Prevention of PTSD by Early Treatment

描述（由申请人提供）：广泛的恐怖主义的到来需要仔细注意防止创伤后应激障碍（PTSD）的多个病例。对照研究表明，早期心理干预可以预防选定的幸存者群体的PTSD。早期干预对大批幸存者的有效性尚不清楚。药物预防的效果同样未知。拟议的工作将测试的假设，认知行为疗法（CBT）和，独立地，舍曲林将有效地防止创伤后应激障碍时，在一个月内的创伤事件，高度痛苦的幸存者，谁是系统地确定在一个大的队列的创伤暴露的个人。它还将评估通过早期干预系统预防PTSD的计划在多大程度上是可行的，幸存者可以接受的，并有效地降低发病率。拟议的工作包括两个嵌入式程序：一个全面的外展和结构化的电话评估4000名幸存者，进行一周和七个月后的创伤性事件，和嵌入式随机对照试验的CBT，舍曲林，和等待名单，提供一个月内的创伤性事件的幸存者与急性应激障碍的症状。等待名单上的幸存者将在三个月后接受CBT。重复的临床评估将探索治疗疗效。重复的电话评估将评估治疗效果。这项研究将产生关于在大量幸存者中进行创伤后应激障碍二级预防的可行性和有效性的重要知识。

DESCRIPTION (provided by applicant): The advent of widespread terrorism requires careful attention to preventing multiple cases of post-traumatic stress disorder (PTSD). Controlled studies suggest that early psychological interventions can prevent PTSD in selected groups of survivors. The effectiveness of early interventions in large groups of survivors is unknown. The effect of pharmacological prevention is equally unknown. The proposed work will test the hypothesis that cognitive behavioral therapy (CBT) and, independently, sertraline will effectively prevent PTSD when provided, within a month of a traumatic event, to highly distressed survivors, who are systematically identified in a large cohort of trauma-exposed individuals. It will also evaluate the extent to which a program to systematically prevent PTSD by early interventions is feasible, acceptable to survivors and effectively reduces morbidity. The proposed work consists of two embedded procedures: a comprehensive outreach and structured telephone evaluation of 4000 survivors, performed one week and seven months following a traumatic event, and an embedded randomized controlled trial of CBT, sertraline, and a wait list, offered within a month of a traumatic event to survivors with symptoms of acute stress disorder. Survivors in the wait list will receive CBT three months later. Repeated clinical assessments will probe treatment efficacy. Repeated telephone evaluations will assess treatment effectiveness. The study will generate vital knowledge about the feasibility and the effectiveness of secondary prevention of PTSD in large cohorts of survivors.