Predicting and Managing Treatment Non-Response in Posttraumatic Stress Disorder.
Predicting and Managing Treatment Non-Response in Posttraumatic Stress Disorder.
复制标题
预测和管理创伤后应激障碍中的无反应。
DOI：
10.1007/s40501-020-00203-1
复制
发表时间：
2020-06
影响因子：
--
通讯作者：
Lara A
中科院分区：
文献类型：
--
作者：
Fonzo GA;Federchenco V;Lara A
本综述旨在综合现有的研究，关于治疗阻力的定义在创伤后应激障碍（PTSD），一线干预治疗无反应的预测因子，和新兴的二线PTSD治疗方案成为一个可访问的资源，为执业临床医生。PTSD中治疗抵抗的概念目前定义和操作性都很差。在常规临床护理中，没有明确的治疗无应答预测因子，但现有研究确定了几个潜在的候选标记，包括男性性别，低社会支持，慢性和早期生活创伤暴露，共病精神障碍，严重的PTSD症状和身体健康状况差。对一线心理治疗和抗抑郁药无反应的PTSD患者最有希望的治疗选择包括经颅磁刺激和氯胺酮输注。亚甲二氧基甲基苯丙胺辅助的心理治疗似乎也很有前途，但仅在研究背景下可用。这些选择需要仔细考虑特定患者的风险和受益。需要更多的研究来制定一个强大的，临床上有用的定义治疗抵抗的创伤后应激障碍;确定可靠的，易于评估的，和可推广的预测创伤后应激障碍治疗无反应;并实施测量和预测在临床环境中，以确定个人不太可能响应一线治疗，并指导他们适当的二线治疗。
This review aims to synthesize existing research regarding the definition of treatment resistance in posttraumatic stress disorder (PTSD), predictors of treatment non-response to first-line interventions, and emerging second-line PTSD treatment options into an accessible resource for the practicing clinician. The concept of treatment resistance in PTSD is currently poorly defined and operationalized. There are no well-established predictors of treatment non-response utilized in routine clinical care, but existing research identifies several potential candidate markers, including male gender, low social support, chronic and early life trauma exposure, comorbid psychiatric disorders, severe PTSD symptoms, and poor physical health. The most promising available treatment options for PTSD patients non-responsive to first-line psychotherapies and antidepressants include transcranial magnetic stimulation and ketamine infusion. Methylenedioxymethamphetamine-assisted psychotherapy also appears promising but is only available in a research context. These options require careful consideration of risks and benefits for a particular patient. More research is required to develop a robust, clinically-useful definition of treatment resistance in PTSD; identify reliable, readily assessable, and generalizable predictors of PTSD treatment non-response; and implement measurement and prediction in clinical settings to identify individuals unlikely to respond to first-line treatments and direct them to appropriate second-line treatments.