Zohar Joseph, Juven-Wetzler Alzbeta, Sonnino Rachel, Cwikel-Hamzany Shlomit, Balaban Evgenya, Cohen Hagit
Department of Psychiatry, Chairn Sheba Medical Center, Tel Hashomer, Israel.
Dialogues Clin Neurosci. 2011;13(3):301-9. doi: 10.31887/DCNS.2011.13.2/jzohar.
Post-traumatic stress disorder (PTSD) is unique amongst psychiatric disorders in two ways. Firstly, there is usually a very clear point of onset- the traumatic event The second unique feature of PTSD is that it is characterized by a failure of the normal response to resolve. Given these two characteristics, PTSD appears a good candidate for secondary prevention, ie, interventions immediately after the trauma. Evidence available starting from current concepts and contemporary research of potential secondary prevention interventions are presented. Common practices in the aftermath of trauma such as debriefing and benzodiazepines need to be carefully considered, taking into account their potential harm to the spontaneous recovery process, and the trajectory of PTSD, and not only judging them according to their immediate (comforting) effects. A discussion of the balance required between aiding recovery but not interfering with the potent natural resolution of symptoms (that is expected in most cases), along with potential avenues of future research, are presented. Results of a small pilot study with a single intervention of hydrocortisone immediately after trauma appear to be promising, and clearly indicate the need for further studies.
创伤后应激障碍（PTSD）在精神疾病中具有两个独特之处。其一，通常有一个非常明确的起病点——创伤事件。PTSD的第二个独特特征是，其特点是正常的应激反应无法得到缓解。鉴于这两个特征，PTSD似乎是二级预防的一个良好候选对象，即创伤后立即进行干预。本文介绍了从当前概念和对潜在二级预防干预措施的当代研究中获得的现有证据。创伤后常见的做法，如心理疏导和使用苯二氮䓬类药物，需要仔细考虑，要考虑到它们对自发恢复过程、PTSD病程的潜在危害，而不仅仅根据其即时（安慰）效果来判断。本文讨论了在帮助恢复但不干扰（大多数情况下预期会出现的）症状的有效自然缓解之间所需的平衡，以及未来潜在的研究途径。一项小型试点研究的结果显示，在创伤后立即单次使用氢化可的松进行干预似乎很有前景，这清楚地表明有必要进行进一步研究。
