Therapeutic Advances in Psychopharmacology最新文献_第3页

Metformin co-commencement at time of antipsychotic initiation for attenuation of weight gain: a systematic review and meta-analysis 在开始服用抗精神病药物时同时服用二甲双胍以减轻体重增加：系统综述和荟萃分析

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-05-30 DOI: 10.1177/20451253241255476

Ou Yu, Mengyao Lu, Terence K. Y. Lai, Margaret Hahn, Sri Mahavir Agarwal, Brian O’Donoghue, Bjørn H. Ebdrup, Dan Siskind

Background:Antipsychotic medications are associated with weight gain and metabolic derangement. However, comprehensive evidence for the efficacy of co-commenced pharmacological treatments to mitigate initial weight gain is limited. Metformin has been shown to be effective in reducing weight among people on antipsychotic medications who are already overweight, but the potential benefits of metformin co-commencement in mitigating antipsychotic-induced weight gain has not been systematically reviewed.Method:We conducted a systematic review of PubMed, EMBASE, PsychInfo, CINAHL, the Cochrane database, and China National Knowledge Infrastructure from inception to 18 November 2023. We undertook a meta-analysis of concomitant commencement of metformin versus placebo for attenuation of weight gain and metabolic syndrome for people with schizophrenia commencing a new antipsychotic.Results:Fourteen studies from Australia, United States, Venezuela, and China with 1126 participants were included. We found that metformin was superior to placebo in terms of attenuating weight gain (−3.12 kg, 95% CI −4.22 to −2.01 kg). Metformin also significantly attenuated derangement of fasting glucose levels, total cholesterol, and total triglyceride levels. Sensitivity analysis on study quality, duration, and antipsychotic agent did not impact the results. Meta-analysis was also conducted on adverse drug reactions (ADR) reported in each study which showed no significant difference in ADR incidence between metformin and placebo groups. Subgroup analysis on antipsychotic-naïve participants and participants switching to new antipsychotic did not impact the results.Conclusion:Metformin led to statistically significant and clinically meaningful attenuation of weight gain as well as attenuation of several other metabolic parameters when commenced concomitantly with antipsychotic medications. Co-commencement of metformin with antipsychotic medications, where tolerated, should be considered in the clinical setting with aim to improve long-term cardiometabolic outcomes for patients with long-term need of antipsychotic treatments.

背景：抗精神病药物与体重增加和代谢紊乱有关。然而，有关联合用药治疗对减轻初期体重增加的疗效的综合证据却很有限。方法：我们对PubMed、EMBASE、PsychInfo、CINAHL、Cochrane数据库和中国国家知识基础设施进行了系统综述。结果：纳入了来自澳大利亚、美国、委内瑞拉和中国的14项研究，共1126名参与者。我们发现，二甲双胍在减轻体重增加方面优于安慰剂（-3.12 千克，95% CI -4.22 至 -2.01 千克）。二甲双胍还能明显减轻空腹血糖水平、总胆固醇和总甘油三酯水平的变化。关于研究质量、持续时间和抗精神病药物的敏感性分析对结果没有影响。我们还对每项研究中报告的药物不良反应（ADR）进行了元分析，结果显示二甲双胍组和安慰剂组之间的药物不良反应发生率无显著差异。结论：二甲双胍与抗精神病药物同时使用时，可显著减轻体重增加，并减轻其他几项代谢指标，具有统计学意义和临床意义。在临床环境中，如果患者能够耐受，应考虑在服用抗精神病药物的同时服用二甲双胍，以改善长期需要抗精神病药物治疗的患者的长期心脏代谢结果。

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引用次数: 0

The cardiovascular safety of tricyclic antidepressants in overdose and in clinical use 过量和临床使用三环类抗抑郁药对心血管的安全性

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-05-30 DOI: 10.1177/20451253241243297

