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Effects of peritraumatic ketamine medication on early and sustained posttraumatic stress symptoms in moderately injured accident victims

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Rationale: Ketamine, an N-methyl-D-aspartate receptor antagonist, produces transient dissociative and psychotic states in healthy humans that resemble symp- toms shown by subjects with acute and chronic posttrau- matic stress disorder (PTSD). Since ketamine is widely used as an analgesic and sedative in emergency care, it might be one factor triggering, modulating, or exacerbat- ing PTSD in accident victims when given in the acute trauma phase. Objectives: The purpose of the present study was to determine whether the peritraumatic administration of ketamine affects acute and sustained PTSD symptoms in accident victims. Methods: A sample of 56 moderate- ly injured accident victims was screened retrospectively for acute (Peritraumatic Dissociative Experiences Ques- tionnaire; Acute Stress Disorder Scale) and for current PTSD symptoms (Impact of Event Scale) approximately 1 year postaccident. All subjects had received a single or fractionated dose of either racemic ketamine (n=17), (S)- ketamine (n=12), or opioids (n=27) during emergency am- bulance transportation. Results: Retrospectively assessed acute symptomatology was strongly increased in (S)-keta- mine subjects in terms of dissociation, reexperiencing, and avoidance, and slightly heightened in racemic ketamines. Current PTSDsymptoms were substantially elevated in (S)- ketamine subjects, while there was no difference observed between opioids and racemic ketamines. Medication groups did not differ in regard to demographic variables, previous or postaccidental traumatic events, time between accident and investigation, and injury severity. Conclusions: The data provide first evidence for a modulating effect of a single-dose ketamine on the severity and duration of post- traumatic stress symptoms in accident victims.

Schönenberg, M., Reichwald, U., Domes, G., Badke, A., & Hautzinger, M. (2005). Effects of peritraumatic ketamine medication on early and sustained posttraumatic stress symptoms in moderately injured accident victims. Psychopharmacology, 182(3), 420-425.
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