PAROXETINE, PROLONGED EXPOSURE, AND BIOLOGY IN PTSD

创伤后应激障碍（PTSD）是一种使人衰弱的， 在平民中造成严重精神病的疾病。发生率 在美国，估计为1%至3%，尽管利率可能相当高 在弱势群体中更高。 在遭受创伤的群体中， 严重的袭击受害者，PTSD的比率可以接近50%。 关于有效的药理学和心理社会学知之甚少 治疗平民创伤后应激障碍，因为大多数研究迄今为止， 在退伍军人中进行。该补助金提供了为期五年的培训 和研究计划，其中包括创伤后应激障碍的3个主要研究领域： 药物治疗、心理社会治疗和生物学相关因素 临床症状。培训将在密集的 导师的监督（Michael Liebowitz，医学博士）和科学 顾问;课程工作;主要研究中心的教程;协作 与既定的调查人员;和原始的研究项目。五 提出了相互关联的项目：1）一个双盲，安慰剂对照， 12-帕罗西汀在PTSD中的一周试验; 2）开发一个有时限的 个体心理治疗，将认知行为和 心理动力学原则; 3）系统的开放试验的综合 心理治疗; 4）治疗前和治疗后皮质醇水平的测量 在两种临床治疗中; 5）假设在#1和#3中的阳性发现， 开展临床试验，以评估帕罗西汀，药丸， 安慰剂、心理疗法和帕罗西汀与心理疗法的组合。 是 假设帕罗西汀和心理治疗对 PTSD，并且联合治疗可能上级单独治疗。

Posttraumatic Stress Disorder (PTSD) is a debilitating, often chronic disorder with serious psychiatric morbidity among civilians. The incidence in the U.S. is estimated at 1 % to 3%, although rates can be considerable higher in vulnerable populations. In traumatized groups such as rape and severe assault victims, the rate of PTSD can approach 50%. Little is known regarding effective pharmacologic and psychosocial treatment in civilians with PTSD, as the majority of research to date has been conducted in war veterans. This grant proposes a five year training and research program, which encompasses 3 major research domains of PTSD: pharmacologic treatment, psychosocial treatment, and biological correlates of clinical symptoms. Training would be accomplished in intensive supervision with the mentor (Michael Liebowitz, M.D.) and scientific advisors; course work; tutorials in major research centers; collaboration with established investigators; and original research projects. Five interrelated projects are proposed: 1) a double-blind, placebo-controlled, 12-week trial of paroxetine in PTSD; 2) development of a time-limited individual psychotherapy which integrates cognitive-behavioral and psychodynamic principles; 3) a systematic open trial of the integrated psychotherapy; 4) measurement of cortisol levels pre- and post-treatment in both clinical treatments; 5) assuming positive findings in #1 and #3, development of a clinical trial to assess the efficacy of paroxetine, pill- placebo, psychotherapy, and combined paroxetine and psychotherapy. It is hypothesized that both paroxetine and psychotherapy will be effective for PTSD, and that the combination might be superior to either treatment alone.