Pharmacological relapse prevention of alcoholism: Clinical predictors of outcome
Pharmacological relapse prevention of alcoholism: Clinical predictors of outcome
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DOI：
10.1159/000083037
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发表时间：
2005-01-01
影响因子：
3.9
通讯作者：
Wiedemann, K
中科院分区：
文献类型：
--
作者：
Kiefer, F;Helwig, H;Wiedemann, K
目的：氨基己酸酯和纳曲酮预防酒精中毒复发的药理作用已得到多项对照试验的支持。目前仍不确定是否存在任何治疗的不同适应症。方法：根据Cloninger和Lesch提出的分型方法，我们对低基线和高基线躯体痛苦、抑郁和焦虑(症状自评量表，SCL-90)、低基线渴求和高基线渴求的患者进行了阿卡米松和纳曲酮的对照试验。这些变量以前被认为是结果的预测因素。结果：比较戒断率的病程，阿卡米松对低基线躯体苦恼患者主要有效，纳曲酮对高基线抑郁患者尤其有效。基线渴求没有显示出预测价值。根据Cloninger的说法，药物治疗对于II型酒精患者是有效的。根据Lesch的分型，醋氨己酸酯主要对I型有效，而纳曲酮对III型和IV型疗效最好。结论：本研究支持不同亚组的酒精依赖患者可能受益于纳曲酮或氨基己酸酯区别治疗的假说。基线精神病理学，特别是分型可能有助于将患者与不同的药物治疗干预措施相匹配。版权所有(C)2005 S.Karger AG，巴塞尔。
Objective: The efficacy of pharmacological relapse prevention in alcoholism with acamprosate and naltrexone has been supported by several controlled trials. It remains uncertain whether any differential indication for treatment exists. Methods: We evaluated outcome data of a controlled trial on acamprosate and naltrexone in patients with low vs. high baseline somatic distress, depression and anxiety ( Symptom Checklist-90, SCL-90), low vs. high baseline craving, and according to typological differentiation as proposed by Cloninger and Lesch. These variables have previously been suggested to be predictors of outcome. Results: Comparing the course of abstinence rates, acamprosate was mainly efficacious in patients with low baseline somatic distress, whereas naltrexone was effective especially in patients with high baseline depression. Baseline craving showed no predictive value. Pharmacological treatment was efficacious in type II alcoholics according to Cloninger. Applying Lesch's typological differentiation, acamprosate was shown to be mainly effective in type I, whereas naltrex-one revealed best treatment effects in type III and IV. Conclusion: The study supports the hypothesis that different subgroups of alcohol dependent subjects might benefit from a differential treatment with either naltrexone or acamprosate. Baseline psychopathology and especially typological differentiation might be useful in matching patients to distinct pharmacotherapeutic interventions. Copyright (C) 2005 S. Karger AG, Basel.