1/2-Optimizing PTSD Treatments

1/2-优化 PTSD 治疗

基本信息

批准号：
8402639
负责人：
NORAH C FEENY
金额：
$ 52.58万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-01-01 至 2015-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8402639
关键词：
Address Aftercare Biological Caring Chronic Client Combined Modality Therapy Complex Diagnosis Diagnostic Effectiveness Exposure to Female Genetic Hydrocortisone Individual Institute of Medicine (U.S.)Intervention Knowledge Long-Term Effects Major Depressive Disorder Measures Medicine Modality Outcome Participant Patient Care Patient Preferences Patients Pharmacological Treatment Pharmacotherapy Post-Traumatic Stress Disorders Process Psychopathology Psychotherapy Randomized Recruitment Activity Relative (related person)Reporting Research Role Sampling Sertraline Social support Strategic Planning Survivors Symptoms Therapeutic Trauma Treatment Effectiveness Zoloft active method biopsychosocial cost effectiveness follow-up functional disability male preference psychologic psychosocial randomized trial response marker treatment adherence treatment effect treatment response

项目摘要

DESCRIPTION (provided by applicant): Although it is well established that both pharmacological and psychological therapies are relatively effective in treating chronic posttraumatic stress disorder (PTSD), the recent Institute of Medicine (IOM, 2007) report highlights vast gaps in our current knowledge noting a lack of knowledge regarding factors influencing treatment acceptance and completion, the combined effectiveness of these pharmacological and psychological treatment, and their efficacy in common subpopulations (e.g., those with diagnostic co-occurrence). To address these gaps, we propose the first large-scale trial to directly focus on individualizing PTSD care across several key parameters: choice of treatment, the effects of combined psychotherapy and pharmacological PTSD treatment, and the presence of co-occurring major depression. Building on our previous psychotherapy and pharmacotherapy trial on PTSD treatment, we will conduct a doubly randomized preference trial in which female and male trauma survivors with chronic PTSD will be randomly assigned to either choice or no choice treatment conditions. In the choice condition, patients will choose between prolonged exposure (PE) and prolonged exposure plus sertraline (PE + SER). In the no choice condition, patients will be randomly assigned to either prolonged exposure alone (PE) or prolonged exposure plus sertraline (PE + SER). In addition, we will specifically recruit and examine patients with co-occurring major depressive disorder (MDD). Outcome, as measured by both psychopathology and broader functioning measures, will be assessed at post-treatment and through 24-month follow-up. We will also examine biopsychosocial markers of response, psychotherapy change processes, and cost-effectiveness of these treatments. The Specific Aims are: 1) To compare the short-term and long-term effectiveness of PE to that of PE + SER; 2) To systematically compare patients who have chosen their treatment to those who have not in terms of treatment adherence, treatment completion, and effectiveness; and 3) To compare individuals with PTSD alone to those with PTSD and co-occurring major depression. In line with the NIMH's strategic plan, this application focuses on more personalized medicine, focusing on patients' choices and better understanding individual trajectories of outcome.

描述（由申请人提供）：尽管已经有充分的确定，药理学和心理疗法在治疗慢性创伤后应激障碍（PTSD）方面均相对有效，但最近的医学研究所（IOM，2007年）报告说，在我们当前的知识中，在我们当前缺乏有关治疗治疗的知识方面的知识的差距很大，这些知识缺乏这些因素，这些因素的综合治疗方法和概念性的效率，以及在这些知识方面的依据，并具有成就，并具有促进性的效率，并具有促进性，并具有成就的效率，并具有成就的影响，并具有促进性的效率，并具有促进性的效率，并具有促进性的效率，并具有促进性的良性，并具有促进性的效率，并具有促进性的效率，并具有良好的知识。（例如，具有诊断性共发生的人）。为了解决这些差距，我们提出了第一个大规模试验，以直接关注几个关键参数的PTSD护理：治疗的选择，联合心理治疗和药理学PTSD治疗的效果以及共同发生的重大抑郁症的存在。在我们先前的心理治疗和PTSD治疗中的药物治疗试验的基础上，我们将进行一项双随机偏好试验，其中患有慢性PTSD的男性和男性创伤幸存者将被随机分配给选择或没有选择治疗条件。在选择条件下，患者将在长时间暴露（PE）和长时间暴露以及舍曲林（PE + SER）之间进行选择。在别无选择的条件下，患者将被随机分配到长时间暴露（PE）或长时间暴露加上舍曲林（PE + SER）。此外，我们将专门招募并检查患有重大抑郁症（MDD）的患者。通过心理病理学和更广泛的功能措施来衡量的结果将在治疗后和24个月的随访中进行评估。我们还将检查这些治疗方法的反应，心理治疗变化过程以及成本效益的生物心理社会标志。具体目的是：1）将PE与PE + Ser的短期和长期有效性进行比较； 2）系统地将选择治疗的患者与没有治疗依从性，治疗完成和有效性的患者进行比较； 3）仅将PTSD的个体与PTSD和同时发生的重度抑郁症进行比较。根据NIMH的战略计划，该应用集中在更个性化的医学上，重点是患者的选择，并更好地了解各个结果的轨迹。