Conditioned pharmacotherapeutic effects: a preliminary study.
Conditioned pharmacotherapeutic effects: a preliminary study.
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DOI：
10.1097/psy.0b013e3181cbd38b
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发表时间：
2010-02
影响因子：
3.3
通讯作者：
Fiorentino D
中科院分区：
文献类型：
--
作者：
Ader R;Mercurio MG;Walton J;James D;Davis M;Ojha V;Kimball AB;Fiorentino D
行为条件作用作为许多药物治疗方案的一个固有组成部分从未被研究过。我们假设，在部分药物（皮质类固醇）强化方案下治疗的银屑病患者，与在标准条件下给予相同剂量药物的患者相比，症状会较轻且复发率较低。
对来自加利福尼亚州和纽约州的46名患者进行了一项双盲、简单随机干预试验。最初，在标准治疗条件下用0.1%曲安奈德丙酮化合物治疗皮损。此后，标准治疗组继续采用连续强化（每次治疗都用活性药物），剂量为初始剂量的100%；部分强化组患者在25 - 50%的时间接受全剂量治疗，其他时间接受安慰剂治疗；剂量控制组患者接受连续强化治疗，剂量为初始剂量的25 - 50%。
在加利福尼亚州，疾病严重程度评分既不支持也不反驳该假设。在纽约州，部分强化组和剂量控制组在基线时没有差异，部分强化组在皮损严重程度上的降低幅度大于剂量控制组，且与接受2 - 4倍药物剂量的标准治疗组患者无差异。就全体患者而言，部分强化组的复发率（26.7%）低于剂量控制组患者（61.5%），且与全剂量治疗组（22.2%）无差异。
一种部分药物治疗强化方案可以用在标准治疗条件下相对无效的累积皮质类固醇剂量来维持银屑病患者的病情。可以想象，皮质类固醇的给药频率仅为目前规定的四分之一或一半就足以治疗银屑病。然而，我们认为，这些初步观察结果暗示了条件作用过程在药物治疗方案中以及对药物治疗方案设计的影响。
Behavioral conditioning as an inherent component of many pharmacotherapeutic protocols has never been examined. We hypothesized that psoriasis patients treated under a partial schedule of pharmacologic (corticosteroid) reinforcement would show less severe symptoms and relapse than those given the same amount of drug under standard conditions. A double blind, simple randomization intervention was conducted with 46 patients from California and New York. Initially, lesions were treated with 0.1% acetonide triamcinolone under standard treatment conditions. Thereafter, a Standard Therapy group continued on continuous reinforcement (active drug every treatment) with 100% of the initial dose; Partial Reinforcement patients received a full dose 25-50% of the time and placebo medication other times; Dose Control patients received continuous reinforcement with 25-50% of the initial dose. Severity of disease scores in CA neither supported nor refuted the hypothesis. In NY, where there was no difference between Partial Reinforcement and Dose Control groups at baseline, partial reinforcement effected a greater reduction in lesion severity than Dose Control conditions and did not differ from Standard Therapy patients receiving 2-4 times more drug. For the entire population, the incidence of relapse under partial reinforcement (26.7%) was lower than in Dose Control patients (61.5%) and did not differ from full-dose treatment (22.2%). A partial schedule of pharmacotherapeutic reinforcement could maintain psoriasis patients with a cumulative amount of corticosteroid that was relatively ineffective when administered under standard treatment conditions. Conceivably, corticosteroid administration only one quarter or half as frequently as currently prescribed is sufficient to treat psoriasis. We posit, however, that these preliminary observations implicate conditioning processes in—and for the design of—regimens of pharmacotherapy.