Belinda Graham1, Natalia M Garcia2, Mark S Burton3, Andrew A Cooper4, Peter P Roy-Byrne5, Matig R Mavissakalian6, Norah C Feeny7, Lori A Zoellner8. 1. Postdoctoral Fellow, Department of Psychology,University of Washington,USA. 2. Graduate Student, Department of Psychology,University of Washington,USA. 3. Graduate Student, Department of Psychological Sciences,Case Western Reserve University,USA. 4. Postdoctoral Fellow, Department of Psychological Sciences,Case Western Reserve University,USA. 5. Professor, Department of Psychiatry and Behavioral Sciences,Harborview Medical Center,USA. 6. Professor,Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center,USA. 7. Professor, Department of Psychological Sciences,Case Western Reserve University,USA. 8. Professor, Department of Psychology,University of Washington,USA.
Abstract
BACKGROUND: Better indicators of prognosis are needed to personalise post-traumatic stress disorder (PTSD) treatments.AimsWe aimed to evaluate early symptom reduction as a predictor of better outcome and examine predictors of early response. METHOD: Patients with PTSD (N = 134) receivedsertraline or prolonged exposure in a randomised trial. Early response was defined as 20% PTSD symptom reduction by session two and good end-state functioning defined as non-clinical levels of PTSD, depression and anxiety. RESULTS:Early response rates were similar in prolonged exposure and sertraline (40 and 42%), but in sertraline only, early responders were four times more likely to achieve good end-state functioning at post-treatment (Number Needed to Treat = 1.8, 95% CI 1.28-3.00) and final follow-up (Number Needed to Treat = 3.1, 95% CI 1.68-16.71). Better outcome expectations of sertraline also predicted higher likelihood of early response. CONCLUSIONS: Higher expectancy of sertraline coupled with early response may produce a cascade-like effect for optimal conditions for long-term symptom reduction. Therefore, assessing expectations and providing clear treatment rationales may optimise sertraline effects. DECLARATION OF INTEREST: None.
RCT Entities:
BACKGROUND: Better indicators of prognosis are needed to personalise post-traumatic stress disorder (PTSD) treatments.AimsWe aimed to evaluate early symptom reduction as a predictor of better outcome and examine predictors of early response. METHOD:Patients with PTSD (N = 134) received sertraline or prolonged exposure in a randomised trial. Early response was defined as 20% PTSD symptom reduction by session two and good end-state functioning defined as non-clinical levels of PTSD, depression and anxiety. RESULTS: Early response rates were similar in prolonged exposure and sertraline (40 and 42%), but in sertraline only, early responders were four times more likely to achieve good end-state functioning at post-treatment (Number Needed to Treat = 1.8, 95% CI 1.28-3.00) and final follow-up (Number Needed to Treat = 3.1, 95% CI 1.68-16.71). Better outcome expectations of sertraline also predicted higher likelihood of early response. CONCLUSIONS: Higher expectancy of sertraline coupled with early response may produce a cascade-like effect for optimal conditions for long-term symptom reduction. Therefore, assessing expectations and providing clear treatment rationales may optimise sertraline effects. DECLARATION OF INTEREST: None.
Entities:
Keywords:
Early response; antidepressants; expectancy; post-traumatic stress disorder
Authors: Rodrigo Machado-Vieira; Giacomo Salvadore; David A Luckenbaugh; Husseini K Manji; Carlos A Zarate Journal: J Clin Psychiatry Date: 2008-06 Impact factor: 4.384
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