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Why does exposure-based therapy fail in some individuals with obsessive-compulsive disorder? 为什么暴露疗法在某些强迫症患者身上会失败?
IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-14 DOI: 10.1080/14737175.2024.2365949
Benedikt Reuter, Annemarie Miano, Josepha Wassermann, Björn Elsner
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引用次数: 0
An overview of the currently available and emerging long-acting formulations of risperidone for schizophrenia and bipolar disorder. 利培酮治疗精神分裂症和双相情感障碍的现有和新兴长效制剂概述。
IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-23 DOI: 10.1080/14737175.2024.2370349
Justin Faden, Camila Ramirez, Vanessa Martinez, Leslie Citrome

Introduction: Long-acting injectable (LAI) antipsychotic medications can help improve treatment adherence in patients with schizophrenia and bipolar disorder. Despite this, they are underutilized. In 2003, intramuscular risperidone became the first available LAI atypical antipsychotic medication, and since then, a number of competing long-acting risperidone formulations have been brought to market, with additional options under active development. These include intramuscular, subcutaneous, long-acting oral, and implantable formulations.

Areas covered: This review summarizes currently available and emerging long-acting risperidone formulations, including efficacy and safety data, and practical considerations aimed to help prescribers distinguish one formulation from another.

Expert opinion: There is an expanding number of currently available LAI antipsychotic medications giving patients and providers an opportunity to personalize and individualize care. Rates of adherence to treatment in patients with schizophrenia and bipolar disorder are low, and individualizing care can help improve this. The risperidone LAI treatment landscape includes five options approved by the U.S. Food and Drug Administration, with others under clinical development. These options differ in regard to mode of administration, approved indications, available dose strengths, injection intervals, needle size, injection volume, storage, and other variables. Prescribers should be familiar with these differing options to help patients find the best fit for their individual needs.

简介:长效注射(LAI)抗精神病药物有助于提高精神分裂症和双相情感障碍患者的治疗依从性。尽管如此,这些药物仍未得到充分利用。2003 年,肌肉注射利培酮成为第一种上市的 LAI 非典型抗精神病药物,从那时起,许多与之竞争的长效利培酮制剂已投放市场,还有更多选择正在积极开发中。这些制剂包括肌肉注射、皮下注射、长效口服和植入制剂:本综述总结了现有的和新出现的长效利培酮制剂,包括疗效和安全性数据,以及旨在帮助处方者区分不同制剂的实际注意事项:目前可供选择的LAI抗精神病药物越来越多,为患者和医疗服务提供者提供了个性化治疗的机会。精神分裂症和双相情感障碍患者坚持治疗的比例较低,而个性化护理有助于改善这一状况。利培酮 LAI 治疗方案包括五种已获美国食品药品管理局批准的方案,其他方案正在临床开发中。这些方案在给药方式、批准适应症、可用剂量强度、注射间隔、针头大小、注射量、储存和其他变量方面各不相同。处方医生应熟悉这些不同的选择,以帮助患者找到最适合其个人需求的药物。
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引用次数: 0
Distinguishing essential tremor from Parkinson's disease: clinical and experimental tools. 区分本质性震颤和帕金森病:临床和实验工具。
IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-17 DOI: 10.1080/14737175.2024.2372339
Luca Angelini, Giulia Paparella, Matteo Bologna

Introduction: Essential tremor (ET) and Parkinson's disease (PD) are the most common causes of tremor and the most prevalent movement disorders, with overlapping clinical features that can lead to diagnostic challenges, especially in the early stages.

Areas covered: In the present paper, the authors review the clinical and experimental studies and emphasized the major aspects to differentiate between ET and PD, with particular attention to cardinal phenomenological features of these two conditions. Ancillary and experimental techniques, including neurophysiology, neuroimaging, fluid biomarker evaluation, and innovative methods, are also discussed for their role in differential diagnosis between ET and PD. Special attention is given to investigations and tools applicable in the early stages of the diseases, when the differential diagnosis between the two conditions is more challenging. Furthermore, the authors discuss knowledge gaps and unsolved issues in the field.

Expert opinion: Distinguishing ET and PD is crucial for prognostic purposes and appropriate treatment. Additionally, accurate diagnosis is critical for optimizing clinical and experimental research on pathophysiology and innovative therapies. In a few years, integrated technologies could enable accurate, reliable diagnosis from early disease stages or prodromal stages in at-risk populations, but further research combining different techniques is needed.

