonergic and noradrenergic markers of post-traumatic stress disorder with and without major depression. Neuropsychopharmacology 20:188–197

    Article  PubMed  Google Scholar 

  65. Davis LL, Clark DM, Kramer GL, Moeller FG, Petty F (1999) D-fenfluramine challenge in posttraumatic stress disorder. Biol Psychiatry 45:928–930

    Article  PubMed  Google Scholar 

  66. Bohus M, Landwehrmeyer G, Stiglmayr C, Limberger M, Bohme R, Schmal C (1999) Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder. J Clin Psychiatry 60:598–603

    Article  PubMed  Google Scholar 

  67. Gelernter J, Southwick S, Goodson S, Morgan A, Nagy L, Charney DS (1999) No association between D2 dopamine receptor (DRD2) “A” system alleles, or DRD2 haplotypes, and posttraumatic stress disorder. Biol Psychiatry 45:620–625

    Article  PubMed  Google Scholar 

  68. Adamec RE, Burton P, Shallow T, Budgell J (1999) Unilateral block of NMDA receptors in the amygdala prevents predator stress-induced lasting increases in anxiety-like behavior and unconditioned startle—effective hemisphere depends on the behavior. Physiol Behav 65:739–751

    Article  PubMed  Google Scholar 

  69. Steiner H (2004) Handbook of mental health interventions in children and adolescents: an integrated developmental approach. Jossey-Bass, San Francisco

    Google Scholar 

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Conflicts of interest and disclosure

The authors confirm that none of the authors involved in writing the manuscript has any current conflicts of interest: the design, conduct, analysis or publication of the manuscript was not supported by any industry involvement.

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    J. Huemer

  2. Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    F. Erhart

  3. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA

    H. Steiner

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  1. J. Huemer
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Huemer, J., Erhart, F. & Steiner, H. Posttraumatic Stress Disorder in Children and Adolescents: A Review of Psychopharmacological Treatment. Child Psychiatry Hum Dev 41, 624–640 (2010). https://doi.org/10.1007/s10578-010-0192-3

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