A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War veterans.
A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War veterans.
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DOI：
10.1176/appi.ajp.2014.13121625
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发表时间：
2014-06
期刊：
影响因子：
--
通讯作者：
Ressler KJ
中科院分区：
文献类型：
--
作者：
Rothbaum BO;Price M;Jovanovic T;Norrholm SD;Gerardi M;Dunlop B;Davis M;Bradley B;Duncan EJ;Rizzo A;Ressler KJ
确定与安慰剂相比，虚拟现实暴露（VRE）增加D-环丝氨酸（50 mg）或阿普唑仑（0.25 mg）在减少伊拉克和阿富汗军事创伤所致PTSD方面的有效性。进行了一项双盲、安慰剂对照的随机临床试验，比较了PTSD受试者（n= 156）VRE的增强方法。在所有条件下，PTSD症状在6次VRE治疗期间从治疗前到治疗后显著改善（p<0.001），并在3、6和12个月随访时保持不变。在任何时间点，D-环丝氨酸组之间的症状没有总体差异。阿普唑仑组和安慰剂组在治疗后临床医生管理的PTSD量表（p = 0.006）和治疗后3个月的PTSD诊断方面存在显著差异，因此阿普唑仑组的PTSD发生率更高（阿普唑仑组为79.2%，安慰剂组为47.8%）。只有D-环丝氨酸组的治疗特异性结果增强剂是会话间消退学习（p<0.005）。在治疗后，D-环丝氨酸组的皮质醇反应性（p<0.05）和VR场景中的惊吓反应（p<0.05）最低。少量的VRE会议与减少创伤后应激障碍的诊断和症状在伊拉克/阿富汗退伍军人，虽然没有控制条件的VRE。总体而言，在初步分析中，D-环丝氨酸对PTSD症状没有优势。在次要分析中，治疗期间使用苯二氮卓类药物可能会损害恢复，D-环丝氨酸可能会增强表现出会话内学习的患者的VRE。与阿普唑仑和安慰剂治疗相比，PTSD患者中的D-环丝氨酸增强治疗可降低皮质醇和惊吓反应性，与动物文献一致。
To determine the effectiveness of Virtual Reality Exposure (VRE) augmented with D-cycloserine (50mg) or alprazolam (0.25mg), compared to placebo, in reducing PTSD due to military trauma in Iraq and Afghanistan. A double-blind, placebo-controlled randomized clinical trial comparing augmentation methods for VRE for subjects (n= 156) with PTSD was conducted. PTSD symptoms significantly improved from pre- to post-treatment over the 6-session VRE treatment (p<.001) across all conditions and were maintained at 3, 6, and 12 months follow-up. There were no overall differences between the D-cycloserine group on symptoms at any time-point. The alprazolam and placebo conditions significantly differed on the post-treatment Clinician Administered PTSD scale (p = .006) and the 3-month post-treatment PTSD diagnosis, such that the alprazolam group showed greater rates of PTSD (79.2% alprazolam vs. 47.8% placebo). Between-session extinction learning was a treatment-specific enhancer of outcome for the D-cycloserine group only (p<.005). At post-treatment, the D-cycloserine group was the lowest on cortisol reactivity (p<.05) and startle response during VR scenes (p<.05). A small number of VRE sessions were associated with reduced PTSD diagnosis and symptoms in Iraq/Afghanistan veterans, although there was no control condition for the VRE. Overall, there was no advantage of D-cycloserine on PTSD symptoms in primary analyses. In secondary analyses, benzodiazepine use during treatment may impair recovery, and D-cycloserine may enhance VRE in patients who demonstrate within-session learning. D-cycloserine augmentation treatment in PTSD patients may reduce cortisol and startle reactivity compared to the alprazolam and placebo treatment, consistent with the animal literature.
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影响因子：
10.6
作者：
Norrholm, Seth D.;Jovanovic, Tanja;Olin, Ilana W.;Sands, Lauren A.;Karapanou, India;Bradley, Bekh;Ressler, Kerry J.
通讯作者：
Ressler, Kerry J.
影响因子：
4.8
作者：
Litz, Brett T.;Salters-Pedneault, Kristalyn;Hofmann, Stefan G.
通讯作者：
Hofmann, Stefan G.
影响因子：
--
作者：
Ressler, KJ;Rothbaum, BO;Davis, M
通讯作者：
Davis, M
影响因子：
5.3
作者：
Sheehan, DV;Lecrubier, Y;Dunbar, GC
通讯作者：
Dunbar, GC
DOI：
10.1176/appi.ajp.2013.12070974
发表时间：
2013-07
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Hofmann SG;Smits JA;Rosenfield D;Simon N;Otto MW;Meuret AE;Marques L;Fang A;Tart C;Pollack MH
通讯作者：
Pollack MH