导言:本质性震颤(ET)和帕金森病(PD)是导致震颤的最常见病因,也是最常见的运动障碍,它们的临床特征相互重叠,可能导致诊断难题,尤其是在早期阶段:在本文中,作者回顾了临床和实验研究,强调了区分 ET 和 PD 的主要方面,尤其关注这两种疾病的主要现象特征。本文还讨论了辅助和实验技术,包括神经生理学、神经影像学、体液生物标志物评估和创新方法,以了解它们在 ET 和 PD 鉴别诊断中的作用。作者特别关注适用于疾病早期阶段的检查和工具,因为此时两种疾病的鉴别诊断更具挑战性。此外,作者还讨论了该领域的知识空白和未解决的问题:区分 ET 和 PD 对于预后和适当治疗至关重要。此外,准确诊断对于优化病理生理学和创新疗法的临床和实验研究也至关重要。几年后,综合技术将能对高危人群的早期疾病或前驱阶段进行准确、可靠的诊断,但还需要结合不同技术开展进一步的研究。
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引用次数: 0
Mindfulness as a therapeutic option for obsessive-compulsive disorder. 将正念作为强迫症的一种治疗方法。
IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-18 DOI: 10.1080/14737175.2024.2365945
Andreas Reis, Marlon Westhoff, Hicham Quintarelli, Stefan G Hofmann

Introduction: Obsessive-compulsive disorder (OCD) is a prevalent mental health issue characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that can cause significant life impairment. Despite cognitive-behavioral therapy (CBT) being the most effective treatment, some individuals experience insufficient symptom reduction or relapse.

Areas covered: This special report explores the potential of mindfulness-based interventions as complementary treatments for OCD, examining the specific techniques used and their practical application. In the initial section, the authors examine ten randomized control trial studies included in the meta-analysis conducted by Chien et al. (2022), demonstrating the effectiveness of mindfulness interventions. The authors focus on elucidating the specific mindfulness techniques used in these studies. Then, the authors discuss the integration of these mindfulness strategies into CBT, focusing on enhancing emotional regulation, cognitive flexibility, and acceptance of intrusive thoughts.

Expert opinion: While mindful based interventions (MBIs) show promise as adjunctive treatments for OCD, variability in OCD symptoms and treatment responses necessitate individualized therapeutic approaches. Further research is required to refine mindfulness-based techniques and optimize their effectiveness. Incorporating MBIs into standard CBT protocols may improve outcomes for patients with persistent OCD symptoms.

简介强迫症(OCD)是一种普遍存在的精神健康问题,其特征是干扰性思维(强迫症)和重复性行为(强迫症),可导致严重的生活障碍。尽管认知行为疗法(CBT)是最有效的治疗方法,但有些患者的症状减轻不足或复发:本特别报告探讨了正念干预作为强迫症辅助疗法的潜力,研究了所使用的具体技术及其实际应用。在第一部分,作者研究了 Chien 等人(2022 年)进行的荟萃分析中包含的十项随机对照试验研究,这些研究证明了正念干预的有效性。作者重点阐明了这些研究中使用的具体正念技术。然后,作者讨论了将这些正念策略整合到 CBT 中的问题,重点是加强情绪调节、认知灵活性以及对侵入性想法的接受:虽然正念干预(MBIs)有望成为强迫症的辅助治疗方法,但强迫症症状和治疗反应的多变性要求采用个性化的治疗方法。需要进一步研究以完善正念技术并优化其有效性。将正念疗法纳入标准的 CBT 方案可改善强迫症持续症状患者的治疗效果。
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引用次数: 0
An update on pharmacotherapy for trigeminal neuralgia. 三叉神经痛药物疗法的最新进展。
IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-13 DOI: 10.1080/14737175.2024.2365946
Joseph V Pergolizzi, Jo Ann LeQuang, Salah N El-Tallawy, Morgan Wagner, Rania S Ahmed, Giustino Varrassi

Introduction: Trigeminal neuralgia is a rare condition that can be effectively treated by carbamazepine or oxcarbazepine but these older drugs are associated with dose-dependent and potentially treatment-limiting adverse effects. Third-generation anticonvulsants, new calcitonin gene-related peptide blockers for migraine, and older drugs such as ketamine and cannabinoids may be promising adjuvants or monotherapeutic options.

