Enhancement of Psychosocial Treatment With D-Cycloserine: Models, Moderators, and Future Directions.
Enhancement of Psychosocial Treatment With D-Cycloserine: Models, Moderators, and Future Directions.
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DOI：
10.1016/j.biopsych.2015.09.007
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发表时间：
2016-08-15
影响因子：
10.6
通讯作者：
Pollack MH
中科院分区：
文献类型：
--
作者：
Otto MW;Kredlow MA;Smits JAJ;Hofmann SG;Tolin DF;de Kleine RA;van Minnen A;Evins AE;Pollack MH
恐惧消退的神经生物学的理解的进展导致d-环丝氨酸（DCS），一种部分谷氨酸能N-甲基-D-天冬氨酸激动剂，作为暴露治疗的增强策略的发展。我们回顾了十年来的研究，这些研究集中在DCS增强机制（例如，恐惧消退）和焦虑症暴露治疗的结果。在一系列小规模研究为这种临床应用提供了强有力的支持之后，最近的大规模研究产生了混合的结果，其中一些显示出微弱或没有效果。我们讨论了混合结果的可能解释，指向患者和会话（即，学习经验）的特点作为可能的调解人的效能感，并提供了方向，为未来的研究在这一领域。我们还回顾了最近的研究，旨在扩大工作DCS增强暴露疗法的焦虑症DCS增强学习为基础的干预成瘾，神经性厌食症，精神分裂症和抑郁症。在这里，我们关注DCS对促进治疗结果的作用和除恐惧消退之外的其他治疗机制（例如，食欲消退，依赖于大脑的学习）。
Advances in the understanding of the neurobiology of fear extinction resulted in the development of d-cycloserine (DCS), a partial glutamatergic N-methyl-D-aspartate agonist, as an augmentation strategy for exposure treatment. We review a decade of research that has focused on the efficacy of DCS for augmenting the mechanisms (e.g., fear extinction) and outcome of exposure treatment across the anxiety disorders. Following a series of small-scale studies offering strong support for this clinical application, more recent larger-scale studies have yielded mixed results, with some showing weak or no effects. We discuss possible explanations of the mixed findings, pointing to both patient and session (i.e., learning experiences) characteristics as possible moderators of efficacy, and offer directions for future research in this area. We also review recent studies that have aimed to extend the work on DCS augmentation of exposure therapy for the anxiety disorders to DCS enhancement of learning-based interventions for addiction, anorexia nervosa, schizophrenia, and depression. Here, we attend to both DCS effects on facilitating therapeutic outcomes and additional therapeutic mechanisms beyond fear extinction (e.g., appetitive extinction, hippocampal-dependent learning).