David Taylor, Sofia Poulou, Ivana Clark

Tricyclic antidepressants (TCAs) remain widely prescribed for depression and many other conditions. There may be important differences between individual TCA in regard to their overdose toxicity and their cardiac toxicity in clinical use. We conducted a systematic review to compare the toxicity of individual TCA in overdose and the risk of serious adverse cardiac events occurring with therapeutic doses. We used the fatal toxicity index (FTI) and case fatality ratio as markers of fatality in overdose, and hazard ratios or odds ratios for the risk of cardiovascular adverse events during normal clinical use. In all, 30 reports of mortality in overdose and 14 observational studies assessing the risk of cardiovascular adverse events in clinical use were included. FTI values were of the same order of magnitude (101–102) for all TCAs except lofepramine. Desipramine appears to be somewhat more likely than other TCAs to lead to death in overdose. Amitriptyline, clomipramine, dothiepin/dosulepin, doxepin, trimipramine and imipramine showed broadly similar toxicity and were usually reported to be less toxic than desipramine. Data on nortriptyline were contradictory. Lofepramine had the lowest risk of death in overdose. The rank order of overdose toxicity was broadly consistent between different FTI definitions and between markers used. With respect to the risk of cardiovascular events at clinically relevant exposure, amitriptyline, nortriptyline and lofepramine were associated with a greater risk of in-use cardiotoxicity. All measures of overdose toxicity were subject to external influences and confounding. The continued use of TCAs in depression and other conditions should be minimized when considering their undoubted toxicity in overdose and possible toxicity in normal clinical use.

三环类抗抑郁药（TCA）仍被广泛用于治疗抑郁症和许多其他疾病。在临床应用中，不同 TCA 的过量毒性和心脏毒性可能存在重大差异。我们进行了一项系统性研究，以比较各种 TCA 药物过量时的毒性和治疗剂量下发生严重不良心脏事件的风险。我们使用致命毒性指数（FTI）和病例死亡率作为过量用药致死的标志，使用危险比或几率比作为正常临床用药期间发生心血管不良事件风险的标志。总共纳入了 30 份关于用药过量致死的报告和 14 份评估临床用药中心血管不良事件风险的观察性研究。除氟西普胺外，所有 TCA 的 FTI 值都在同一数量级（101-102）。与其他 TCA 相比，去甲丙咪嗪似乎更有可能导致用药过量死亡。阿米替林、氯米帕明、多硫平/多虑平、多虑平、曲米帕明和丙咪嗪显示出大致相似的毒性，通常报告的毒性低于去甲丙咪嗪。有关去甲替林的数据相互矛盾。罗非拉明用药过量致死的风险最低。在不同的快速道毒性定义和所使用的标记物之间，用药过量毒性的排序大体一致。就临床相关暴露量下的心血管事件风险而言，阿米替林、去甲替林和洛非普拉明与使用中的心脏毒性风险较大相关。过量毒性的所有测量指标都受到外部影响和混杂因素的影响。考虑到TCA类药物在过量使用时无疑会产生毒性，而在正常临床使用时又可能产生毒性，因此应尽量减少在抑郁症和其他疾病中继续使用TCA类药物。

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引用次数: 0

Corrigendum to "Semaglutide for the treatment of antipsychotic-associated weight gain in patients not responding to metformin - a case series". 塞马鲁肽用于治疗对二甲双胍无应答的抗精神病药物相关体重增加患者--病例系列》的更正。

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.1177/20451253241258536

[This corrects the article DOI: 10.1177/20451253231165169.].

引用次数: 0

Clozapine-induced cholinergic urticaria: a case report. 氯氮平诱发胆碱能性荨麻疹：一份病例报告。

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-05-14 eCollection Date: 2024-01-01 DOI: 10.1177/20451253241241056

Nadia El Ouni Amami, Husen Ali-Diabacte, Sarra Ateb, Hamadi Ben Rejeb, Avicenne Bellis, Reza Bellis, Dominique Januel, Noomane Bouaziz

