***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Patients attending an accident and emergency department may exhibit psychological disturbances post-injury . Early interventions have been suggested to reduce the risk of post-injury disorder , including psychoeducation . AIMS We assessed the efficacy of providing such self-help information . METHOD Patients who had experienced trauma were r and omised to two groups : those given ( n=75 ) and not given ( n=67 ) a  self-help booklet .  Psychological assessment s were completed within 2 , 10 - 12 and 24 - 26 weeks . RESULTS Post-traumatic stress disorder ( PTSD ) , anxiety and depression decreased ( P < 0.05 ) with time but there were no group differences in PTSD or anxiety . The controls were less depressed ( P < 50.05 ) at follow-up . There was a reduction in PTSD caseness within the control ( 50 % ) compared with the intervention ( 20 % ) group which was almost significant ( P < 0.06 ) . CONCLUSIONS This trial failed to support the efficacy of providing self-help information as a preventive strategy to ameliorate PTSD Background : Writing assignments have shown promising results in treating traumatic symptomatology . Yet no studies have compared their efficacy to the current treatment of choice , cognitive behavior therapy ( CBT ) . The present study evaluated the efficacy of structured writing therapy ( SWT ) and CBT as compared to a waitlist control condition in treating acute stress disorder ( ASD ) and posttraumatic stress disorder ( PTSD ) . Methods : A r and omized controlled trial was conducted at an outpatient clinic . Participants ( n = 125 ) ( a ) satisfied DSM-IV criteria for ASD or PTSD , ( b ) were 16 years or older , ( c ) were sufficiently fluent in Dutch or English , ( d ) had no psychiatric problems except ASD or PTSD that would hinder participation or required alternative clinical care , and ( e ) received no concurrent psychotherapy .  Treatment consisted of five 1.5-hour sessions of CBT or SWT for participants with ASD or acute PTSD and ten 1.5-hour sessions for participants with chronic PTSD . Outcome measures included the Structured Clinical Interview for DSM-IV , Impact of Event Scale , Beck Depression Inventory , State-Trait Anxiety Inventory and the Dissociative Experiences Scale . Results : At posttest and follow-up , treatment was associated with improved diagnostic status and lower levels of intrusive symptoms , depression and state anxiety , while a trend was noted for the reduction of avoidance symptoms . Treatment did not result in lower levels of trait anxiety or dissociation . No differences in efficacy were detected between CBT and SWT . Conclusions : The present study confirmed the efficacy of CBT for ASD and PTSD and identified SWT as a promising alternative treatment BACKGROUND Little is known about the effect of pharmacotherapy in the prevention of  post-traumatic stress disorder ( PTSD ) relapse .  AIMS To assess the efficacy and tolerability of fluoxetine in preventing PTSD relapse . METHOD This was a double-blind , r and omised , placebo-controlled study . Following 12 weeks of acute treatment , patients who responded were rer and omised and continued in a 24-week relapse prevention phase with fluoxetine ( n=69 ) or placebo ( n=62 ) . The primary efficacy assessment was the prevention of PTSD relapse , based on the time to relapse . RESULTS Patients in the fluoxetine/fluoxetine group were less likely to relapse than patients in the fluoxetine/placebo group ( P=0.027 ) . There were no clinical ly significant differences in treatment-emergent adverse events between treatment groups . CONCLUSIONS Fluoxetine is effective and well tolerated in the prevention of PTSD relapse for up to 6 months A cognitive-behavioral therapy ( CBT ) program for posttraumatic stress disorder ( PTSD ) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers .  CBT was compared with treatment as usual ( TAU ) in a r and omized controlled trial with 108 clients with PTSD and either major mood disorder ( 85 % ) or schizophrenia or schizoaffective disorder ( 15 % ) , of whom 25 % also had borderline personality disorder . Eighty-one percent of clients assigned to CBT participated in the program . Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessment s in PTSD symptoms , other symptoms , perceived health , negative trauma-related beliefs , knowledge about PTSD , and case manager working alliance . The effects of CBT on PTSD were strongest in clients with severe PTSD . Homework completion in CBT predicted greater reductions in symptoms . Changes in trauma-related beliefs in CBT mediated improvements in PTSD . The findings suggest that clients with severe mental illness and PTSD can benefit from CBT , despite severe symptoms , suicidal thinking , psychosis , and vulnerability to hospitalizations BACKGROUND This study investigated the efficacy of propranolol prescribed shortly after trauma exposure in the prevention of  posttraumatic stress disorder ( PTSD ) symptoms and diagnosis . METHODS Eleven patients received 40 mg of propranolol 3 times daily for 7 days , followed by a taper period of 8 - 12 days . They were compared with eight patients who refused propranolol but agreed to participate in the study . Though nonr and omized , the two groups did not differ on demographics , exposure characteristics , physical injury severity , or peritraumatic emotional responses . RESULTS Posttraumatic stress disorder rates were higher in the group who refused propranolol ( 3/8 ) compared with those who received the medication ( 1/11 ) , as were the levels of PTSD symptoms ( U = 85 , p = .037 ) . CONCLUSIONS Our results are consistent with earlier findings and suggest that propranolol may be useful for mitigating PTSD symptoms or perhaps even preventing the development of PTSD OBJECTIVES The exposure to intense physical and psychological stress during intensive care can result in posttraumatic stress disorder ( PTSD ) in survivors . Cortisol is a biological stress mediator that can have a protective effect during severe stress . The administration of stress doses of hydrocortisone during treatment in the intensive care unit could theoretically result in a lower incidence of PTSD . We tested this hypothesis in survivors of septic shock . DESIGN A retrospective case-controlled analysis . SETTING A 20-bed multidisciplinary intensive care unit of a tertiary-care university hospital . PATIENTS We identified 27 patients who received st and ard therapy for septic shock . These patients served as controls and were compared with an equal number of patients who received hydrocortisone in addition to st and ard treatment . These patients were selected from our data base with regard to age ( + /-4 yrs ) , gender , and cause of septic shock to be as similar as possible with control patients . INTERVENTIONS Patients from the hydrocortisone group had received stress doses of hydrocortisone ( 100 mg bolus , followed by 0.18 mg/kg/hr ) in addition to st and ard treatment . Patients from the control group received st and ard protocol -driven treatment only . PTSD was diagnosed with the Posttraumatic Stress Syndrome-10 inventory , a self-report scale for diagnosis of PTSD . Health-related quality of life was measured using the Medical Outcomes Study Short-Form Survey ( Medical Outcomes Trust , Boston , MA ) , which consists of 36 questions . MEASUREMENTS AND MAIN RESULTS Patients who received hydrocortisone during septic shock had a significantly lower incidence of PTSD than patients who received st and ard treatment only ( 5 of 27 vs. 16 of 27 ; p = .01 ) and had significantly higher scores on the mental health index of the Medical Outcomes Study Short-Form health-related quality -of-life question naire ( 68 vs. 44 points ; p = .009 ) . CONCLUSIONS Data from this study support the hypothesis that the administration of stress doses of hydrocortisone in doses equivalent to the maximal endocrine secretion rate during septic shock reduces the incidence of PTSD and improves emotional well-being in survivors . This hypothesis should be tested in a prospect i ve r and omized trial Context Uncovering heterogeneities in the progression of early PTSD symptoms can improve our underst and ing of the disorder 's pathogenesis and prophylaxis . Objectives To describe discrete symptom trajectories and examine their relevance for preventive interventions . Design Latent Growth Mixture Modeling ( LGMM ) of data from a r and omized controlled study of early treatment . LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data . Setting Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity . Participants Adult survivors of potentially traumatic events consecutively admitted to the hospital 's emergency department ( ED ) were assessed ten days and one- , five- , nine- and fifteen months after ED admission . Participants with data at ten days and at least two additional assessment s ( n = 957 ) were included ; 