Areas covered: The new drugs, their presumed mechanisms of action, safety and efficacy are discussed herein. There is a paucity of robust clinical evidence in support of these drugs for trigeminal neuralgia. New migraine agents are considered as well although migraines and trigeminal neuralgia are distinct, albeit similar, conditions. No new drugs have been released to market in recent years with the specific indication of trigeminal neuralgia.

Expert opinion: In real-world clinical practice, about half of trigeminal neuralgia patients take more than one agent for prevention and combination therapy may be the optimal approach. Combination therapy might allow for lower doses of carbamazepine or oxcarbazepine, thus reducing the number and severity of potential adverse events but the potential for pharmacokinetic drug-drug interactions must be considered. Drug therapy for trigeminal neuralgia involves acute or abortive treatments, often administered in hospital versus long-term preventive therapy, usually involving oral agents.

简介三叉神经痛是一种罕见的疾病,卡马西平或奥卡西平可有效治疗这种疾病,但这些老药会产生剂量依赖性不良反应,并可能限制治疗效果。第三代抗惊厥药、治疗偏头痛的新型降钙素基因相关肽阻断剂以及氯胺酮和大麻素等老药可能是有前景的辅助药物或单一治疗选择:本文讨论了新药及其假定的作用机制、安全性和疗效。支持这些药物治疗三叉神经痛的有力临床证据还很少。虽然偏头痛和三叉神经痛是两种不同的疾病,但两者具有相似性,本文也考虑了新的偏头痛药物。近年来,还没有针对三叉神经痛这一特定适应症的新药上市:在实际临床实践中,约有一半的三叉神经痛患者服用一种以上的药物进行预防,联合疗法可能是最佳方法。联合疗法可以降低卡马西平或奥卡西平的剂量,从而减少潜在不良反应的数量和严重程度,但必须考虑药代动力学药物间相互作用的可能性。三叉神经痛的药物治疗包括急性或终止治疗(通常在医院进行)和长期预防治疗(通常使用口服药物)。
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引用次数: 0
Current nonstimulant medications for adults with attention-deficit/hyperactivity disorder. 目前治疗成人注意力缺陷/多动症的非兴奋剂药物。
IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-25 DOI: 10.1080/14737175.2024.2370346
Giulio Emilio Brancati, Anna Magnesa, Donatella Acierno, Marco Carli, Ugo De Rosa, Alessandro Froli, Samuele Gemignani, Lisa Ventura, Francesco Weiss, Giulio Perugi

Introduction: Stimulants, including methylphenidate and amphetamines, are the first-line pharmacological treatment of ADHD in adults. However, in patients who do not respond or poorly tolerate stimulants, non-stimulant medications are usually recommended.

Areas covered: The authors provide a narrative review of the literature on non-stimulant treatments for adult ADHD, including controlled and observational clinical studies conducted on adult samples. Atomoxetine has been extensively studied and showed significant efficacy in treating adult ADHD. Issues related to dosing, treatment duration, safety, and use in the case of psychiatric comorbidity are summarized. Among other compounds indicated for ADHD in adults, antidepressants sharing at least a noradrenergic or dopaminergic component, including tricyclic compounds, bupropion, and viloxazine, have shown demonstratable efficacy. Evidence is also available for antihypertensives, particularly guanfacine, as well as memantine, metadoxine, and mood stabilizers, while negative findings have emerged for galantamine, antipsychotics, and cannabinoids.

Expert opinion: While according to clinical guidelines, atomoxetine may serve as the only second-line option in adults with ADHD, several other nonstimulant compounds may be effectively used in order to personalize treatment based on comorbid conditions and ADHD features. Nevertheless, further research is needed to identify and test more personalized treatment strategies for adults with ADHD.

