Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: a randomized controlled trial.
Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: a randomized controlled trial.
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DOI：
10.1176/appi.ajp.2011.11020321
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发表时间：
2012-01
期刊：
影响因子：
--
通讯作者：
Marshall RD
中科院分区：
文献类型：
--
作者：
Schneier FR;Neria Y;Pavlicova M;Hembree E;Suh EJ;Amsel L;Marshall RD
选择性5-羟色胺再摄取抑制剂通常被推荐与创伤后应激障碍（PTSD）的认知行为疗法联合使用，但PTSD的联合初始治疗尚未在受控条件下进行研究。也有一些研究，无论是治疗PTSD与恐怖主义有关。这项研究比较了长期暴露（一种认知行为疗法）加帕罗西汀（一种选择性5-羟色胺再摄取抑制剂）与长期暴露加安慰剂治疗恐怖主义相关PTSD的效果。2001年9月11日世界贸易中心袭击的PTSD成年幸存者被随机分配到10周的治疗组，分别接受长期暴露（10次）加帕罗西汀（N = 19）和长期暴露加安慰剂（N = 18）。第10周后，患者停止长期暴露，并接受额外12周的继续随机治疗。在10周的联合治疗期间，与长期暴露加安慰剂治疗的患者相比，长期暴露加帕罗西汀治疗的患者在PTSD症状（发生率比= 0.50; 95%CI = 0.30 - 0.85; p = 0.013）和缓解状态（比值比= 12.6; 95%CI = 1.23 - 129; p = 0.034）方面的改善显著更大。联合治疗的反应率和生活质量也得到了显著改善。继续随机治疗12周以上的患者亚组显示无组间差异。帕罗西汀联合长期暴露的初始治疗比长期暴露加安慰剂治疗与世贸中心袭击有关的PTSD更有效。联合用药和长期暴露治疗值得进一步研究，在更大的样本与不同形式的创伤后应激障碍，并在更长的随访期。
Selective serotonin reuptake inhibitors are often recommended in combination with established cognitive behavioral therapies for posttraumatic stress disorder (PTSD), but combined initial treatment of PTSD has not been studied under controlled conditions. There are also few studies of either treatment in PTSD related to terrorism. This study compared combined prolonged exposure (a cognitive behavioral therapy) plus paroxetine (a selective serotonin reuptake inhibitor) to prolonged exposure plus placebo in the treatment of terrorism-related PTSD. Adult survivors of the World Trade Center attacks of September 11, 2001 with PTSD were randomized to 10 weeks of treatment with combined prolonged exposure (10 sessions) plus paroxetine (N=19) versus prolonged exposure plus placebo (N=18). After week 10, patients discontinued prolonged exposure and were offered 12 additional weeks of continued randomized treatment. Patients treated with prolonged exposure plus paroxetine experienced significantly greater improvement in PTSD symptoms (incidence rate ratio=0.50; 95% CI=0.30–0.85; p=.013) and remission status (odds ratio=12.6; 95% CI=1.23–129; p=.034) during 10 weeks of combined treatment than patients treated with prolonged exposure plus placebo. Response rate and quality of life also improved significantly more with combined treatment. The subset of patients who continued randomized treatment for 12 more weeks showed no group differences. Initial treatment with combined paroxetine plus prolonged exposure was more efficacious than prolonged exposure plus placebo for PTSD related to the World Trade Center attacks. Combined medication and prolonged exposure treatment deserves further study in larger samples with diverse forms of PTSD, and over longer periods of follow-up.
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