Efficacy of traumatic memory reactivation with or without propranolol in PTSD with high dissociative experiences

Background: 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.
Objective: 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.
Method: 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).
Results: 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.
Conclusions: 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.

Traumatic memory reactivation procedure is an effective way to treat dissociative symptoms in patients with PTSD.
The improvement of these dissociative symptoms was associated to a decrease of both PTSD and depression severity.
Dissociative symptoms do not seem to mitigate the efficacy of traumatic memory reactivation during the treatment of PTSD.

Traumatic memory reactivation procedure is an effective way to treat dissociative symptoms in patients with PTSD.
The improvement of these dissociative symptoms was associated to a decrease of both PTSD and depression severity.
Dissociative symptoms do not seem to mitigate the efficacy of traumatic memory reactivation during the treatment of PTSD.

背景：伴解离症状的创伤后应激障碍（Post-traumatic stress disorder, PTSD）现已成为该疾病的正式亚型。解离亚型与更多的精神科共病相关。截至目前，解离对PTSD治疗疗效的影响仍不明确。
研究目的：本研究旨在比较创伤记忆再激活程序、每周给药一次且连续六周的普萘洛尔（propranolol）或安慰剂，在伴或不伴高解离症状的PTSD患者中减轻PTSD及重性抑郁发作（Major Depressive Episode, MDE）症状的疗效差异。
研究方法：为此，我们纳入66名确诊为慢性PTSD的成年人开展随机临床试验，采用结构化临床访谈PTSD模块（SCID PTSD module）、创伤后应激障碍检查表（PCL-S）、贝克抑郁量表第二版（Beck’s Depression Inventory-II, BDI-II）以及解离体验量表（Dissociative Experiences Scale, DES）进行评估。
研究结果：无论是否伴高解离体验的患者，在6次治疗周期内的PCL-S评分均出现显著改善；且所有患者在治疗后随访阶段，其PCL-S评分仍持续下降。然而，高解离体验的有无与普萘洛尔治疗的特异性疗效并无关联。针对MDE症状的分析也得到了完全一致的结果。值得注意的是，治疗前伴高解离体验的患者在完成6次治疗后，其DES评分出现了极为显著的改善，且该改善效果在治疗后3个月的随访中得以维持。
研究结论：创伤记忆再激活程序可有效治疗PTSD患者的解离症状，且此类解离症状的改善与PTSD及抑郁症状严重程度的降低显著相关。

创伤记忆再激活程序可有效治疗PTSD患者的解离症状。
此类解离症状的改善与PTSD及抑郁症状严重程度的降低显著相关。
解离症状似乎并不会削弱创伤记忆再激活程序在PTSD治疗中的疗效。

创伤记忆再激活程序可有效治疗PTSD患者的解离症状。
此类解离症状的改善与PTSD及抑郁症状严重程度的降低显著相关。
解离症状似乎并不会削弱创伤记忆再激活程序在PTSD治疗中的疗效。