导言:兴奋剂(包括哌醋甲酯和苯丙胺)是治疗成人多动症的一线药物。然而,对于对兴奋剂无反应或耐受性差的患者,通常建议使用非兴奋剂药物:作者对成人多动症的非刺激剂治疗文献进行了叙述性综述,包括针对成人样本进行的对照和观察性临床研究。阿托莫西汀已被广泛研究,并显示出治疗成人多动症的显著疗效。本文总结了与剂量、疗程、安全性以及在精神疾病合并症情况下的使用有关的问题。在其他用于治疗成人多动症的化合物中,至少含有去甲肾上腺素能或多巴胺能成分的抗抑郁药,包括三环化合物、安非他明和维洛沙嗪,都显示出明显的疗效。降压药(尤其是胍法辛)以及美金刚、美他多辛和情绪稳定剂也提供了证据,而加兰他敏、抗精神病药和大麻素则出现了负面研究结果:虽然根据临床指南,阿托西汀可作为成人多动症患者的唯一二线选择,但其他几种非兴奋剂化合物也可有效使用,以便根据合并症和多动症特征进行个性化治疗。不过,还需要进一步研究,以确定和测试针对成人多动症患者的更多个性化治疗策略。
{"title":"Current nonstimulant medications for adults with attention-deficit/hyperactivity disorder.","authors":"Giulio Emilio Brancati, Anna Magnesa, Donatella Acierno, Marco Carli, Ugo De Rosa, Alessandro Froli, Samuele Gemignani, Lisa Ventura, Francesco Weiss, Giulio Perugi","doi":"10.1080/14737175.2024.2370346","DOIUrl":"10.1080/14737175.2024.2370346","url":null,"abstract":"<p><strong>Introduction: </strong>Stimulants, including methylphenidate and amphetamines, are the first-line pharmacological treatment of ADHD in adults. However, in patients who do not respond or poorly tolerate stimulants, non-stimulant medications are usually recommended.</p><p><strong>Areas covered: </strong>The authors provide a narrative review of the literature on non-stimulant treatments for adult ADHD, including controlled and observational clinical studies conducted on adult samples. Atomoxetine has been extensively studied and showed significant efficacy in treating adult ADHD. Issues related to dosing, treatment duration, safety, and use in the case of psychiatric comorbidity are summarized. Among other compounds indicated for ADHD in adults, antidepressants sharing at least a noradrenergic or dopaminergic component, including tricyclic compounds, bupropion, and viloxazine, have shown demonstratable efficacy. Evidence is also available for antihypertensives, particularly guanfacine, as well as memantine, metadoxine, and mood stabilizers, while negative findings have emerged for galantamine, antipsychotics, and cannabinoids.</p><p><strong>Expert opinion: </strong>While according to clinical guidelines, atomoxetine may serve as the only second-line option in adults with ADHD, several other nonstimulant compounds may be effectively used in order to personalize treatment based on comorbid conditions and ADHD features. Nevertheless, further research is needed to identify and test more personalized treatment strategies for adults with ADHD.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"743-759"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141445915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preferences and perceptions of 617 migraine patients on acute and preventive migraine treatment attributes and clinical trial endpoints. 617 名偏头痛患者对急性和预防性偏头痛治疗属性及临床试验终点的偏好和看法。
IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-13 DOI: 10.1080/14737175.2024.2365312
Michail Vikelis, Dimitrios Rikos, Andreas A Argyriou, Pinelopi Papachristou, Dimitrios Rallis, Theodoros Karapanayiotides, Andreas Galanopoulos, Konstantinos Spingos, Nikolaos Dimisianos, Emmanouil Giakoumakis, Periklis Zavridis, Konstantinos Notas, George S Vlachos, Panagiotis Soldatos, Konstantinos Bilias, Georgia Xiromerisiou, Jobst Rudolf, Emmanouil V Dermitzakis, Alan M Rapoport

Background: To identify the preferences and perceptions of migraine patients for acute and preventive treatment options and to investigate which treatment outcomes are the most important.

Design and methods: The authors performed a choice-format survey in a cohort of migraine patients from Greece and Cyprus. A self-administered questionnaire developed in collaboration with the Greek Society of Migraine Patients was used.

Results: Questionnaires were collected from 617 migraine patients. Efficacy was preferred over safety as the single most important parameter, both in acute and preventive treatment. When analyzing single outcomes, patients prioritized a complete pain remission at 1-hour post-dose for acute therapies. Regarding migraine prevention, a 75% reduction in frequency, intensity of pain, accompanying symptoms and acute medication intake were considered as most important. Conversely, outcomes routinely used in clinical trials, namely complete or partial pain remission at 2-hours post-dose for acute treatment and 50% or 30% reduction in migraine frequency for prevention, were not deemed particularly relevant. Tablet formulation was mostly preferred, both in acute and preventive treatment. Conclusion: Listening to patients' needs may add a piece of the puzzle that is generally missing in clinical practice and often explains the lack of adherence in both acute and preventative anti-migraine therapies.

