PAROXETINE, PROLONGED EXPOSURE, AND BIOLOGY IN PTSD

创伤后应激障碍(PTSD)是一种衰弱的，通常是慢性的 在平民中存在严重精神障碍和精神障碍。发病率 在美国，估计为1%至3%，尽管这一比率可能相当可观 在易受伤害的人群中更高。在遭受创伤的团体中，如强奸和 严重攻击受害者时，创伤后应激障碍的发生率可接近50%。 关于有效的药理学和心理社会作用，人们知之甚少 对患有创伤后应激障碍的平民的治疗，正如迄今为止的大多数研究所做的那样 是在退伍军人中进行的。这笔赠款建议进行为期五年的培训 和研究计划，包括创伤后应激障碍的三个主要研究领域： 药物治疗、心理社会治疗和生物相关性 临床症状。培训将以强化的形式完成 导师的监督(医学博士Michael Liebowitz)和科学性 导师；课程工作；主要研究中心的教程；协作 与成熟的调查人员合作；以及原创研究项目。五 相关项目被提出：1)双盲、安慰剂对照、 帕罗西汀治疗创伤后应激障碍的12周试验；2)开发一种有时间限制的 认知-行为和心理治疗相结合的个体心理治疗 心理动力学原理；3)整合性的系统开放试验 心理治疗；4)治疗前后皮质醇水平的测定 在两个临床治疗中；5)假设在#1和#3中有阳性结果， 一项临床试验的发展，以评估帕罗西汀，药片- 安慰剂、心理疗法以及帕罗西汀和心理疗法的结合。它是 假设帕罗西汀和心理疗法对 创伤后应激障碍，联合治疗可能比单独治疗更好。

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.