The purpose of this study is to examine the short-term consequences of trauma and to
determine the effectiveness of the drug sertraline in preventing and treating post-traumatic
stress disorder (PTSD) and acute stress disorder (ASD) symptoms.
ASD and PTSD are common consequences of exposure to traumatic events. Despite growing
evidence of neurobiological dysfunction in ASD and PTSD, the origin of these disorders is
still unknown. This study will attempt to identify psychophysiological markers of ASD and
find an effective treatment for its symptoms.
Victims of serious motor vehicle collisions will be evaluated with clinical assessments and
standardized questionnaires within 2 weeks after the accident. Symptoms of exaggerated
startle, emotional reactivity to trauma-related and trauma-unrelated cues, and cerebellum
functioning will be evaluated. Participants will be randomized to receive either sertraline
or placebo (an inactive sugar pill) for 8 weeks. Psychometric testing and psychological
evaluations will be conducted 4, 10, and 14 weeks after the accident and after a 2-week
taper of the study medication.
Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are common consequences
of exposure to traumatic events. Despite growing evidence of neurobiological dysfunction in
ASD and PTSD, the pathogenesis of these disorders is still unknown. Drs. Osuch and Ursano
(Uniformed Services University of the Health Sciences) have received support to conduct a
14-week study that will investigate the efficacy of the serotonergic medication sertraline
(Zoloft) in the treatment and prevention of posttraumatic psychiatric sequelae in ASD
victims. The present project is an amendment to Drs. Osuch and Ursano's study. It will
attempt to identify early psychological and neurobiological abnormalities in ASD. More
specifically, the present project will examine to what extent sensitization and conditioning
processes, as well as emotional dysregulation, contribute to ASD. We also propose to
investigate the potential association between cerebellum dysfunction and peritraumatic
dissociations. To accomplish this goal, a series of three experiments will be implemented to
investigate: 1) the symptom of exaggerated startle; 2) emotional reactivity to
trauma-related and trauma-unrelated cues; and 3) cerebellum functioning using eyeblink
conditioning. This study will inform on the short-term consequences of trauma, will help
identify potential psychophysiological markers of ASD that emerge following trauma, and will
examine the effects of an SSRI on preventing trauma-related neurobiological deficits.
We specifically propose to:
1. Characterize psychophysiological responses in ASD victims shortly after trauma;
2. Assess the effect of sertraline treatment on these psychophysiological responses.
To accomplish aim 1, non-treated ASD victims will be compared to two control groups, a
non-ASD trauma group and a non-trauma healthy group. The two control groups will be used to
disentangle the effect of trauma from the effect of acute stress disorder. To accomplish aim
2, the ASD sertraline group will be compared to the ASD placebo group following treatment.
Forty victims of serious motor vehicle collision (MVC) with ASD will be recruited from a
community hospital emergency room and evaluated with clinical assessments, and standardized
questionnaires within 2 weeks after the MVC. The subjects will then be randomized to either
sertraline or placebo for 8 weeks duration. Psychometric testing and psychological
evaluations will be conducted at 4, 10 weeks post-MVC, and after a 2-week taper of the
medication and 2 more weeks (14 weeks post-MVC).
We hypothesize that ASD patients will show:
An enhancement or sensitization of baseline startle;
An increase in autonomic arousal and in startle amplitude to trauma-related cues;
A delayed eyeblink conditioning;
Normalization of these deficits after sertraline treatment.
This preliminary study is expected to lay the groundwork for a larger study of the early
impact of traumatic events on psychophysiological and psychological processes. In the
long-term, we expect to 1) better characterize the onset of symptoms and their evolution
over time following trauma, 2) identify psychophysiological markers for PTSD, 3) identify
ASD victims at-risk for PTSD, and 4) improve our ability to prevent the development of
chronic psychopathology following trauma.
Subjects will be above seventh grade education level aged 18-65 years old and free of
current or past psychopathology and organic central nervous system disorders that may
interfere with the tests.
Ongoing medical illness that may interfere with the tests; psychiatric or neurological
disorder (including seizure); Past or current substance abuse; Current psychotropic
medication; current medication that may interfere with the tests; Impaired hearing; major
uncorrected visual impairment, or migraine headache.