心理干预对成人创伤后应激障碍是有效的，与同时服用精神药物无关:一项随机对照试验的荟萃分析。

IF 16.3 1区医学 Q1 PSYCHIATRY Psychotherapy and Psychosomatics Pub Date : 2023-01-01 DOI:10.1159/000527850

Thole H Hoppen, Nexhmedin Morina

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引用次数: 0

摘要

背景:在大多数检查成人创伤后应激障碍(PTSD)心理干预的试验中，参与者被允许继续服用处方精神药物。目的:我们的目的是进行第一次荟萃分析，调查这种同时用药对疗效的潜在影响。方法:为此，我们检索Medline, PsycINFO, Web of Science和ptsdbars，从成立到2022年4月21日，满足以下标准的试验:(1)随机对照试验(RCT)，(2)创伤后应激障碍作为主要治疗重点，(3)基于访谈的创伤后应激障碍基线率≥70%，(4)N≥20，(5)平均年龄≥18岁。当精神药物的摄入没有(充分)报道时，试验被排除。结果:大多数已发表的试验没有报道精神药物的摄入。共有75项rct (N = 4,901例患者)符合纳入标准。以创伤为中心的认知行为疗法(TF-CBT)是研究最充分的干预手段。除一项分析外，心理治疗的短期疗效并没有因参与者在心理治疗期间同时服用精神药物的比例而有所不同。在比较治疗后TF-CBT和主动对照条件的试验中，当大多数参与者同时用药时(g = 0.87, 95% CI 0.53-1.22)， TF-CBT比未用药时更有效(g = 0.27;95% CI 0.01-0.54, p = 0.017)，只有在药物参与者比例高的试验中，较年轻的年龄(b1 = -0.04, p = 0.008)和较高的女性比例(b1 = 0.01, p = 0.014)与较高的疗效相关。在随访中没有发现同时服用精神药物的参与者比例的疗效差异。结论:结果表明心理干预对创伤后应激障碍是有效的，与同时服用精神药物无关。

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Psychological Interventions for Adult Post-Traumatic Stress Disorder Are Effective Irrespective of Concurrent Psychotropic Medication Intake: A Meta-Analysis of Randomized Controlled Trials.

Background: Participants are allowed to stay on their prescribed psychotropic medication in most trials examining psychological interventions for adult post-traumatic stress disorder (PTSD).

Objectives: We aimed to conduct the first meta-analysis investigating the potential influence of such concurrent medication on efficacy.

Method: To this end, we searched Medline, PsycINFO, Web of Science, and PTSDpubs from inception to April 21, 2022, for trials meeting the following criteria: (1) randomized controlled trial (RCT), (2) PTSD as primary treatment focus, (3) interview-based PTSD baseline rate ≥70%, (4) N ≥ 20, (5) mean age ≥18 years. Trials were excluded when intake of psychotropics was not (sufficiently) reported.

Results: Most published trials did not report on the intake of psychotropic medication. A total of 75 RCTs (N = 4,901 patients) met inclusion criteria. Trauma-focused cognitive behavior therapy (TF-CBT) was the most well-researched intervention. Short-term efficacy of psychological treatments did not differ by the proportion of participants taking concurrent psychotropic medication during psychological treatment in all but one analysis. In trials comparing TF-CBT and active control conditions at posttreatment, TF-CBT was more effective when most participants were concurrently medicated (g = 0.87, 95% CI 0.53-1.22) rather than unmedicated (g = 0.27; 95% CI 0.01-0.54, p = 0.017), with younger age (b1 = -0.04, p = 0.008) and higher proportion of females (b1 = 0.01, p = 0.014) being associated with higher efficacy only in trials with high proportions of medicated participants. No differences in efficacy by proportions of participants taking concurrent psychotropic medication were found at follow-up.

Conclusions: Results suggest that psychological interventions are effective for PTSD irrespective of concurrent intake of psychotropics.

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.