Tackling the global problem of traumatic stress in low-income countries: a pilot clinical trial comparing reconsolidation therapy to paroxetine in Nepal.

Autor: Brunet A; Research Centre of the Douglas Mental Health University Institute, and Department of Psychiatry, McGill University, 6875 boulevard LaSalle, Montréal, Quebec, H4H 1R3, Canada. alain.brunet@mcgill.ca., Sapkota RP; Research Centre of the Douglas Mental Health University Institute, and Department of Psychiatry, McGill University, 6875 boulevard LaSalle, Montréal, Quebec, H4H 1R3, Canada.; Division of Social and Transcultural Psychiatry, Global Mental Health Program, McGill University, Montréal, QC, Canada., Guragain B; Centre for Victims of Torture (CVICT), Kathmandu, Nepal., Tremblay J; Research Centre of the Douglas Mental Health University Institute, and Department of Psychiatry, McGill University, 6875 boulevard LaSalle, Montréal, Quebec, H4H 1R3, Canada., Saumier D; Research Centre of the Douglas Mental Health University Institute, and Department of Psychiatry, McGill University, 6875 boulevard LaSalle, Montréal, Quebec, H4H 1R3, Canada., Kirmayer LJ; Division of Social and Transcultural Psychiatry, Global Mental Health Program, McGill University, Montréal, QC, Canada.; Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada.
Jazyk: angličtina
Zdroj: BMC psychiatry [BMC Psychiatry] 2021 Sep 03; Vol. 21 (1), pp. 434. Date of Electronic Publication: 2021 Sep 03.
DOI: 10.1186/s12888-021-03441-6
Abstrakt: Background: Traumatic stress is a global mental health problem requiring novel, easily implemented treatment solutions. We compared the effectiveness and efficiency of Reconsolidation Therapy (RT) to the well-established antidepressant paroxetine, in reducing symptoms of traumatic stress among patients from Nepal, a low-income country.
Methods: Forty-six adults with posttraumatic stress disorder (PTSD) were randomized to one of two groups. The reconsolidation blocker propranolol was administered 90 min before briefly recalling a traumatic memory with a therapist, weekly for six consecutive weeks. This was compared to daily paroxetine for 26 weeks. Self-reported PTSD symptoms were assessed blindly at the 7th, 13th, and 26th weeks.
Results: An intent-to-treat analysis revealed a robust pre- to post-treatment main effect (β 1  = - 4.83, 95% CI = [- 5.66, - 4.01], p < .001), whereby both groups improved, with Cohen's effect sizes of d = 2.34 (95% CI = [1.57, 3.12]) for paroxetine, and of 2.82 (95% CI = [1.98, 3.66]) for RT after 7 weeks, suggesting treatment effectiveness for both groups in a real-world setting. Three and six-month follow-up yielded further significant improvement in both groups, which did not differ from each other.
Conclusion: RT also displayed promising efficiency, considering that it had been discontinued weeks earlier while the paroxetine treatment was continued, as recommended. RT could be taught in low-income countries as part of the local therapeutic resources to treat the core symptoms of PTSD, provided that such results are replicated on a broader scale.
Trial Registration: ISRCTN34308454 (11/10/2017).
(© 2021. The Author(s).)
Databáze: MEDLINE
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