Early PTSD symptom trajectories: persistence, recovery, and response to treatment: results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS).
Early PTSD symptom trajectories: persistence, recovery, and response to treatment: results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS).
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DOI：
10.1371/journal.pone.0070084
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Shalev AY
中科院分区：
文献类型：
--
作者：
Galatzer-Levy IR;Ankri Y;Freedman S;Israeli-Shalev Y;Roitman P;Gilad M;Shalev AY
揭示早期PTSD症状进展的异质性可以提高我们对该疾病发病机制和预防的理解。描述离散的症状轨迹并检查其与预防干预的相关性。潜在增长混合模型（LGMM）的数据来自早期治疗的随机对照研究。LGMM通过探索可观测数据的离散混合分布来识别潜在的纵向轨迹。哈达萨医院不加选择地接收来自耶路撒冷和附近地区的创伤幸存者。在艾德入院后10天、1个月、5个月、9个月和15个月，对连续入住医院急诊科（艾德）的潜在创伤事件的成年幸存者进行评估。纳入了在10天内有数据和至少两次额外评估的参与者（n =957）; 125人在1至9个月内接受了认知行为治疗（CBT）。 我们使用LGMM来识别症状进展的潜在参数，并测试CBT对这些参数的影响。CBT包括认知治疗（n = 41）或延长暴露（PE，n = 49），从艾德入院后29.8±5.7天开始，或延迟PE（n = 35），从151.8±42.4天开始，每周12次。 CBT有效地减少了整个样本中的PTSD症状。PTSD症状的潜在轨迹; CBT对这些轨迹的影响。确定了三种轨迹：快速缓解（1至5个月症状迅速减轻;样本的56%），缓慢缓解（15个月内症状逐渐减轻; 27%）和非缓解（症状持续升高; 17%）。CBT加速了缓慢汇款类的恢复，但对其他类没有影响。创伤后应激障碍症状的早期过程的特征是不同的和不同的反应模式，这些反应模式与理解这种疾病和预防其发生密切相关。PTSD的发病机制的研究可能会受益于使用集群症状轨迹作为其因变量。
Uncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis. To describe discrete symptom trajectories and examine their relevance for preventive interventions. Latent Growth Mixture Modeling (LGMM) of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data. Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity. Adult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED) were assessed ten days and one-, five-, nine- and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957) were included; 125 received cognitive behavioral therapy (CBT) between one and nine months. We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41) or prolonged exposure (PE, n = 49), starting 29.8±5.7 days after ED admission, or delayed PE (n = 35) starting at 151.8±42.4 days. CBT effectively reduced PTSD symptoms in the entire sample. Latent trajectories of PTSD symptoms; effects of CBT on these trajectories. Three trajectories were identified: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%). CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes. The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder and preventing its occurrence. Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables.
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