Treatment of recent trauma survivors with benzodiazepines: a prospective study.
ABSTRACT Most types of psychotropic drugs have been tried in the treatment of chronic posttraumatic stress disorder (PTSD), but have yielded limited results. Theory and retrospective research predict that early treatment may be more efficacious. Specifically, high-potency benzodiazepines have been recommended for the treatment of acute responses to trauma and for prevention of PTSD. This study prospectively evaluates the effect of early administration of benzodiazepines on the course of PTSD and PTSD symptoms.
Thirteen trauma survivors (the benzodiazepine group) were treated within 6.7 +/- 5.8 days after the trauma (range, 2-18) with either clonazepam (N = 10, 2.7 +/- 0.8 mg/day) or alprazolam (N = 3, 2.5 mg/day). Thirteen other trauma survivors, pair-matched with subjects in the active treatment group for gender and symptom severity in the first week after the trauma, constitute the control group. Both groups were reevaluated 1 and 6 months after the trauma for PTSD symptoms (Horowitz Impact of Event Scale; Mississippi Rating Scale for Combat-Related PTSD-civilian trauma version), PTSD status (Clinician Administered PTSD Scale), state anxiety, depression, and resting heart rate.
Subjects in the benzodiazepine group did not differ from controls in 1-month and 6-month PTSD and anxiety scores. Repeated measures ANOVA showed no group or group-by-time effect on psychometric measures. A trend toward group-by-time interaction in resting heart rate was noted (progressive decrease in the benzodiazepine group). Nine benzodiazepine subjects and 3 controls met PTSD diagnostic criteria 6 months after the trauma.
Contrary to expectations, the early administration of benzodiazepines to trauma survivors with high levels of initial distress did not have a salient beneficial effect on the course of their illness, while reducing physiologic expression of arousal.
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ABSTRACT: All living organisms depend on homeostasis, the complex set of interacting metabolic chemical reactions for maintaining life and well‐being. This is no less true for psychiatric well‐being than for physical well‐being. Indeed, a focus on homeostasis forces us to see how inextricably linked mental and physical well‐being are. This paper focuses on these linkages. In particular, it addresses the ways in which understanding of disturbed homeostasis may aid in creating classes of patients with mood and anxiety disorders based on such phenotypes. At the cellular level, we may be able to compensate for the inability to study living brain tissue through the study of homeostatic mechanisms in fibroblasts, pluripotent human cells, and mitochondria and determine how homeostasis is disturbed at the level of these peripheral tissues through exogenous stress. We also emphasize the remarkable opportunities for enhancing knowledge in this area that are offered by advances in technology. The study of human behavior, especially when combined with our greatly improved capacity to study unique but isolated populations, offers particularly clear windows into the relationships among genetic, environmental, and behavioral contributions to homeostasis.Annals of the New York Academy of Sciences 12/2014; 13341(1). DOI:10.1111/nyas.12600 · 4.31 Impact Factor
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ABSTRACT: Objective. While benzodiazepines are commonly used in the treatment of posttraumatic stress disorder (PTSD), no systematic review or meta-analysis has specifically examined this treatment. The goal of this study was to analyze and summarize evidence concerning the efficacy of benzodiazepines in treating PTSD. Method. The review protocol was undertaken according to the principles recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and is registered with the PROSPERO international prospective register of systematic reviews (www.crd.york.ac.uk/PROSPERO, registration number CRD42014009318). Two authors independently conducted a search of all relevant articles using multiple electronic databases and independently abstracted information from studies measuring PTSD outcomes in patients using benzodiazepines. Eighteen clinical trials and observational studies were identified, with a total of 5,236 participants. Outcomes were assessed using qualitative and quantitative syntheses, including meta-analysis. Results. Benzodiazepines are ineffective for PTSD treatment and prevention, and risks associated with their use tend to outweigh potential short-term benefits. In addition to adverse effects in general populations, benzodiazepines are associated with specific problems in patients with PTSD: worse overall severity, significantly increased risk of developing PTSD with use after recent trauma, worse psychotherapy outcomes, aggression, depression and substance use. Potential biopsychosocial explanations for these results are proposed based on studies that have investigated benzodiazepines, PTSD, and relevant animal models. Conclusions. The results of this systematic review suggest that benzodiazepines should be considered relatively contraindicated for patients with PTSD or recent trauma. Evidence-based treatments for PTSD should be favored over benzodiazepines.Journal of Psychiatric Practice 07/2015; · 1.35 Impact Factor
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ABSTRACT: This article reviews the various current treatment options of posttraumatic stress disorder (PTSD), a prevalent and disabling condition. The primary-source literature was reviewed using PubMed search, and sec-ondary-source review articles and chapters were also used. Evidence from several studies suggests that both psychopharmacologic and psychotherapeutic therapies can be effective in PTSD. Selective serotonin reuptake inhibitors are generally the most appropriate choice of first-line medication for PTSD, and effective pharma-cotherapy should be continued for at least 12 months. Psychotherapy, especially cognitive behavior therapy, is found to be effective in the treatment of PTSD. In addition to those therapies, eye movement desensitiza-tion and reprocessing therapy, and transcranial magnet-ic stimulation would be relatively new treatment options for PTSD.