Prevention of Post Traumatic Stress Disorder by Early Treatment

To prospectively evaluate the effect of early treatment (cognitive therapy (CT), cognitive-behavioral therapy (CBT) and escitalopram (SSRI) in preventing the occurrence of post-traumatic stress disorder in recent survivors of traumatic events.

Consecutive civilian trauma survivors will be contacted, by phone, within five days of admission to Hadassah University Hospital in Jerusalem and asked about their early psychological responses to the event. A short telephone interview will be administered to consenting subjects, to evaluate the presence of acute stress disorder (ASD). Subjects with ASD (full or partial) and those who so desire will be invited to clinical assessment, which will take place within the next two weeks. Survivors with significant symptoms of post-traumatic stress disorder will be randomized to five arms of twelve-week long treatment: CBT, CT, SSRI/placebo and waiting list (WL) and start treatment immediately. Subjects will be allowed to decline one form of therapy. WL subjects will start therapy 12 weeks later. All subjects who had clinical interview will be interviewed again at four and seven months - and 14 months following trauma (phone interview).

Traumatic Events, Post-traumatic Stress Disorder, Treatment (psychological), Treatment (pharmacological), Prevention, SSRIs

Twelve weeks of treatment with placebo pills resembling the original Escitalopram 10mg tablets but containing no active substance

Symptoms of post-traumatic Stress Disorder per PSS-SR (questionnaire) and CAPS (structured interview)

Inclusion Criteria: Adults survivors of traumatic events Exclusion Criteria: Traumatic brain injury Lifetime psychosis Life time (prior) PTSD Medical conditions forbidding SSRIs

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