125 received cognitive behavioral therapy ( CBT ) between one and nine months . Approach We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters . CBT consisted of 12 weekly sessions of either cognitive therapy ( n = 41 ) or prolonged exposure ( PE , n = 49 ) , starting 29.8±5.7 days after ED admission , or delayed PE ( n = 35 ) starting at 151.8±42.4 days . CBT effectively reduced PTSD symptoms in the entire sample . Main Outcome Measure Latent trajectories of PTSD symptoms ; effects of CBT on these trajectories . Results Three trajectories were identified : Rapid Remitting ( rapid decrease in symptoms from 1- to 5-months ; 56 % of the sample ) , Slow Remitting ( progressive decrease in symptoms over 15 months ; 27 % ) and Non-Remitting ( persistently elevated symptoms ; 17 % ) . CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes . Conclusions The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are central ly relevant to underst and ing the disorder and preventing its occurrence . Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables BACKGROUND Exposure to intense physical and psychological stress during septic shock can result in posttraumatic stress disorder in survivors . Patients with chronic posttraumatic stress disorder often show sustained reductions in serum cortisol concentration . This investigation examines whether increasing serum cortisol levels with hydrocortisone treatment during septic shock reduces the incidence of posttraumatic stress disorder in survivors . METHODS Patients ( n = 20 ) were recruited from a prospect i ve , r and omized double-blind study on the hemodynamic effects of hydrocortisone during septic shock . Eleven patients had received placebo and nine  stress doses of hydrocortisone . Posttraumatic stress disorder was diagnosed 31 months ( median ) after intensive care unit discharge using SCID-IV ( DSM-IV- criteria ) . Furthermore , the number of categories of traumatic memory from ICU treatment was determined in both groups at that time . RESULTS Only one of nine patients from the hydrocortisone group developed posttraumatic stress disorder , compared with seven of 11 patients in the placebo group ( p = .02 ) . There was no significant difference with regard to the number of categories of traumatic memory between the hydrocortisone and placebo groups . CONCLUSIONS The administration of hydrocortisone during septic shock in a dosage similar to the endogenous maximal production rate was associated with a lower incidence of posttraumatic stress disorder in long-term survivors , which seems to be independent of the number of categories of traumatic memory Abstract Background : Endocannabinoids ( ECs ) are rapidly acting immune-modulatory lipid-signaling molecules that are important for adaptation to stressful and aversive situations . They are known to interact with glucocorticoids and other stress-responsive systems . Maladaptation to acute or chronic stress represents a major risk factor for the development of psychiatric disorders . In the present study , we administered stress doses of hydrocortisone in a prospect i ve , r and omized , placebo-controlled double-blind study in patients undergoing cardiac surgery ( CS ) to examine the relationship between the use of glucocorticoids , plasma EC levels , and the occurrence of early postoperative cognitive dysfunction ( delirium ) and of later development of depression . Methods : We determined plasma levels of the ECs an and amide and 2-arachidonoylglycerol ( 2-AG ) in CS patients of the hydrocortisone ( n=56 ) and the placebo group ( n=55 ) preoperatively , at postoperative day ( POD ) 1 , at intensive care unit discharge , and at 6 months after CS ( n=68 ) . Postoperative delirium was diagnosed according to Diagnostic and Statistical Manual of the American Psychiatric Association IVth Edition ( DSM-IV ) criteria , and depression was determined by vali date d question naires and a st and ardized psychological interview ( Structured Clinical Interview for DSM-IV ) . Results : Stress doses of hydrocortisone did not affect plasma EC levels and the occurrence of delirium or depression . However , patients who developed delirium on POD 1 had significantly lower 
    Output:
    
There is moderate quality evidence for the efficacy of hydrocortisone for the prevention of PTSD development in adults .
We found no evidence to support the efficacy of propranolol , escitalopram , temazepam and gabapentin in preventing PTSD onset .