Clozapine, renowned for its efficacy in treatment-resistant schizophrenia, is associated with rare yet potentially severe side effects, including hematological disorders, myocarditis, seizures and gastrointestinal obstruction. Dermatological adverse effects, though less serious, can profoundly impact patients' quality of life. We present the first reported case of cholinergic urticaria induced by clozapine, in a 25-year-old male with treatment-resistant schizophrenia. Four months into clozapine therapy, the patient developed intensely pruritic erythematous lesions triggered by sweating, significantly impairing his daily activities. Despite attempts at management, including dose reduction and antihistamine therapy, the urticaria persisted. However, a favorable outcome was achieved upon switching to quetiapine. This case underscores the importance of recognizing and managing treatment-related adverse effects, even when they arise late in treatment, and highlights the need for individualized therapeutic approaches.We discuss potential mechanisms underlying clozapine-induced cholinergic urticaria and emphasize the significance of patient-centered care in optimizing treatment outcomes in schizophrenia.

氯氮平因其在治疗耐药性精神分裂症方面的疗效而闻名，但它也有一些罕见但潜在的严重副作用，包括血液病、心肌炎、癫痫发作和胃肠道梗阻。皮肤方面的不良反应虽然不太严重，但也会严重影响患者的生活质量。我们报告了首例氯氮平诱发胆碱能性荨麻疹的病例，患者是一名 25 岁的男性，患有难治性精神分裂症。在接受氯氮平治疗四个月后，患者出现了因出汗而引发的剧烈瘙痒性红斑，严重影响了他的日常活动。尽管尝试了各种治疗方法，包括减少剂量和抗组胺药治疗，但荨麻疹依然存在。不过，在改用喹硫平治疗后，他的病情得到了好转。我们讨论了氯氮平诱发胆碱能性荨麻疹的潜在机制，并强调了以患者为中心的护理对于优化精神分裂症治疗效果的重要性。

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引用次数: 0

Neuroimaging features of cognitive impairments in schizophrenia and major depressive disorder 精神分裂症和重度抑郁症认知障碍的神经影像学特征

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-05-04 DOI: 10.1177/20451253241243290

Yu-Ting Li, Chi Zhang, Jia-Cheng Han, Yu-Xuan Shang, Zhu-Hong Chen, Guang-Bin Cui, Wen Wang

Cognitive dysfunctions are one of the key symptoms of schizophrenia (SZ) and major depressive disorder (MDD), which exist not only during the onset of diseases but also before the onset, even after the remission of psychiatric symptoms. With the development of neuroimaging techniques, these non-invasive approaches provide valuable insights into the underlying pathogenesis of psychiatric disorders and information of cognitive remediation interventions. This review synthesizes existing neuroimaging studies to examine domains of cognitive impairment, particularly processing speed, memory, attention, and executive function in SZ and MDD patients. First, white matter (WM) abnormalities are observed in processing speed deficits in both SZ and MDD, with distinct neuroimaging findings highlighting WM connectivity abnormalities in SZ and WM hyperintensity caused by small vessel disease in MDD. Additionally, the abnormal functions of prefrontal cortex and medial temporal lobe are found in both SZ and MDD patients during various memory tasks, while aberrant amygdala activity potentially contributes to a preference to negative memories in MDD. Furthermore, impaired large-scale networks including frontoparietal network, dorsal attention network, and ventral attention network are related to attention deficits, both in SZ and MDD patients. Finally, abnormal activity and volume of the dorsolateral prefrontal cortex (DLPFC) and abnormal functional connections between the DLPFC and the cerebellum are associated with executive dysfunction in both SZ and MDD. Despite these insights, longitudinal neuroimaging studies are lacking, impeding a comprehensive understanding of cognitive changes and the development of early intervention strategies for SZ and MDD. Addressing this gap is critical for advancing our knowledge and improving patient prognosis.

