Pubblicazioni

Autori:

Bertolini, Federico; Robertson, Lindsay; Bisson, Jonathan I; Meader, Nicholas; Churchill, Rachel; Ostuzzi, Giovanni; Stein, Dan J; Williams, Taryn; Barbui, Corrado

Titolo:

Early pharmacological interventions for universal prevention of post-traumatic stress disorder (PTSD)

Anno:

2022

Tipologia prodotto:

Articolo in Rivista

Tipologia ANVUR:

Articolo su rivista

Lingua:

Inglese

Formato:

Elettronico

Referee:

Sì

Nome rivista:

COCHRANE LIBRARY

ISSN Rivista:

1465-1858

N° Volume:

2

Numero o Fascicolo:

CD013443

Intervallo pagine:

1-101

Parole chiave:

post-traumatic stress disorder (PTSD); pharmacological interventions; prevention; assessment

Breve descrizione dei contenuti:

Background: Post-traumatic stress disorder (PTSD) is a severe and debilitating condition. Several pharmacological interventions have been proposed with the aim to prevent or mitigate it. These interventions should balance efficacy and tolerability, given that not all individuals exposed to a traumatic event will develop PTSD. There are different possible approaches to preventing PTSD; universal prevention is aimed at individuals at risk of developing PTSD on the basis of having been exposed to a traumatic event, irrespective of whether they are showing signs of psychological difficulties. Objectives: To assess the efficacy and acceptability of pharmacological interventions for universal prevention of PTSD in adults exposed to a traumatic event. Search methods: We searched the Cochrane Common Mental Disorders Controlled Trial Register (CCMDCTR), CENTRAL, MEDLINE, Embase, two other databases and two trials registers (November 2020). We checked the reference lists of all included studies and relevant systematic reviews. The search was last updated on 13 November 2020. Selection criteria: We included randomised clinical trials on adults exposed to any kind of traumatic event. We considered comparisons of any medication with placebo or with another medication. We excluded trials that investigated medications as an augmentation to psychotherapy. Data collection and analysis: We used standard Cochrane methodological procedures. In a random-effects model, we analysed dichotomous data as risk ratios (RR) and number needed to treat for an additional beneficial/harmful outcome (NNTB/NNTH). We analysed continuous data as mean differences (MD) or standardised mean differences (SMD). Main results: We included 13 studies which considered eight interventions (hydrocortisone, propranolol, dexamethasone, omega-3 fatty acids, gabapentin, paroxetine, PulmoCare enteral formula, Oxepa enteral formula and 5-hydroxytryptophan) and involved 2023 participants, with a single trial contributing 1244 participants. Eight studies enrolled participants from emergency departments or trauma centres or similar settings. Participants were exposed to a range of both intentional and unintentional traumatic events. Five studies considered participants in the context of intensive care units with traumatic events consisting of severe physical illness. Our concerns about risk of bias in the included studies were mostly due to high attrition and possible selective reporting. We could meta-analyse data for two comparisons: hydrocortisone versus placebo, but limited to secondary outcomes; and propranolol versus placebo. No study compared hydrocortisone to placebo at the primary endpoint of three months after the traumatic event. The evidence on whether propranolol was more effective in reducing the severity of PTSD symptoms compared to placebo at three months after the traumatic event is inconclusive, because of serious risk of bias amongst the included studies, serious inconsistency amongst the studies' results, and very serious imprecision of the estimate of effect (SMD -0.51, 95% confidence interval (CI) -1.61 to 0.59; I2 = 83%; 3 studies, 86 participants; very low-certainty evidence). No study provided data on dropout rates due to side effects at three months post-traumatic event. The evidence on whether propranolol was more effective than placebo in reducing the probability of experiencing PTSD at three months after the traumatic event is inconclusive, because of serious risk of bias amongst the included studies, and very serious imprecision of the estimate of effect (RR 0.77, 95% CI 0.31 to 1.92; 3 studies, 88 participants; very low-certainty evidence). No study assessed functional disability or quality of life. Only one study compared gabapentin to placebo at the primary endpoint of three months after the traumatic event, with inconclusive evidence in terms of both PTSD severity and probability of experiencing PTSD, because of imprecision of the effect estima

Pagina Web:

https://doi.org/10.1002/14651858.cd013443.pub2

Id prodotto:

124878

Handle IRIS:

11562/1057656

ultima modifica:

15 novembre 2022

Citazione bibliografica:

Bertolini, Federico; Robertson, Lindsay; Bisson, Jonathan I; Meader, Nicholas; Churchill, Rachel; Ostuzzi, Giovanni; Stein, Dan J; Williams, Taryn; Barbui, Corrado, Early pharmacological interventions for universal prevention of post-traumatic stress disorder (PTSD) «COCHRANE LIBRARY» , vol. 2 , n. CD013443 , 2022 , pp. 1-101

Consulta la scheda completa presente nel repository istituzionale della Ricerca di Ateneo