Treatment of PTSD in Cardiac Patients

描述(申请人提供)：本修订申请采用NIMH“R-34”治疗发展奖励机制，题为“心脏病患者的创伤后应激障碍的治疗”。该应用程序的目标是开发一种治疗创伤后应激障碍(PTSD)症状的方法，这种症状是由经历过心肌梗死(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，并可能引发创伤后应激障碍的症状。事实上，最近的研究报告说，10%-20%的心血管疾病患者存在显著的创伤后应激障碍症状，这些症状与不坚持药物治疗以及糟糕的医疗和精神结果有关。创伤后应激障碍的症状与心肌梗死后的抑郁高度相关。然而，创伤后应激障碍症状通常不是MI后治疗患者的目标，与没有ML的抑郁症患者相比，有ML的患者的经典抑郁治疗没有那么有帮助。因此，创伤后应激障碍的治疗可能是一种很有希望的新方法，可以改善心肌梗死患者的精神和医学结果。创伤后应激障碍确实存在有效的治疗选择，但没有在ML幸存者身上进行研究。现有的治疗方法需要大幅改进，以便用于正在适应心肌梗死后新现实的这群患有内科疾病的个人(而不是预期将恢复到创伤前功能的单一事件创伤幸存者)。该提案的计划是开发一种针对多发性骨髓瘤幸存者出现的创伤后应激障碍症状的改良创伤认知行为疗法，并在随机对照研究中进行测试。我们将评估这种方法的安全性以及潜在的好处。如果结果令人鼓舞，预计在这项初步研究之后将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.