Prevention of PTSD by Early Treatment

描述(由申请人提供)：广泛的恐怖主义的出现需要仔细注意预防创伤后应激障碍(PTSD)的多个病例。对照研究表明，早期心理干预可以在选定的幸存者群体中预防创伤后应激障碍。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。这项拟议的工作将检验这样一种假设，即认知行为疗法(CBT)和舍曲林在创伤事件发生后一个月内提供给高度痛苦的幸存者时，将有效地预防创伤后应激障碍，这些幸存者是在一大群创伤暴露者中系统地确定的。它还将评估通过早期干预系统地预防创伤后应激障碍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：在创伤事件发生后一周和七个月对4000名幸存者进行全面的外展和结构化电话评估，以及在创伤事件发生后一个月内向有急性应激障碍症状的幸存者提供CBT、舍曲林和等待名单的嵌入式随机对照试验。等待名单上的幸存者将在三个月后接受CBT。反复的临床评估将探索治疗效果。反复的电话评估将评估治疗效果。这项研究将在大批幸存者中产生关于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.