认知功能障碍是精神分裂症（SZ）和重度抑郁症（MDD）的主要症状之一，不仅在发病时存在，在发病前甚至在精神症状缓解后也存在。随着神经成像技术的发展，这些非侵入性方法为了解精神疾病的潜在发病机制和认知矫正干预措施提供了宝贵的信息。本综述综合了现有的神经影像学研究，以探讨认知障碍的领域，尤其是 SZ 和 MDD 患者的处理速度、记忆、注意力和执行功能。首先，在SZ和MDD患者的处理速度缺陷中都观察到了白质（WM）异常，SZ患者的WM连接异常和MDD患者的小血管疾病导致的WM高密度是不同的神经影像学发现。此外，在各种记忆任务中，SZ 和 MDD 患者的前额叶皮层和内侧颞叶功能均出现异常，而杏仁核活动异常可能导致 MDD 患者偏好负面记忆。此外，包括前顶叶网络、背侧注意网络和腹侧注意网络在内的大规模网络受损与注意力缺陷有关，SZ 和 MDD 患者均是如此。最后，背外侧前额叶皮层（DLPFC）的异常活动和体积以及DLPFC与小脑之间的异常功能连接与SZ和MDD患者的执行功能障碍有关。尽管有了这些认识，但纵向神经影像学研究仍然缺乏，这阻碍了对认知变化的全面了解以及对 SZ 和 MDD 早期干预策略的制定。填补这一空白对于增进我们的知识和改善患者预后至关重要。

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引用次数: 0

Psychedelic skepticism: back to the sixties? 迷幻怀疑论：回到六十年代？

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-04-25 DOI: 10.1177/20451253241243242

Eduardo Ekman Schenberg

引用次数: 0

Network analysis of the comorbidity between post-traumatic stress, depression and anxiety symptoms among frontline healthcare workers during the COVID-19 pandemic 对 COVID-19 大流行期间一线医护人员的创伤后应激反应、抑郁和焦虑症状之间的共存关系进行网络分析

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-04-20 DOI: 10.1177/20451253241243292

Hui Ouyang, Lili Wu, Wenjie Yan, Keyi Si, Hongli Lv, Jingye Zhan, Jing Wang, Yanpu Jia, Zhilei Shang, Wenfang Chen, Weizhi Liu

Background:Coronavirus disease 2019 pandemic pointed out significant mental symptoms of frontline healthcare workers (HCWs).Objective:We aimed to estimate the prevalence and comorbidity of post-traumatic stress symptoms (PTSS), depression and anxiety symptoms in HCWs from Fangcang shelter hospitals during the pandemic.Design:Demographic information, post-traumatic stress disorder checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7) were obtained online based on stratified random sampling design during April 2022, with 284 eligible responses.Method:Hierarchical regression analyses were applied to investigate independent variables associated with psychological status outcomes (PHQ-9, GAD-7 and PCL-5), and the network analyses were applied to explore the comorbidity using all items of PCL-5, PHQ-9 and GAD-7.Results:(1) 10.56%, 13.03% and 8.10% of HCWs reported PTSS, depression and anxiety symptoms. Fifty-three (18.66%) HCWs experienced at least one mental health disorder, among which 26.42–37.74% HCWs had comorbidity of two or three mental disorders; (2) several influence factors of mental health were identified, including medical professions, working hours, contacted patients ( p < 0.05); (3) prominent bridge symptoms between PTSS and depression were sleep problems, suicide ideation, concentration difficulties and recklessness. Comorbidity between PTSS and anxiety was thought to mainly stem from negative affect, such as afraid, anxious, annoyed and worrying. Depressed mood and worry might be good targets during treatment of comorbidity of depression and anxiety.Conclusion:Our data suggest mild level of PTSS, depression and anxiety symptoms among HCWs during the pandemic and might give novel insights into assessment and intervention of comorbidity.

