Intranasal Oxytocin to Prevent Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial in Emergency Department Patients
Intranasal Oxytocin to Prevent Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial in Emergency Department Patients
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DOI：
10.1016/j.biopsych.2016.11.012
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发表时间：
2017-06-15
影响因子：
10.6
通讯作者：
Olff, Miranda
中科院分区：
文献类型：
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作者：
van Zuiden, Mirjam;Frijling, Jessie L.;Olff, Miranda
背景：目前针对创伤后应激障碍（PTSD）的预防性干预措施很少。创伤后早期鼻内给予催产素可能预防PTSD，因为先前发现催产素对PTSD易感因素有有益影响，包括神经恐惧反应性、外周应激反应性和社会情绪功能。因此，我们研究了创伤后早期鼻内给予催产素对随后临床评定的PTSD症状的影响。然后我们评估基线特征是否会减缓干预的效果。方法：我们进行了一项多中心、随机、双盲、安慰剂对照的临床试验。中度至重度急性窘迫的成年急诊科患者（n = 120； 85%的事故受害者）被随机分配到鼻内催产素组（8天/40 IU，每天两次）或安慰剂组（8天/10次，每天两次），在创伤后12天内开始。临床创伤后应激障碍量表（CAPS）在基线（创伤后10天内）和创伤后1.5个月、3个月和6个月进行。意向治疗样本包括107名参与者（催产素：53名；安慰剂：54名）。结果：我们没有观察到创伤后1.5个月（主要结局）或随访期间（次要结局）CAPS总分的组间显著差异。二次分析显示，基线CAPS得分高的受试者接受催产素治疗后，其CAPS得分显著低于基线CAPS得分高的受试者接受安慰剂治疗后的CAPS得分。结论：创伤后早期给予催产素并没有减轻所有创伤暴露的急性痛苦参与者的临床评价的PTSD症状。然而，临床医生评价的急性PTSD症状严重程度较高的参与者确实显示出催产素的有益作用。虽然重复的研究是有保证的，但这些发现表明，催产素给药是一种有希望的预防PTSD的干预措施，用于患有高度急性PTSD症状的个体。
BACKGROUND: There are currently few preventive interventions available for posttraumatic stress disorder (PTSD). Intranasal oxytocin administration early after trauma may prevent PTSD, because oxytocin administration was previously found to beneficially impact PTSD vulnerability factors, including neural fear responsiveness, peripheral stress reactivity, and socioemotional functioning. Therefore, we investigated the effects of intranasal oxytocin administration early after trauma on subsequent clinician-rated PTSD symptoms. We then assessed whether baseline characteristics moderated the intervention's effects.METHODS: We performed a multicenter, randomized, double-blind, placebo-controlled clinical trial. Adult emergency department patients with moderate to severe acute distress (n = 120; 85% accident victims) were randomized to intranasal oxytocin (8 days/40 IU twice daily) or placebo (8 days/10 puffs twice daily), initiated within 12 days posttrauma. The Clinician-Administered PTSD Scale (CAPS) was administered at baseline (within 10 days posttrauma) and at 1.5, 3, and 6 months posttrauma. The intention-to-treat sample included 107 participants (oxytocin: n = 53; placebo: n = 54).RESULTS: We did not observe a significant group difference in CAPS total score at 1.5 months posttrauma (primary outcome) or across follow-up (secondary outcome). Secondary analyses showed that participants with high baseline CAPS scores receiving oxytocin had significantly lower CAPS scores across follow-up than participants with high baseline CAPS scores receiving placebo.CONCLUSIONS: Oxytocin administration early after trauma did not attenuate clinician-rated PTSD symptoms in all trauma-exposed participants with acute distress. However, participants with high acute clinician-rated PTSD symptom severity did show beneficial effects of oxytocin. Although replication is warranted, these findings suggest that oxytocin administration is a promising preventive intervention for PTSD for individuals with high acute PTSD symptoms.