This is a longitudinal study of patients who are being followed at The Johns Hopkins Burn Center after sustaining severe burns. It will add genetic and neuroendocrine testing to a battery of psychometric, demographic and medical measurements that are currently being collected in patients following severe burn trauma. Genetic methods will include microarray methodology with a 1,536 SNP array that contains all of the SNPs that have been previously evaluated in PTSD, as well as more than 1,000 SNPs associated with genes that have been implicated in stress, substance abuse, and depression. In addition to SNP analyses, we will genotype patients for three candidate genes that have been implicated in PTSD or stress: 5HTTLPR, FKBP5, and NPY. The dexamethasone suppression test at the time of discharge from the burn unit will be employed to evaluate function of the glucocorticoid system and its relationship to subsequent PTSD or genetic polymorphisms. We will explore the potential role and/or relationships between personality features, childhood trauma, alcohol and substance abuse, comorbid psychiatric diagnoses and PTSD. It is hypothesized that one or several of the SNPs included on the microarray and/or candidate genes that are evaluated will interact with psychosocial and environmental variables and will be associated with increased risk for PTSD.
Safety, Meaning, Activation, and Relaxation Training (SMART)
Burns are painful, life-threatening and disfiguring. Severe psychological distress, pain and sleep disturbance are among the most common, enduring, and disabling of secondary complications, but no evidence-based treatments exist for these complex problems in the acute burn-care setting. The current study is a randomized, controlled effectiveness trial comparing a focused cognitive-behavioral therapy program (SMART) to supportive counseling.