背景：2019年冠状病毒病大流行指出一线医护人员（HCWs）有明显的精神症状。目的：我们旨在估计大流行期间芳村收容所医院医护人员创伤后应激症状（PTSS）、抑郁和焦虑症状的患病率和合并症。设计：2022年4月，通过分层随机抽样设计在线获取人口统计学信息、DSM-5创伤后应激障碍核对表（PCL-5）、患者健康问卷（PHQ-9）和广泛性焦虑症问卷（GAD-7），共获得284份符合条件的回复。方法：应用层次回归分析研究与心理状态结果（PHQ-9、GAD-7和PCL-5）相关的自变量，并应用网络分析探讨PCL-5、PHQ-9和GAD-7所有项目的合并症。53名（18.66%）医护人员至少有一种精神障碍，其中26.42%-37.74%的医护人员合并有两种或三种精神障碍；(2)发现了几个影响精神健康的因素，包括医疗专业、工作时间、接触的病人（P <0.05）；(3)PTSS和抑郁症之间突出的桥接症状是睡眠问题、自杀意念、注意力不集中和鲁莽。PTSS 与焦虑的共病被认为主要源于负面情绪，如害怕、焦虑、烦恼和担忧。结论：我们的数据表明，在流感大流行期间，高危人群中存在轻度的创伤后应激障碍、抑郁和焦虑症状，这可能为评估和干预合并症提供了新的见解。

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引用次数: 0

Effect of long-acting antipsychotic treatment on psychiatric hospitalization rate in early psychosis patients: a naturalistic study 长效抗精神病药物治疗对早期精神病患者精神病住院率的影响：一项自然研究

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-04-20 DOI: 10.1177/20451253241243273

Raúl Sancho-Echeverria, Claudia Aymerich, José Manuel Rodríguez-Sánchez, Patxi Gil, Borja Pedruzo, Miguel Ángel González-Torres, Paolo Fusar-Poli, Celso Arango, Ana Catalan

Background:The effectiveness of long-acting injectable (LAI) antipsychotics in preventing relapses of first-episode psychosis is currently debated.Objectives:The study aimed to investigate the number of psychiatric hospitalizations comparing the LAI cohort versus the oral cohort during different phases of the illness, pre-LAI treatment, during LAI treatment, and after LAI treatment.Design:A naturalistic study was conducted on two independent cohorts of early psychosis patients receiving treatment from a specific early intervention service. The first cohort comprised 228 patients who received LAIs, while the second cohort comprised 667 patients who had never received LAIs.Methods:This study was designed as a longitudinal observational study conducted within a naturalistic clinical setting in two cohorts of early psychosis patients. Repeated series ANCOVA (ANCOVA-r) was used to study the number of hospitalizations in the different study periods (T1 = from the date of the first psychiatric record to the beginning of the mirror period; T2 = the mirror period; T3 = from the LAI implementation to the LAI discontinuation; and T4 = from the LAI discontinuation to the end). In all cases, discontinuation of LAI involved the return to oral treatment. In all, 35 patients had not T4 as they were still on LAI treatment at the time of database closing (September 2020), and their data were not included in the analysis of the effect of the LAI discontinuation.Results:The patients in the LAI cohort were younger, more frequently males, presented more schizophrenia diagnoses, and had a higher number of hospitalizations (2.50 ± 2.61 versus 1.19 ± 1.69; p < 0.001) than the oral cohort. The number of hospitalizations at the end of the follow-up was higher in the LAI cohort [0.20 (standard deviation (SD)) = 0.79] versus 0.45 [SD = 0.45 (SD = 1.13); F(23.90), p < 0.001]. However, after the introduction of LAIs, the differences in hospitalization rates between the two cohorts became less pronounced. Once LAI treatment was ceased, the hospitalization rate increased again.Conclusion:In our study, early psychosis patients receiving LAIs experienced a greater decrease in hospitalizations after introducing the LAI treatment than those treated solely with oral medication. These findings support using LAIs as a viable strategy for preventing rehospitalization and improving the overall course of treatment for individuals with early psychosis.

