Consequently, the question arises of whether hydrocortisone administration would be useful if not administered right after the exposure (in the “golden hours”). When the same dose of Cortisol was administered 14 days after the stressor and 1 hour after presenting a reminder, the results were strikingly different. Cortisol given not in the “golden hours” was totally ineffective in reducing the “anxiety

index.” The current lack of prospective studies following the Inhibitors,research,lifescience,medical lead of animal studies regarding the potential utility for early administration of Cortisol spurred us to initiate a pilot study to examine this.33 Three major points were raised. The first was whether Inhibitors,research,lifescience,medical psychiatry has a “window of opportunity” for treatment as in other medical fields (ie, stroke or myocardial infarction). The second was whether it would be possible to reach people within a short time after the trauma and to give them the

treatment in a timely fashion. The third question is whether a single medium to high dose of IV hydrocortisone (1 00 to 120 mg) would alter the trajectory of PTSD. In this study, Inhibitors,research,lifescience,medical the window of opportunity was limited to the first 6 hours after the exposure, and consequently this was done in the emergency room of a general hospital. Patients who had a higher risk of developing PTSD were selected, in order to have an enriched sample. To achieve this, the patients selected were those fulfilling criteria A, 2 of the symptoms in criteria B, 3 Inhibitors,research,lifescience,medical out of 4 of criteria C, D, E, and F, and meeting criterion H of the ASD criteria set out in DSM-IV.1 Twenty-five patients were

recruited from the emergency room; 20 after traffic accidents and 5 following other civilian events. They were randomly assigned to treatment with IV hydrocortisone (100 to 140 mg) (n=15) or selleck chemical placebo (n=10).The patients were followed up by telephone the day after the treatment, and then at 2 weeks, 1 month, and 3 months, with a personal interview including the Clinician Inhibitors,research,lifescience,medical Administered PTSD Scale (CAPS). Out of the 25 patients, 19 completed 2 weeks, 15 completed 1 month, and 17 completed the 3-month followup. The results of this preliminary study suggest that Cortisol was effective in reducing both acute stress disorder (20% in the Cortisol new group vs 66.7% in the placebo condition) as well as rates of PTSD (12.5% vs 37.5% at 1month (ns), and 0% vs 37.5% at 3-month follow-up). This is shown in Figure 6. Figure 6. Rates of acute stress disorder/post-traumatic stress disorder after early administration of cortisol/placebo. The results reflect both the utility of the enriched sample concept, ie, in the placebo group, 37.5% had indeed developed PTSD at 1- and 3-month follow up, and it also points out the effect of early intervention with hydrocortisone, as only 12.5% at 1 -month and none at 3month follow-up presented with PTSD.