Propranolol for the Treatment of Acute Stress Disorder

Inclusion Criteria Exposure to trauma between 1 and 3 weeks of evaluation. Traumatic event involving at most minor physical injury (i.e., release from the ER within 12 hours of admission, without surgical intervention). Mentally healthy prior to trauma exposure. DSM-IV diagnosis of ASD. CAPS score equal or greater than 40. Eighteen-65 years old, in good physical health as confirmed by a complete physical exam (including normal vital signs), electrocardiogram, neurological exam, and routine laboratory tests of blood and urine. (However, if patients have had blood work through the ER or their primary MD within the last 6 months, these results will be used instead of repeating blood draws for inclusion into the study). Male and female. Capable of providing informed consent, obtained prior to any study procedures. Free of all psychotropic medication for at least 1 week, excluding short-term hypnotics. Exclusion Criteria Any DSM IV Axis I diagnosis preceding exposure to trauma. In order to compare a homogenous subject group we require all participants to be physically and mentally healthy before exposure to trauma. Treatment with psychotropic medication other than short acting hypnotic or sedative medication since exposure to trauma. Allowing such treatment acknowledges patient distress and ensures administration of minimal level of care. Short acting medications enables having patients free of medication when absolutely necessary. History of traumatic brain injury involving loss of consciousness for at least 20 minutes or anterograde amnesia for at least 24 hours. Blood pressure over 150/100 or under 100/60 (applicable for either systolic or diastolic measures). Pulse over 100 or under 60 per minute. Cardiac arrhythmia, coronary artery disease or any cardiac dysfunction with a potential to develop congestive heart failure. Bronchospastic pulmoray disease, chronic obstructive pulmonary disease or any active lung disease. Raynaud phenomenon. Potential participants with other immune vasculitis will be referred to internal medicine consult. Risk factors for coronary artery disease: Family history, diabetes, hyperlipidemia, hypertension, peripheral vascular disease or physical signs suggestive of cardiac compromise. Any questionable case will be referred to internal medicine consult. Treatment with any adrenergic compound, prescription or over-the-counter (OTC; for example, preparations containing yohimbine sold OTC). Unable to comply with study procedures or assessments. Patients at current risk for homicide or suicide. Litigation before or during the study. Seeking compensation so soon after trauma, before or during any treatment trial, may represent ambivalence in the true motivation for cure. Patients who meet DSM-IV criteria for substance abuse (alcohol or drugs) or dependence within 6 months prior to screening. Women of childbearing potential who are not practicing a clinically accepted method of contraception or who have a positive pregnancy test or who are lactating. Patients suffering from any major chronic physical disorder not specifically mentioned here, even if stable, will have to be individually approved by the PI or another participating MD.