Post-Traumatic Stress Disorder Clinical Trial
Official title:
Prevention of PostConcussion-Like Symptoms for Patients Presenting at the Emergency Room: A Randomized Controlled Study of Early Single Eye Movement Desensitization and Reprocessing (EMDR) Intervention Versus Usual Care
Millions people, all over the world, are admitted in the Emergency Department after a trauma or simply to receive medical cares. In France, it represents 10 million patients. Probably because of stress associated with the event, 20% will suffer a combination of non-specifics symptoms which persist for many months and with daily life quality impairment. The investigators hypothesize that an early intervention, such as Eye-Movement, Desensitization and Reprocessing (EMDR) could be performed in the ED and could prevent the occurrence of these symptoms.
Emergency department are a privileged service for patients suffering from trauma and
stressful medical conditions. In France, every year 10 million people come or are taken to
the emergency department (ED). Many studies have shown that 10-20% of these trauma patients
develop a non-specific set of symptoms that can persist for several months after ED
assessment. These includes, for example, headache, memory and/or concentration impairment,
stress intolerance, irritability... These symptoms lead to an alteration in the quality of
social, family and professional life, and therefore affect one to two millions people in
France alone.
The association between these symptoms and mild traumatic brain injury (MTBI) has already
been demonstrated. It was defined as post-concussion syndrome (PCS) according to the
DSM-IV-TR. However, several recent studies have shown that these symptoms are not specific to
MTBI but may appear for any type of trauma and event for stressful medical conditions. PCS
seems to appear for events occurring in a stressful environment or in people with
psychological weaknesses. These symptoms will therefore be referred here to
Post-concussion-like symptoms (PCLS). Moreover, PCLS appear to be very similar and sometime
overlap those of the numbing and hyperarousal dimension of the Post Traumatic Stress Disorder
(PTSD).
A recent study, carried out by our team in the ED of Bordeaux University Hospital, showed
that PCLS was associated with a high level of stress at ED discharge, whatever that stress
level at entry.
The Eye-Movement Desensitization and Reprocessing (EMDR) is a recognized psychotherapeutic
approach in the treatment of PTSD and several single-session versions of the protocol have
been proposed : one of them is Recent Traumatic Episode Protocol EMDR (R-TEP EMDR).The
investigators hypothesize that the introduction of an early R-TEP EMDR intervention in
emergencies can reduce the level of stress and thus the occurrence of the PCLS and PTSD
symptoms among a subset of patients screened for their high risk of PCLS.
The study is a two-site open-label two-group randomized controlled trial designed to assess
the efficacy of an early R-TEP EMDR intervention performed in the ED by comparing PCLS and
PTSD symptoms at 3 and 12 months between the two randomization groups: (i) R-TEP EMDR; (ii)
care as usual.
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