背景:目的:确定偏头痛患者对急性和预防性治疗方案的偏好和看法,并调查哪些治疗结果是最重要的:作者对希腊和塞浦路斯的偏头痛患者进行了一次选择形式的调查。采用了与希腊偏头痛患者协会合作开发的自填式问卷:结果:共收集了 617 名偏头痛患者的问卷。无论是急性治疗还是预防性治疗,疗效都比安全性更重要。在分析单一结果时,患者优先考虑急性疗法用药后 1 小时疼痛完全缓解。在偏头痛预防方面,患者认为最重要的是频率、疼痛强度、伴随症状和急性用药量减少 75%。相反,临床试验中常规使用的结果,即急性治疗用药后 2 小时疼痛完全缓解或部分缓解,以及预防用药后偏头痛频率减少 50% 或 30%,被认为并不特别重要。无论是急性治疗还是预防性治疗,片剂都是首选。结论倾听患者的需求可能会为临床实践中普遍缺失的难题增添一环,这往往也是急性和预防性抗偏头痛疗法缺乏依从性的原因所在。
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引用次数: 0
An overview of the efficacy and safety of brexpiprazole for the treatment of schizophrenia in adolescents. 概述布来匹唑治疗青少年精神分裂症的疗效和安全性。
IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-05 DOI: 10.1080/14737175.2024.2367695
Chesika J Crump, Hagar Abuelazm, Kirolos Ibrahim, Shaishav Shah, Rif S El-Mallakh

Introduction: The onset of psychotic symptoms occurs prior to age 19 in 39% of the patients with schizophrenia. There are limited approved treatment options for adolescents with schizophrenia. Brexpiprazole was approved by the United States Food and Drug Administration (FDA) for treatment of schizophrenia in adolescents in 2022.

Areas covered: Extrapolation of adult data to youth and use of pharmacologic modeling coupled with open long-term safety data were used by the FDA to approve brexpiprazole for adolescent schizophrenia. They were all reviewed herein.

Expert opinion: D2 receptor partial agonist antipsychotic agents are preferred in the early phase of treatment of psychotic disorders. Approval of brexpiprazole in adolescent schizophrenia provides an additional option. Brexpiprazole was approved by the FDA on the basis of extrapolation of adult data without controlled trials in adolescents. This reduces placebo exposure in young people. Two previous agents (asenapine and ziprasidone) approved for adult schizophrenia failed to separate from placebo in adolescent schizophrenia studies; this partially undermines the process of extrapolation. For brexpiprazole, the paucity of data in adolescents relegates it to a second-line agent. More research on brexpiprazole is needed to delineate its relative role in the management of adolescent schizophrenia.

导言:39%的精神分裂症患者在 19 岁之前就会出现精神症状。目前,针对青少年精神分裂症患者的获批治疗方案十分有限。美国食品和药物管理局(FDA)于2022年批准布雷哌唑用于治疗青少年精神分裂症:美国食品和药物管理局通过将成人数据外推至青少年、使用药理学模型以及公开的长期安全性数据,批准布雷克哌唑用于治疗青少年精神分裂症。本文对这些内容进行了综述:专家意见:D2受体部分激动剂类抗精神病药物是治疗精神障碍早期阶段的首选药物。在青少年精神分裂症的治疗中,布雷克吡唑的获批提供了另一种选择。美国食品和药物管理局批准布雷克哌唑的依据是对成人数据的推断,而没有在青少年中进行对照试验。这减少了青少年接触安慰剂的机会。之前批准用于成人精神分裂症的两种药物(阿塞那平和齐拉西酮)在青少年精神分裂症研究中未能与安慰剂区分开来;这在一定程度上破坏了外推过程。对于布来哌唑来说,青少年研究数据的匮乏使其只能作为二线药物使用。需要对布来哌唑进行更多的研究,以确定其在治疗青少年精神分裂症中的相对作用。
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引用次数: 0
Rethinking the role of trazodone in the different depressive dimensions. 重新思考曲唑酮在不同抑郁维度中的作用。
IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-17 DOI: 10.1080/14737175.2024.2363843
Isabella Berardelli, Andrea Amerio, Francesco Bartoli, Alessandro Cuomo, Giacomo Deste, Laura Orsolini, Gaia Sampogna, Maurizio Pompili

Introduction: The efficacy of trazodone for several psychopathologic dimensions of depression has been shown in the literature. Trazodone has been widely used in some clinical contexts (e.g. for insomnia and depression in the elderly). However, the role of trazodone in several aspects of depression is not well known.

