Treatment of PTSD in Cardiac Patients

描述（由申请人提供）：本修订后的申请使用NIMH“R-34”治疗发展奖励机制，标题为“心脏病患者PTSD的治疗”。本应用程序的目的是开发一种治疗创伤后应激障碍（PTSD）症状的方法，这种症状是由心肌梗死（Ml）的情感创伤经历引起的。Ml是一种急性的、危及生命的事件，可能伴随着无助或恐惧的感觉。因此，根据DSM-IV-TR的定义，它可以被定义为情感创伤，并可能引发PTSD的症状。事实上，最近的研究报告称，10-20%的心血管疾病患者存在明显的PTSD症状，这些症状与不坚持药物治疗以及不良的医疗和精神治疗结果有关。创伤后应激障碍症状与心肌梗死后抑郁症高度共病。然而，创伤后应激障碍症状通常不是治疗心肌梗死后患者的目标，与没有心肌梗死的抑郁症患者相比，经典的抑郁症治疗方法对有Ml的患者没有帮助。因此，创伤后应激障碍的治疗可能是一种有希望的新方法，可以改善心肌梗死患者的精神和医疗结果。创伤后应激障碍的有效治疗方案确实存在，但没有在Ml幸存者中进行研究。现有的治疗方法需要进行实质性的修改，以便用于这类正在适应新的心肌梗死后现实的疾病个体（而不是期望调整回其创伤前功能的单一事件创伤幸存者）。这项提议的计划是开发一种改进的创伤认知行为疗法，用于治疗Ml幸存者出现的PTSD症状，并在一项随机对照研究中进行测试。我们将评估这种方法的安全性和潜在益处。如果结果令人鼓舞，预计将在这项初步研究之后进行全面的疗效试验。

DESCRIPTION (provided by applicant): This revised application is using the NIMH "R-34" treatment development award mechanism and is entitled "treatment of PTSD in cardiac patients". The goal of this application is to develop a treatment for posttraumatic stress disorder (PTSD) symptoms that are caused by the emotionally traumatic experience of having had a myocardial infarction (Ml). Ml is an acute, life-threatening event that may be accompanied by a feeling of helplessness or fear. Therefore, it can qualify as emotionally traumatic according to the DSM-IV-TR definition, and may elicit symptoms of PTSD. Indeed, recent studies report that significant PTSD symptoms exist in 10-20% of patients with cardiovascular illnesses, and that these symptoms are associated with nonadherence to medications and poor medical as well as psychiatric outcome. PTSD symptoms are highly comorbid with depression post-MI. Yet, PTSD symptoms are not usually targeted in efforts to treat patients post-MI, and classic depression treatments are not as helpful in patients who had an Ml as compared with depressed patients without Ml. The treatment of PTSD may therefore be a promising new approach to improve psychiatric as well as medical outcome in patients who had a myocardial infarction. Effective treatment options for PTSD do exist, but they were not studied in Ml survivors. Existing treatments need to be substantially modified in order to be used in this population of medically ill individuals who are adjusting to a new post-MI reality (as opposed to a single-incident trauma survivor who is expected to adjust back to his or her pre-trauma functioning). The plan of this proposal is to develop a modified trauma-focused cognitive-behavioral treatment for PTSD symptoms that occur in Ml survivors and test it in a randomized, controlled study. We will evaluate the safety as well as the potential benefits of this approach. A full efficacy trial is expected to follow this pilot study if the results are encouraging.