It is therefore possible that trauma-relevant nightmares are peculiar in that they do not occur during REM sleep. This is in keeping with study subject reports that even with PTSD nightmare reduction, normal dreaming

was preserved or even restored following the prazosin treatment arm. Another double-blind placebo-controlled crossover study of civialians addressed whether daytime-only prazosin treatment reduced PTSD symptoms during a trauma-relevant stress paradigm that simultaneously measured PFC-related executive function (Taylor et al., 2006). The Stroop Color-Word Interference Test (Golden, 1976), has been used for decades to assess cognitive function, and shown to involve PFC activity in humans (Milham et al., 2003). The E-Stroop is a modification developed to study the cognitive effects of increased emotional arousal in PTSD Epigenetics activator in a controlled laboratory setting (McNally et al., 1990). In brief, it is a timed task that requires the participant to read a list of trauma-relevant words and name the color of ink that

each word is printed in. The experimental trauma-related Protein Tyrosine Kinase inhibitor word list consisted of five words chosen by each participant from their personal narrative of their etiologic trauma event (e.g., “fire” and “9/11” for a World Trade Center occupant who survived the September 11, 2001, terrorist attack). Time to completion, errors of omission and commission, as well as subjective distress were all recorded. At doses averaging 3.2 ± 1.3 mg, prazosin simultaneously reduced subjective stress and improved cognitive performance over the placebo condition, suggesting that alpha 1 adrenergic

blockade improved PFC function in PTSD individuals under duress (Taylor et al., 2006). Together, these clinical trials support the role of alpha-1 adrenergic blockade in reducing PTSD symptoms. These studies showed a reduction in daytime symptoms of PTSD, even when only dosed at night. Several studies report a reduction of the hyperarousal category of PTSD symptoms as measured by the CAPS. It is interesting that most of the symptoms in this category Idoxuridine are those associated with PFC deficits including irritability, aggression, recklessness, and impaired concentration. In the trauma-relevant stress paradigm study, prazosin’s simultaneous reduction of both subjective stress and objective measures of cognitive function further support preclinical findings that alpha-1 receptor stimulation impairs PFC function, and that blockade of these receptors can restore function. A recent case report cites high doses of prazosin, up to 30 or 40 mg, as efficacious and well-tolerated in the treatment of daytime PTSD symptoms, (Koola et al., 2014) underscoring the need for further studies on the use of higher doses of prazosin to treat daytime PTSD symptoms.