背景：长效注射（LAI）抗精神病药物在预防首发精神病复发方面的有效性目前还存在争议。研究目的：本研究旨在调查在LAI治疗前、LAI治疗期间和LAI治疗后的不同疾病阶段，LAI队列与口服队列的精神病住院次数比较。方法：本研究设计为一项纵向观察研究，在自然临床环境中对两组早期精神病患者进行观察。重复序列方差分析（ANCOVA-r）用于研究不同研究时期（T1=从首次精神病记录日期到镜像期开始；T2=镜像期；T3=从实施LAI到停用LAI；T4=从停用LAI到研究结束）的住院次数。在所有情况下，停用LAI都需要恢复口服治疗。结果：与口服队列相比，LAI队列中的患者更年轻，男性更多，精神分裂症诊断更多，住院次数更高（2.50±2.61对1.19±1.69；p <0.001）。在随访结束时，LAI队列的住院次数[0.20（标准差（SD））= 0.79]对0.45[SD = 0.45（SD = 1.13）；F（23.90），p <；0.001]更高。然而，在使用 LAI 后，两组患者住院率的差异变得不那么明显了。结论：在我们的研究中，与仅接受口服药物治疗的患者相比，接受LAI治疗的早期精神病患者在引入LAI治疗后的住院率下降幅度更大。这些研究结果支持将LAI作为预防再住院和改善早期精神病患者整体治疗过程的可行策略。

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引用次数: 0

Attentional bias modification and attention control training in PTSD: a systematic review and meta-analysis 创伤后应激障碍中的注意偏差修正和注意控制训练：系统回顾和荟萃分析

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-04-16 DOI: 10.1177/20451253241243260

Fan Zhang, Chenwei Huang, Wenjie Yan, Hui Ouyang, Weizhi Liu

Background:Cognitive models of post-traumatic stress disorder (PTSD) highlighted the effect of maladaptive cognitive processing in the development and maintenance of PTSD. PTSD is related to attentional bias (AB) toward threatening stimuli and greater attentional bias variability (ABV). Attentional bias modification (ABM) and attention control training (ACT) have demonstrated the effect of improving PTSD, but the results of randomized controlled trials (RCTs) are controversial.Objectives:The current study aimed to evaluate the extent of evidence supporting the efficacy of ABM in the treatment of PTSD.Design:Systematic review and meta-analysis.Methods:We searched PUBMED, PsycINFO, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for articles published between 1980 and 2022. RCTs of ABM for adult participants with PTSD symptoms were identified. The primary outcome was changes in PTSD severity, and the second outcome was changes in AB and ABV. Trial quality was assessed using the Cochrane Risk of Bias Tool. Publication bias was assessed using the Doi plot and Luis Furuya-Kanamori (LFK) index.Results:Eight RCTs comparing the effect of ABM to ACT were included in the review, and six studies were meta-analyzed. Meta-analysis favored ACT in improving PTSD symptoms and ABV, and the effect size was large. ABM and ACT demonstrated similar effects in improving AB.Conclusion:ACT should not only be seen as a control training condition but also has therapeutic values. However, since the current meta-analysis only included a limited number of studies, further research was still needed to examine the clinical value of ACT in PTSD treatment.

背景：创伤后应激障碍（PTSD）的认知模型强调了不良认知加工在创伤后应激障碍的发展和维持中的作用。创伤后应激障碍与对威胁性刺激的注意偏差（AB）和更大的注意偏差变异性（ABV）有关。注意偏差修正（ABM）和注意控制训练（ACT）已证明具有改善创伤后应激障碍的效果，但随机对照试验（RCT）的结果却存在争议。方法：我们检索了 PUBMED、PsycINFO、EMBASE、ClinicalTrials.gov 和 Cochrane Central Register of Controlled Trials 在 1980 年至 2022 年间发表的文章。确定了针对有创伤后应激障碍症状的成年参与者的 ABM RCT。主要结果是创伤后应激障碍严重程度的变化，次要结果是 AB 和 ABV 的变化。试验质量采用 Cochrane 偏倚风险工具进行评估。结果：8 项比较 ABM 与 ACT 效果的研究被纳入综述，6 项研究进行了元分析。荟萃分析结果表明，ACT在改善创伤后应激障碍症状和ABV方面更胜一筹，且效果显著。结论：ACT 不应仅被视为一种对照训练条件，它还具有治疗价值。然而，由于目前的荟萃分析只包含了数量有限的研究，因此仍需进一步研究ACT在创伤后应激障碍治疗中的临床价值。

