A double-blind, placebo-controlled trial of lamotrigine for pathological skin picking: treatment efficacy and neurocognitive predictors of response.
A double-blind, placebo-controlled trial of lamotrigine for pathological skin picking: treatment efficacy and neurocognitive predictors of response.
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DOI：
10.1097/jcp.0b013e3181e617a1
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发表时间：
2010-08
影响因子：
2.9
通讯作者：
Kim SW
中科院分区：
文献类型：
--
作者：
Grant JE;Odlaug BL;Chamberlain SR;Kim SW
虽然病理性皮肤采摘 (PSP) 是一种相对常见的行为，但其治疗数据有限。目前的研究旨在检验拉莫三嗪对成人 PSP 的疗效和耐受性，并检验治疗反应的神经认知预测因子。在一项为期 12 周的随机、双盲、安慰剂对照试验中，32 名 PSP 受试者（29 名女性受试者 [90.6%]；平均年龄，32.8±13.3 岁）接受了拉莫三嗪作为单一疗法的治疗。基线认知评估包括停止信号和维度内/维度外设定转移任务。拉莫三嗪的剂量范围为 12.5 至 300 mg/d。主要结果测量是选择由耶鲁-布朗强迫症量表（针对神经质痛斥而修改）测量的症状。还通过心理社会功能的测量来评估受试者。拉莫三嗪和安慰剂在主要或次要终点方面没有显着的总体差异。分配至拉莫三嗪组的 7 名受试者 (43.8%) 被认为是有反应者（在耶鲁-布朗强迫症量表中定义为≥ 35%），而分配至安慰剂组的受试者有 5 名 (31.3%)。与拉莫三嗪无反应者相比，最终对拉莫三嗪有反应的人在基线时表现出认知灵活性受损（超维度转变）。这些研究结果表明，尽管拉莫三嗪治疗安全且耐受性良好，但与安慰剂相比，拉莫三嗪治疗对于整个 PSP 患者可能并不有效。然而，这些神经认知数据表明，拉莫三嗪可能对认知灵活性相对受损的一部分患者有价值。
Although a relatively common behavior, treatment data for pathological skin picking (PSP) are limited. The current study sought to examine the efficacy and tolerability of lamotrigine in adults with PSP and to examine neurocognitive predictors of treatment response. Thirty-two subjects (29 female subjects [90.6%]; mean age, 32.8±13.3 years) with PSP were treated in a 12-week randomized, double-blind, placebo-controlled trial of lamotrigine as monotherapy. Baseline cognitive assessment comprised the stop signal and intradimensional/extradimensional set shift tasks. Lamotrigine dosing ranged from 12.5 to 300 mg/d. The primary outcome measure was picking symptoms measured by the Yale-Brown Obsessive Compulsive scale Modified for Neurotic Excoriation. Subjects also were assessed with measures of psychosocial functioning. No significant overall differences were noted between lamotrigine and placebo on the primary or secondary end points. Seven subjects assigned to lamotrigine (43.8%) were considered responders (defined as≥ 35% n the Yale-Brown Obsessive Compulsive scale Modified for Neurotic Excoriation) compared with 5 (31.3%) assigned to placebo. Those who ultimately responded to lamotrigine exhibited impaired cognitive flexibility (extradimensional shifting) at baseline compared with lamotrigine nonresponders. These findings suggest that, although safe and well tolerated, lamotrigine treatment may not be efficacious in patients with PSP as a whole, compared with placebo. However, these neurocognitive data suggest that lamotrigine may be valuable in a subset of patients who exhibit relatively impaired cognitive flexibility.