伴有高度分离体验的创伤后应激障碍患者中,有无普萘洛尔情况下创伤性记忆再激活的疗效。
Efficacy of traumatic memory reactivation with or without propranolol in PTSD with high dissociative experiences.
作者信息
Roullet Pascal, Taïb Simon, Thalamas Claire, Vaiva Guillaume, El Hage Wissam, Yrondi Antoine, Birmes Philippe
机构信息
University of Toulouse, UPS, Toulouse, France.
Centre Régional Psychotraumatisme Occitanie, Toulouse University Hospital, France.
出版信息
Eur J Psychotraumatol. 2022 Dec;13(2):2151098. doi: 10.1080/20008066.2022.2151098. Epub 2022 Dec 1.
Post-traumatic stress disorder (PTSD) with dissociative symptoms is now a full-fledged subtype of this disorder. The dissociative subtype is associated with a greater number of psychiatric comorbidities. To date, the impact of dissociation on the efficacy of PTSD treatment remains unclear. The aim of this study was to compare the efficacy of a traumatic memory reactivation procedure with the administration of propranolol or a placebo once a week for six consecutive weeks in reducing PTSD and MDE symptoms between PTSD subjects with or without high dissociative symptoms. For that, we conducted a randomized clinical trial in 66 adults diagnosed with longstanding PTSD and measured the SCID PTSD module, the PTSD Checklist (PCL-S), Beck's Depression Inventory-II (BDI-II), and the Dissociative Experiences Scale (DES). Patients with and without high dissociative experience had significant improvement in their PCL-S scores over the 6 treatment sessions, and PCL-S scores continued to decline in all patients during the post-treatment period. However, there was no correlation between the presence/absence of high dissociative experiences and no specific effect of propranolol treatment. We found exactly the same results for MDE symptoms. Interestingly, patients with high dissociative experiences before treatment exhibited very significant improvement in their DES scores after the 6 treatment sessions, and patients maintained this improvement 3 months post-treatment. The traumatic memory reactivation procedure is an effective way to treat dissociative symptoms in patients with PTSD, and improvement of these dissociative symptoms was associated with a decrease in both PTSD and depression severity.
伴有解离症状的创伤后应激障碍(PTSD)现已成为该障碍的一个成熟亚型。解离亚型与更多的精神共病相关。迄今为止,解离对PTSD治疗效果的影响仍不明确。本研究的目的是比较创伤记忆激活程序与连续六周每周服用一次普萘洛尔或安慰剂在减轻有无高度解离症状的PTSD患者的PTSD和MDE症状方面的疗效。为此,我们对66名被诊断为患有长期PTSD的成年人进行了一项随机临床试验,并测量了SCID PTSD模块、PTSD检查表(PCL-S)、贝克抑郁量表第二版(BDI-II)和解离体验量表(DES)。有和没有高度解离体验的患者在6次治疗过程中PCL-S评分均有显著改善,且在治疗后阶段所有患者的PCL-S评分持续下降。然而,有无高度解离体验之间没有相关性,且普萘洛尔治疗没有特定效果。我们在MDE症状方面也得到了完全相同的结果。有趣的是,治疗前有高度解离体验的患者在6次治疗后DES评分有非常显著的改善,且在治疗后3个月患者仍保持这种改善。创伤记忆激活程序是治疗PTSD患者解离症状的有效方法,这些解离症状的改善与PTSD和抑郁严重程度的降低相关。
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