Patients with posttraumatic stress disorder (PTSD) who fail to respond to established treatments are at risk for chronic disability and distress. Although treatment-resistant PTSD (TR-PTSD) is a common clinical problem, there is currently no standard method for evaluating previous treatment outcomes. Development of a tool that could quantify the degree of resistance to previously provided treatments would inform research in patients with PTSD. We conducted a systematic review of PTSD treatment trials to identify medication and psychotherapy interventions proven to be efficacious for PTSD. We then developed a semi-structured clinician interview called the Emory Treatment Resistance Interview for PTSD (E-TRIP). The E-TRIP includes clinician-administered questions to assess the adequacy and benefit derived from past treatment trials. For each adequately delivered treatment to which the patient failed to respond, a score is assigned depending on the strength of evidence supporting the treatment’s efficacy. The E-TRIP provides a comprehensive assessment of prior PTSD treatments that should prove valuable for researchers studying TR-PTSD and evaluating the efficacy of new treatments for patients with PTSD. The E-TRIP is not intended to guide treatment; rather, the tool quantifies the level of treatment resistance in patients with PTSD in order to standardize TR-PTSD in the research domain.

ObjectiveThis study analyzed predictors of post-traumatic stress disorder (PTSD) in civilian trauma victims to assess how peritraumatic dissociation (PD) relates to PTSD symptom development. We examined PD and PTSD symptoms from a prior trauma simultaneously to better understand the extent to which past and current reactions to a trauma can predict the development of PTSD for a current trauma.MethodsParticipants (N=48) were recruited from the emergency department (ED) of a large, southeastern hospital and assessed immediately after a trauma and again at 4 weeks and 12 weeks post-trauma. We used both self-report and interviewer-based questionnaires to assess PD and PTSD symptoms for prior and current trauma.ResultsA hierarchical linear regression revealed that at 4-week follow up, when controlling for several demographic variables and trauma type, a model including both PD and PTSD symptoms from a prior trauma significantly predicted PTSD outcome (F(47)= 3.70, p=0.00), with PD and prior PTSD symptoms significantly contributing 17% and 9% of variance respectively. At 12 weeks, PTSD symptoms from prior trauma (β=0.094, p=0.538) and PD (β=−0.017, p=0.909) did not account for a significant proportion of the variance in PTSD for the enrolling trauma.ConclusionPrior and current reactions to trauma are both important factors in predicting the development of PTSD symptoms to a current trauma. The more immediate measurement of PD during presentation to the ED may explain the strength of its relationship to PTSD symptom development. Furthermore, our findings support the use of PTSD symptoms of a past trauma, as opposed to trauma frequency, as a predictor of PTSD from a subsequent trauma. Methodological limitations and future directions are discussed.

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