Reduction of PTSD Symptoms With Pre-Reactivation Propranolol Therapy: A Randomized Controlled Trial
Reduction of PTSD Symptoms With Pre-Reactivation Propranolol Therapy: A Randomized Controlled Trial
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DOI：
10.1176/appi.ajp.2017.17050481
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发表时间：
2018-05-01
影响因子：
17.7
通讯作者：
Pitman, Roger K.
中科院分区：
文献类型：
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作者：
Brunet, Alain;Saumier, Daniel;Pitman, Roger K.
目的：作者评估了在普萘洛尔（一种去甲肾上腺素能 β 受体阻滞剂）的影响下进行的创伤记忆重新激活在减轻创伤后应激障碍 (PTSD) 症状方面的功效。普萘洛尔是一种去甲肾上腺素能 β 受体阻滞剂，作为一种假定的再巩固阻滞剂。方法：这是一项为期 6 周、双盲、安慰剂对照、随机临床试验，受试者为 60 名被诊断为长期患有创伤后应激障碍的成年人。 创伤后应激障碍。在短暂的记忆重新激活课程前 90 分钟给予普萘洛尔或安慰剂，每周一次，连续 6 周。该假设预测，在意向治疗分析中，与使用安慰剂的创伤再激活相比，使用普萘洛尔再激活创伤可在减少临床医生管理的 PTSD 量表 (CAPS) 和患者评估的 PTSD 特定检查表 (PCL-S) 上的 PTSD 症状方面具有显着的治疗效果。 结果：治疗后 CAPS 评分的估计组间差异，根据 治疗前值（协方差分析）具有统计学意义，为 11.50。普萘洛尔的组内治疗前至治疗后效果大小（Cohen's d）为 1.76，安慰剂为 1.25。对于 PCL-S，混合线性模型估计的时间组间相互作用每周平均下降 2.43 点，总显着性差异比安慰剂高 14.58 点。普萘洛尔治疗前后的效应大小为 2.74，安慰剂为 0.55。根据方案对两种结果的分析得出了类似的显着结果。结论：预再激活普萘洛尔是再巩固理论提出的一种治疗方案，似乎是一种新颖且有效的 PTSD 治疗方法。需要对各种创伤人群进行长期随访的复制研究。
Objective: The authors assessed the efficacy of trauma memory reactivation performed under the influence of propranolol, a noradrenergic beta-receptor blocker, as a putative reconsolidation blocker, in reducing symptoms of posttraumatic stress disorder (PTSD).Method: This was a 6-week, double-blind, placebo-controlled, randomized clinical trial in 60 adults diagnosed with long-standing PTSD. Propranolol or placebo was administered 90 minutes before a brief memory reactivation session, once a week for 6 consecutive weeks. The hypothesis predicted a significant treatment effect of trauma reactivation with propranolol compared with trauma reactivation with placebo in reducing PTSD symptoms on both the Clinician-Administered PTSD Scale (CAPS) and the patient-rated PTSD Checklist-Specific (PCL-S) in an intention-to-treat analysis.Results: The estimated group difference in posttreatment CAPS score, adjusted for pretreatment values (analysis of covariance), was a statistically significant 11.50. The within-group pre- to posttreatment effect sizes (Cohen's d) were 1.76 for propranolol and 1.25 for placebo. For the PCL-S, the mixed linear model's estimated time-by-group interaction yielded an average decrease of 2.43 points per week, for a total significant difference of 14.58 points above that of placebo. The pre- to posttreatment effect sizes were 2.74 for propranolol and 0.55 for placebo. Per protocol analyses for both outcomes yielded similar significant results.Conclusions: Pre-reactivation propranolol, a treatment protocol suggested by reconsolidation theory, appears to be a novel and efficacious treatment for PTSD. Replication studies using a long-term follow-up in various trauma populations are required.