Posttraumatic Stress Disorder and Neuroprogression in Women Following Sexual Assault: Protocol for a Randomized Clinical Trial Evaluating Allostatic Load and Aging Process Acceleration

Author(s):Show less -

Coimbra, Bruno Messina ^{[1, 2]} ; Yeh, Mary ^{[1, 2]} ; D'Elia, Ana Teresa ^{[1, 2]} ; Maciel, Mariana Rangel ^{[1, 2]} ; Carvalho, Carolina Muniz ^{[3, 1, 4]} ; Milani, Ana Carolina ^{[1, 2]} ; Mozzambani, Adriana ^{[1, 2]} ; Juruena, Mario ^{[5, 6]} ; Belangero, Sintia Iole ^{[3, 1, 4]} ; Jackowski, Andrea Parolin ^{[1, 4]} ; Poyares, Dalva ^[7] ; Mello, Andrea Feijo ^{[1, 2]} ; Mello, Marcelo Feijo ^{[1, 2]}

Affiliation

^[1] Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo - Brazil

^[2] Univ Fed Sao Paulo, Program Res & Care Violence & PTSD, Rua Major Maragliano 241, BR-04017030 Sao Paulo - Brazil

^[3] Univ Fed Sao Paulo, Dept Morphol & Genet, Sao Paulo - Brazil

^[4] Univ Fed Sao Paulo, Lab Integrat Neurosci, Sao Paulo - Brazil

^[5] Kings Coll London, London - England

^[6] South London & Maudsley NHS Fdn Trust, Inst Psychiat Psychol & Neurosci, Biomed Res Ctr, Ctr Affect Disorders, Dept Psychol Med, London - England

^[7] Univ Fed Sao Paulo, Dept Psychobiol, Sao Paulo - Brazil

• Document type: Journal article
• Source: JMIR RESEARCH PROTOCOLS; v. 9, n. 11 NOV 2020.
• Web of Science Citations: 0

Abstract

Background: Posttraumatic stress disorder (PTSD) is a prevalent, chronic, and severe disorder related to traumatic events. Women are disproportionately affected by PTSD than men and are more at risk in the occurrence of sexual assault victimization. Estimates suggest that 50% of women develop PTSD following sexual assault and successful clinical management can be challenging. Growing evidence has implicated neural, immune, and endocrine alterations underpinning PTSD, but only few studies have assessed the evolution of acute PTSD in women. Objective: This study aims to measure whether the onset of PTSD is associated with accelerated aging in women following sexual assault. We hypothesize that the increase of allostatic load caused by PTSD leads to neuroprogression. We will implement a randomized clinical trial to compare responses to treatment with either interpersonal psychotherapy adapted for PTSD (IPT-PTSD) or the selective serotonin reuptake inhibitor sertraline. Methods: We will include women between 18 and 45 years of age, who experienced sexual assault from 1 to 6 months before the initial evaluation, and present with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnosis of PTSD. Baseline evaluation will comprise clinical and psychometric assessments, structural and functional magnetic resonance imaging, neuropsychological testing, polysonmography, evaluation of immune and endocrine parameters, and genetic analyses. Age-matched female healthy controls will be included and subjected to the same evaluation. Patients will be randomized for treatment in 1 of the 2 arms of the study for 14 weeks; follow-up will continue until 1 year after inclusion via treatment as usual. The researchers will collect clinical and laboratory data during periodic clinical assessments up to 1-year follow-up. Results: Data collection started in early 2016 and will be completed by the end of the first semester of 2020. Analyses will be performed soon afterward, followed by the elaboration of several articles. Articles will be submitted in early 2021. This research project has obtained a grant from the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP 2014/12559-5). Conclusions: We expect to provide insight into the consequences of recent sexual assault exposure in women by investigating the degree of neuroprogression developing from an early stage of PTSD. We also expect to provide important evidence on the efficacy of a non-exposure psychotherapy (IPT-PTSD) to mitigate PTSD symptoms in recently sexually assaulted women. Further, we aim to obtain evidence on how treatment outcomes are associated with neuroprogression measures. (AU)

• FAPESP's process: 14/12559-5 - Posttraumatic stress disorder and neuroprogression: new approaches to understand the effects of violence on mental functioning
• Grantee: Marcelo Feijó de Mello
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 15/26473-8 - Search for genetic, epigenetic and molecular markers of post-traumatic stress disorder
• Grantee: Carolina Muniz Felix de Carvalho
• Support Opportunities: Scholarships in Brazil - Doctorate