Area covered: Eight experts from academic and medical centers across Italy met to identify the difficulties and barriers faced in daily clinical practice in the assessment and management of major depressive disorder and how the use of trazodone could address some unmet needs. The objective of the expert meetings and the present document was to increase knowledge of particular areas of treatment with trazodone.

Expert opinion: Evidence of the role of trazodone in patients affected by major depressive disorder with anxiety symptoms, insomnia, agitation, cognitive deficits, alcohol use disorders, physical comorbidities, and suicide risk has been identified, showing the effectiveness of trazodone in different presentations of major depressive disorder. The main characteristics of patients with depression for whom trazodone seems to be most effective have been identified, providing clinicians with information on possible uses of this drug in such population of patients.

简介文献显示,曲唑酮对抑郁症的几种精神病理学方面具有疗效。曲唑酮已被广泛应用于某些临床领域(如治疗老年人失眠症和抑郁症)。然而,曲唑酮在抑郁症的多个方面所起的作用并不为人所知:来自意大利各地学术和医疗中心的八位专家举行了会议,以确定日常临床实践中在评估和管理重度抑郁障碍方面所面临的困难和障碍,以及曲唑酮的使用可如何满足一些未得到满足的需求。专家会议和本文件旨在增加对曲唑酮治疗特定领域的了解:专家意见:有证据表明曲唑酮对伴有焦虑症状、失眠、躁动、认知障碍、酒精使用障碍、躯体合并症和自杀风险的重度抑郁障碍患者的作用,显示曲唑酮对重度抑郁障碍的不同表现有效。研究还确定了曲唑酮似乎对其最有效的抑郁症患者的主要特征,为临床医生提供了在此类患者中使用该药物的可能信息。
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引用次数: 0
Challenges in the treatment of dysthymia: a narrative review. 癔症治疗面临的挑战:叙述性综述。
IF 4.3 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-05-28 DOI: 10.1080/14737175.2024.2360671
Livia Mathias, Laiana A Quagliato, Mauro G Carta, Antonio E Nardi, Elie Cheniaux

Introduction: Despite its milder severity, the chronic nature of dysthymia leads to significant impairments and functional limitations. The treatment of dysthymia has received considerably less research attention compared to major depressive disorder (MDD).

Areas covered: The authors have conducted a comprehensive review on the treatment of dysthymia. Their primary objective was to identify therapeutic options that have demonstrated genuine efficacy. To do this, they searched the PubMed database, without any time restrictions, to retrieve original studies. The samples were exclusively comprised individuals diagnosed with dysthymia according to the diagnostic criteria outlined in DSM-III, DSM-III-R, DSM-IV, or DSM-IV-TR.

Expert opinion: Within the realm of dysthymia treatment, several antidepressants, including imipramine, sertraline, paroxetine, minaprine, moclobemide, and amineptine, in addition to the antipsychotic agent amisulpride, have demonstrated superiority over placebo. In certain studies, psychotherapeutic interventions did not distinguish themselves significantly from pharmacological treatments and failed to exhibit greater efficacy than a placebo. However, these findings remain inconclusive due to the limited number of studies and substantial methodological limitations prevalent in a significant proportion of them. Limitations include factors like small sample sizes, the absence of placebo comparisons, and a lack of study blinding.

简介尽管癔症的严重程度较轻,但其慢性性质会导致严重的损伤和功能限制。与重度抑郁障碍(MDD)相比,癔症的治疗受到的研究关注要少得多:作者对癔症的治疗进行了全面的综述。他们的主要目的是找出真正有效的治疗方案。为此,他们在没有任何时间限制的情况下搜索了PubMed数据库,以检索原始研究。样本完全由根据 DSM-III、DSM-III-R、DSM-IV 或 DSM-IV-TR 诊断标准被诊断为癔症的患者组成:在癔症治疗领域,包括丙咪嗪、舍曲林、帕罗西汀、米那普林、吗氯贝胺和氨平汀在内的几种抗抑郁剂,以及抗精神病药物阿米舒必利,都已证明优于安慰剂。在某些研究中,心理治疗干预与药物治疗没有明显区别,也没有显示出比安慰剂更强的疗效。然而,由于研究数量有限,且相当一部分研究在方法上存在很大局限性,因此这些研究结果仍无法得出结论。这些局限性包括样本量小、缺乏安慰剂对比以及缺乏研究盲法等因素。
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引用次数: 0
期刊
Expert Review of Neurotherapeutics
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