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引用次数: 0

Patient-reported outcomes on sleep quality and circadian rhythm during treatment with intravenous ketamine for treatment-resistant depression. 静脉注射氯胺酮治疗耐药抑郁症期间患者报告的睡眠质量和昼夜节律结果。

IF 4.2 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology

Pub Date : 2024-03-04 eCollection Date: 2024-01-01 DOI: 10.1177/20451253241231264

Raymond Yan, Tyler Marshall, Atul Khullar, Travis Nagle, Jake Knowles, Mai Malkin, Brittany Chubbs, Jennifer Swainson

Background: Intravenous (IV) ketamine is a rapid acting antidepressant used primarily for treatment-resistant depression (TRD). It has been suggested that IV ketamine's rapid antidepressant effects may be partially mediated via improved sleep and changes to the circadian rhythm.

Objectives: This study explores IV ketamine's association with changes in patient-reported sleep quality and circadian rhythm in an adult population with TRD.

Methods: Adult patients (18-64 years) with TRD scheduled for IV ketamine treatment were recruited to complete patient rated outcomes measures on sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and circadian rhythm using the Morningness-Eveningness Questionnaire (MEQ). Over a 4-week course of eight ketamine infusions, reports were obtained at baseline (T0), prior to second treatment (T1), prior to fifth treatment (T2), and 1 week after eighth treatment (T3).

Results: Forty participants with TRD (mean age = 42.8, 45% male) were enrolled. Twenty-nine (72.5%) had complete follow-up data. Paired t tests revealed statistically significant improvements at the end of treatment in sleep quality (PSQI) (p = 0.003) and depressive symptoms (Clinically Useful Depression Outcome Scale-Depression, p < 0.001) while circadian rhythm (MEQ) shifted earlier (p = 0.007). The PSQI subscale components of sleep duration (p = 0.008) and daytime dysfunction (p = 0.001) also improved. In an exploratory post hoc analysis, ketamine's impact on sleep quality was more prominent in patients with mixed features, while its chronobiotic effect was prominent in those without mixed features.

Conclusion: IV ketamine may improve sleep quality and advance circadian rhythm in individuals with TRD. Effects may differ in individuals with mixed features of depression as compared to those without. Since this was a small uncontrolled study, future research is warranted.

背景：静脉注射氯胺酮是一种速效抗抑郁剂，主要用于治疗难治性抑郁症（TRD）。有研究认为，静脉注射氯胺酮的快速抗抑郁作用可能部分是通过改善睡眠和改变昼夜节律来实现的：本研究探讨了静脉注射氯胺酮与TRD成人患者报告的睡眠质量和昼夜节律变化之间的关系：研究招募了计划接受氯胺酮静脉滴注治疗的成年TRD患者（18-64岁），他们使用匹兹堡睡眠质量指数（PSQI）和晨起-活力问卷（MEQ）完成了患者评定的睡眠质量和昼夜节律结果测量。在为期4周的8次氯胺酮输注疗程中，分别在基线（T0）、第二次治疗前（T1）、第五次治疗前（T2）和第八次治疗后1周（T3）获得报告：40名患有TRD的患者（平均年龄=42.8岁，45%为男性）参加了此次研究。29人（72.5%）拥有完整的随访数据。配对 t 检验显示，治疗结束时，睡眠质量（PSQI）（P = 0.003）和抑郁症状（临床实用抑郁结果量表-抑郁，P = 0.007）均有显著改善。PSQI 子量表中的睡眠时间（p = 0.008）和日间功能障碍（p = 0.001）也有所改善。在一项探索性的事后分析中，氯胺酮对睡眠质量的影响在具有混合特征的患者中更为突出，而对无混合特征的患者而言，氯胺酮的慢性生物效应则更为突出：结论：静脉注射氯胺酮可改善TRD患者的睡眠质量并促进昼夜节律。结论：静脉注射氯胺酮可改善TRD患者的睡眠质量并促进昼夜节律，但对混合型抑郁症患者的效果可能与无混合型抑郁症患者不同。由于这只是一项小型的非对照研究，因此未来的研究还很有必要。

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引用次数: 0