Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder: a pilot study.
OBJECTIVE
Pediatric burn patients often exhibit acute stress disorder (ASD) symptoms. Information on psychopharmacological treatment of ASD symptoms in children is scarce. This pilot study used a prospective, randomized, double-blind design to test whether thermally injured children suffering ASD symptoms benefit from imipramine.


METHODS
Twenty-five children, aged 2 to 19 years, received either imipramine or chloral hydrate for 7 days. A structured interview (clinically useful, but validity and reliability not yet established) was used to assess the presence and frequency of ASD symptoms both before treatment and 3 times during the treatment period.


RESULTS
Eleven females and 14 males participated, with a mean total burn surface area of 45% (SD = 23%) and mean age of 8 years (SD = 6). Imipramine was more effective than chloral hydrate in treating ASD symptoms (chi 2 [1, N = 25] = 5.24, p < .02). Five of 13 were positive responders to chloral hydrate (38%). Ten of 12 were positive responders to low-dose imipramine (83%).


CONCLUSIONS
This pilot study suggests a place for cautious initial use of imipramine to reduce ASD symptoms in burned children. Care must be taken to minimize cardiovascular risks in an off-label application of imipramine in children, especially those receiving additional medications.
Robert
R
R
Shriners Burns Hospital, Galveston, TX 77550, USA.
Blakeney
P E
PE
Villarreal
C
C
Rosenberg
L
L
Meyer
W J
WJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002053:Burn Units / Q000706:statistics & numerical data; D002056:Burns / Q000150:complications*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002697:Chloral Hydrate / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use*; D008297:Male; D010865:Pilot Projects; D010919:Placebos; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000209:etiology*; D013781:Texas
D010919:Placebos; D002697:Chloral Hydrate; D007099:Imipramine