Prazosin for post-traumatic nightmares: A clinical audit in acute public psychiatric unit patients

Objective Post-traumatic nightmares (PTNs) are a debilitating symptom of post-traumatic stress disorder (PTSD), yet evidence for pharmacological treatment remains inconsistent. This audit examined the effectiveness and tolerability of prazosin for PTNs in an Australian inpatient psychiatric population. Method A clinical audit with pre-test post-test analysis was conducted using records from Monash Health wards. Adult patients ( n = 50) prescribed prazosin for PTNs for ≥7 days were included. Symptom severity was measured using the Clinical Global Impression-Severity (CGI-S) scale at treatment initiation and discharge, and clinical response using the Clinical Global Impression-Improvement (CGI-I) scale. Demographics, trauma histories, comorbidities, dosing, and adverse effects were also recorded. Results Participants were predominantly female (74%) and aged 18–34 years. The median CGI-S improved from 5 (“markedly ill”) to 2 (“borderline mentally ill”), representing a 3-point reduction (p < .01). CGI-I ratings indicated patients were “much improved” (median = 2). Prazosin was discontinued in 12 of 114 patients, most commonly due to dizziness or hypotension. Conclusions Prazosin was associated with clinically and statistically significant improvements in PTNs in this cohort, noting confounding variables and subjective assessment with no control group. Findings support clinical use while underscoring the need for larger, prospective Australian trials.