The Use of Valproic Acid and Morning Dosing of Prazosin for the Reduction of Hyperarousal and Intrusive Symptoms in Post-Traumatic Stress Disorder: A Case Report

Patient is a 28-year female, past medical history of hypothyroidism controlled on levothyroxine, who presented involuntarily to the psychiatric inpatient unit with paranoia and visual hallucinations of six months duration. Patient showed overt signs of hyperarousal and endorsed a fear of people following her, along with visual hallucinations described as words being written on walls, and nightmares, and was diagnosed with psychotic disorder, unspecified. Patient had multiple prior admissions dating back to 6 months prior, with similar presentation of paranoia and visual hallucinations. Risperidone was initiated and up titrated, with minimal improvement at each attempt. Upon current presentation, patient was started on risperidone 1mg twice daily for thought process and prazosin for nightmares. The risperidone was titrated up to 4mg twice daily and prazosin to 2mg nightly, with reported nightmare alleviation, but minimum improvement of paranoia, hyperarousal, and visual hallucinations. Upon further investigation, patient disclosed a direct traumatic event occurring 6 months ago with no prior psychiatric history. Patient was ultimately diagnosed with Post-Traumatic Stress Disorder (PTSD). Risperidone was titrated down and eventually tapered off. Valproic acid 500mg twice daily was initiated for the reduction of hyperarousal. An additional 2mg dose of prazosin was added in the morning for the alleviation of the visual hallucinations, which were deemed to be psychological responses to the inciting event. Immediate, drastic improvement was noted, with stability and discharge achieved two days later.