Ila M. P. Linares · Francisco S. Guimaraes; Alan Eckeli; Ana C. S. Crippa Clarissa Trzesniak; Ila M Linares; Érica R Coimbra; Alexandre Veriano Júnior. 1 Research Projects at FAPESP. graduation at Formação de Psicologo from Universidade Federal de São Carlos (), graduation at Bacharelado em. Dec 3, Mateus M. Bergamaschi,1,2,3,* Regina H. C. Queiroz,2,3 Marcos H. N. Chagas,1, 3 Ila M. P. Linares,1,3 Kátia C. Arrais,1,3 Danielle C. G. de.
M. Linares Ila P.
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The funding agency had no role in the study design or in the decision to submit the paper for publication. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Services on Demand Journal.
Abstract Background Secondary interventions are implemented within a short interval following the occurrence of traumatic events with the purpose of preventing the onset of PTSD. Results Psychological measures used in the studies lack homogeneity regarding the type of intervention and the assessment of intervention outcomes. Discussion Future trials should be focused on determining the best interventions for the secondary prevention of PTSD.
Results and discussion Table 1 presents the clinical and demographic data of the participants included in the 29 articles reviewed, whereas Table 2 describes the methodological aspects of the studies. Psychological interventions We considered as psychological interventions those approaches that were not based on the administration of pharmacological substances.
Debriefing Four articles described the use of interventions based on a techniques know as debriefing 7 , 11 , 25 , Other types of psychological intervention Thirteen studies used different types of intervention including, for example, video-based interventions, counseling, and self help programs e.
Pharmacological interventions As shown in Table 2 , drugs used in the selected studies included propranolol, escitalopram, docosahexaenoic and eicosapentaenoic acid, hydrocortisone, and morphine.
Other relevant aspects In respect to the sample size, we highlight the discrepancy in the number of participants across the studies. Conclusion The main difficulty in the analysis of the 29 articles included in this review rose from the significant methodological variations across the studies, as discussed above.
August 24, ; Accepted: How to cite this article. Decreased trauma symptoms, low relative risk of depression, low relative risk of stress, and low feelings of self-blame. Patients reported significantly less frequent intrusive, arousal, and total PTSD symptoms than controls.
Level of depressive, anxiety and post-traumatic symptoms and prevalence of psychiatric disorders did not differ. Dissociation at the time at which treatment starts may indicate poorer response to early intervention.
Those with reduced dissociation at the start of treatment benefited most from early treatment. Intervention participants reported significantly lower PTSR than the assessment group at 4 and 12 weeks post injury. Combined genetic variants may serve to predict those most at risk for developing PTSD following trauma. Psychotherapeutic intervention may mitigate this risk. Brief cognitive-behavioral intervention caused changes in perceptions of self and changes in trauma-related symptom.
Morphine administered in the initial 48 hours was apparently more protective than the dose administered over the initial week. Hydrocortisone recipients reported fewer PTSD and depression symptoms than placebo recipients. Non significant trend for propranolol group CAPS scores did not differ in the propranolol and placebo groups. None of the study drugs showed a significant benefit over placebo on depressive or post-traumatic stress symptoms.
Significant reduction in CAPS scores over the course of treatment in both the escitalopram and placebo groups. Among the five trials using pharmacological interventions, only one used a single dose of the test medication On average, test medications were administered for seven days in the remaining studies. Two articles reported results compatible with a lower occurrence of PTSD and related symptoms 12, These results were based mainly on scales applied after the intervention and at follow-up assessments.
In the studies that found no statistically significant effects of pharmacological interventions in the prevention of PTSD, the authors described variables that may have interfered in their results, such as poor adherence to treatment, and suggest that it may be preferable to recruit individuals at increased risk of developing PTSD, such as individuals with high stress levels The article by Bryant et al.
Another study reported that, despite their weak results, propranolol may be useful in the prevention of PTSD because the results of psychophysiological tests suggest that the drug reduces the arousal elicited by exposure to stimuli resembling the traumatic event In addition to the results described above, methodological aspects including sample size, gender and age of participants, type of trauma, assessment scales, randomization procedures, intervention starting time, and follow-up duration also deserve attention, as they can have a direct impact on the results obtained.
In respect to the sample size, we highlight the discrepancy in the number of participants across the studies. Some authors have underscored the need for further investigations involving larger samples in order to confirm the data obtained to date 14,22, Regarding the gender of participants, two of the articles reviewed had discrepancies in the number of female and male participants 20, Both studies included a higher number of men in the groups of patients undergoing the intervention compared to the other groups.
It should also be noted that, in some studies, samples were formed exclusively by women 13,16,17,23,25,32 or men Although the authors make no mention to the discrepancies in the numbers of male and female participants, evidence points to a higher vulnerability to PTSD in females Therefore, studies with unbalanced gender distributions may not be as representative as studies with gender-balanced samples in what concerns the prevalence of the disorder.
This can be, however, a limitation that is difficult to overcome in populations that are more vulnerable to certain types of trauma and with a high predominance of one gender, as in the case of soldiers mainly men or victims of sexual abuse mainly women. Only one of the articles reviewed did not inform the mean age of participants 8. This is highly relevant because, although the onset of PTSD may occur at any age, it is more common in young adults since they are more prone to have the type of experiences that trigger the disorder Still in respect to the age of study participants, there was less homogeneity in the data presented by some authors 7,17, These articles do not discuss the age discrepancies in their samples, as well as the possible influence of this factor on their results.
From the 29 articles reviewed, four had no uniform samples in terms of the type of trauma experienced, that is, these studies assessed more than one type of trauma 17,18,22, There is evidence in the literature of correlations between the type of trauma experienced and gender-related vulnerability In this sense, variations in the types of trauma assessed in a same study can be seen as a limitation that hinders the reproducibility of its results.
Despite that, there was no standard in what concerns the instruments used in the articles reviewed. In general, the studies included scales to assess symptoms of depression and anxiety.
The lack of homogeneity in the types of instruments used in the studies also hampers the comparison of results available to date, as well as the generalization of findings. The randomization and blinding strategies used in the trials were also examined in this review.
Only one of the articles included informed that the study sample had not been randomized In respect to the study design, only two articles did not describe the inclusion of comparison groups 25, The remaining articles included one or more comparison groups. Still regarding the study design, the trial by Bryant et al. The time between the occurrence of the trauma and the beginning of the intervention varied greatly across studies, from 6 hours 31 to 10 weeks 9.
It has been argued that the shorter the interval between the traumatic event and the beginning of the intervention, the more likely is the blockade of the consolidation of aversive memories 17 with a consequent reduction in the possible negative emotional consequences of the trauma. Regarding follow-up assessments, all the studies reviewed included this type of analysis; however, the frequency and the interval between assessments varied.
Some limitations related to follow-up assessments were pointed in the studies reviewed, such as excessively short intervals between assessments 17 and poor treatment adherence by participants during long follow-up periods Design, analysis, and metaanalysis.
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Early interventions for the prevention of PTSD in adults: a systematic literature review
Ila M.P. LinaresI; Clarissa TrzesniakI; Marcos Hortes N. ChagasI; Jaime E. C. HallakI; Antonio E. NardiII; José Alexandre S. CrippaI. IDepartment of. Review article. Early interventions for the prevention of PTSD in adults: a systematic literature review. ILA M. P. LINARES. FELIPE D'ALESSANDRO F. CORCHS. D.J. Veltman, W.E. Tuinebreijer, D. Winkelman, A.A. Lammertsma, M.P. Witter, R.J. Dolan, P.M. EmmelkampNeurophysiological correlates of habituation during .