GHU PARIS Psychiatrie and Neurosciences, Site Sainte-Anne, Paris, France.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
J Clin Sleep Med. 2022 Jul 1;18(7):1847-1855. doi: 10.5664/jcsm.10010.
Posttraumatic nightmares may exacerbate and perpetuate the daytime symptoms of posttraumatic stress disorder and might represent a therapeutic target. The therapeutic strategy of memory reconsolidation using the β-adrenergic receptor blocker propranolol associated with re-exposure psychotherapy is a promising treatment in patients with posttraumatic stress disorder. Previous studies have established this therapy is effective in reducing overall clinician-assessed posttraumatic stress disorder symptoms, but to date no previous study has specifically focused on posttraumatic nightmares in this therapy. This study provides a preliminary assessment of the evolution of nightmare severity during this therapy protocol compared with the decrease of the other posttraumatic stress disorder symptoms. It evaluates the incidence of side effects and examines the relative effects on posttraumatic nightmares.
Patients were recruited as part of the Paris Mémoire Vive Study. Data were collected using a prospective longitudinal design including 1 baseline visit, 6 therapeutic visits, and 2 follow-up visits. During the 6 therapeutic visits, propranolol was administered orally 60 to 75 minutes prior to the psychotherapeutic session.
On average, nightmare severity decreased from "severe" to "mild" during the protocol and remained stable 2 months after the last session. Whereas 85% of patients reported nightmares at baseline, only 50% still had them after the protocol. The protocol was generally well tolerated and did not increase nightmare severity for any patient in the study.
Memory reconsolidation therapy with propranolol seems promising in reducing nightmare severity, up to and including remission. However, research using a randomized controlled design and assessing maintenance of nightmare extinction is warranted.
Registry: ClinicalTrials.gov; Name: Using Reconsolidation Blockade to Treat Trauma Related Disorders After Paris Attacks: An Effectiveness Study (PARIS-MEM); Identifier: NCT02789982; URL: https://www.clinicaltrials.gov/ct2/show/NCT02789982.
Mallet C, Chick CF, Maatoug R, Fossati P, Brunet A, Millet B. Memory reconsolidation impairment using the β-adrenergic receptor blocker propranolol reduces nightmare severity in patients with posttraumatic stress disorder: a preliminary study. . 2022;18(7):1847-1855.
创伤后梦魇可能会加重和延续创伤后应激障碍的日间症状，并且可能成为一个治疗靶点。使用β-肾上腺素能受体阻滞剂普萘洛尔结合再暴露心理治疗的记忆再巩固治疗策略，是一种有前途的治疗创伤后应激障碍的方法。先前的研究已经证实，这种疗法可以有效降低总体临床评估的创伤后应激障碍症状，但迄今为止，没有先前的研究专门针对这种疗法中的创伤后梦魇。本研究初步评估了与其他创伤后应激障碍症状减轻相比，在该治疗方案期间，梦魇严重程度的变化。它评估了副作用的发生率，并检查了对创伤后梦魇的相对影响。
研究对象是巴黎记忆研究的一部分。数据收集采用前瞻性纵向设计，包括 1 次基线访问、6 次治疗访问和 2 次随访访问。在 6 次治疗访问中，普萘洛尔在心理治疗前 60 至 75 分钟口服给药。
平均而言，在方案期间，梦魇严重程度从“严重”降至“轻度”，并在最后一次治疗后 2 个月保持稳定。尽管 85%的患者在基线时有梦魇，但只有 50%的患者在方案结束后仍有梦魇。该方案总体上耐受性良好，没有增加研究中任何患者的梦魇严重程度。
使用普萘洛尔的记忆再巩固治疗似乎有望降低梦魇严重程度，包括缓解。然而，使用随机对照设计和评估梦魇消退维持的研究是必要的。
注册机构：ClinicalTrials.gov；名称：使用再巩固阻断治疗巴黎袭击后与创伤相关的障碍：一项有效性研究（PARIS-MEM）；标识符：NCT02789982；网址：https://www.clinicaltrials.gov/ct2/show/NCT02789982。
Mallet C, Chick CF, Maatoug R, Fossati P, Brunet A, Millet B. 使用β-肾上腺素能受体阻滞剂普萘洛尔进行记忆再巩固损伤可降低创伤后应激障碍患者的梦魇严重程度：初步研究。睡眠医学。2022;18(7):1847-1855.
