Topiramate was effective in improving reexperiencing and avoidance/numbing symptom clusters in patients with PTSD. This study supports the use of anticonvulsants for the improvement of symptoms of PTSD.

Background: violence is a public health major concern, and it is associated with post-traumatic stress disorder and other psychiatric outcomes. Brazil is one of the most violent countries in the world, and has an extreme social inequality. Research on the association between violence and mental health may support public health policy and thus reduce the burden of disease attributable to violence. The main objectives of this project were: to study the association between violence and mental disorders in the Brazilian population; to estimate the prevalence rates of exposure to violence, post-traumatic stress disorder, common metal disorder, and alcohol hazardous use and dependence: and to identify contextual and individual factors, including genetic factors, associated with the outcomes.

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, polysomnography, 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 Fundação de Amparo à Pesquisa do Estado de São 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. Trial Registration Brazilian Clinical Trials Registry RBR-3z474z; http://www.ensaiosclinicos.gov.br/rg/RBR-3z474z/ International Registered Report Identifier (IRRID) DERR1-10.2196/19162

Background : Most posttraumatic stress disorder (PTSD) sleep disturbances reports have been conducted in male combat veteran populations, usually decades after the disorder’s onset. Given the increase in the prevalence of violence against women and the fact that women are at greater risk for developing PTSD, it is critical to examine sleep abnormalities in this population. Objectives : To examine subjective and objective sleep quality in young women with PTSD following sexual assault compared with a control group at baseline and after one year of treatment. Methods : Seventy-four women with PTSD following sexual assault and 64 healthy controls with no history of sexual assault were assessed using the Clinician-Administered PTSD Scale (CAPS-5), the Beck Depression Inventory, the Beck Anxiety Inventory, the Pittsburgh Sleep Quality Index (PSQI), the Modified Fatigue Impact Scale, and the Insomnia Severity Index. Subjects also underwent full in-lab polysomnography. PTSD participants received pharmacological and/or psychological therapy between baseline and one-year follow-up. Results : The PTSD group had significantly higher scores in the clinical and sleep measurements than the control group. Although the PTSD group reported poorer subjective sleep quality than healthy controls, there were few between-group differences in objective sleep. Analysis of the PTSD group at baseline and one-year follow-up showed that the PSQI global score was a significant predictor of PTSD improvement. Conclusions : Sleep quality is impaired in young women with PTSD and may impact long-term treatment responses. Better sleep quality is significantly associated with PTSD improvement, independent of depression and anxiety.

Background: Topiramate might be effective in the treatment of posttraumatic stress disorder (PTSD) because of its antikindling effect and its action in both inhibitory and excitatory neurotransmitters. Open-label studies and few controlled trials have suggested that this anticonvulsant may have therapeutic potential in PTSD. This 12-week randomized, double-blind, placebo-controlled clinical trial will compare the efficacy of topiramate with placebo and study the tolerability of topiramate in the treatment of PTSD.