A Double-Blind, Randomized, Placebo-Controlled Trial of Fluoxetine in Patients With Intermittent Explosive Disorder
A Double-Blind, Randomized, Placebo-Controlled Trial of Fluoxetine in Patients With Intermittent Explosive Disorder
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DOI：
10.4088/jcp.08m04150
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发表时间：
2009-05-01
影响因子：
5.3
通讯作者：
Kavoussi, Richard J.
中科院分区：
文献类型：
--
作者：
Coccaro, Emil F.;Lee, Royce J.;Kavoussi, Richard J.
背景资料：间歇性爆炸性障碍（IED）是一种冲动性攻击性障碍，在生命的某个阶段影响多达7.3%的美国人口。由于中央多巴胺能（5-HT）系统功能障碍与冲动的攻击行为，药理学增强5-HT活性应减少冲动的攻击行为在个人与IED.Method：一个双盲，随机，安慰剂对照试验的选择性5-HT摄取抑制剂氟西汀进行了100个人与IED（研究诊断标准）和当前的历史冲动的攻击行为。主要疗效指标是门诊使用的外显攻击量表改良（OAS-M）的攻击评分。次要疗效指标包括OAS-M的易激惹评分和临床疗效总评量表（CGI-I）评分。结果：氟西汀治疗后OAS-M攻击性和OAS-M易激惹评分持续下降，早在治疗第2周时就明显下降（终点时攻击性p <0.01，易激惹p <0.001）。在CGI-I的应答者比例方面，氟西汀也上级安慰剂（p <0.001）。对数据进行更仔细的检查发现，46%的氟西汀治疗受试者的冲动性攻击行为（如IED的A标准所反映的）完全或部分缓解。氟西汀没有发挥抗抑郁或抗焦虑作用，其对冲动性攻击的影响不受当前抑郁或焦虑症状的存在。结论：氟西汀治疗具有明确的抗攻击作用，在冲动性攻击的个人与IED。然而，尽管氟西汀的抗攻击作用似乎很强，但在接受氟西汀治疗的受试者中，它们导致IED的完全或部分缓解率低于50%。J Clin Psychiatry 2009;70（5）：653-662（C）版权所有2009 Physicians Postgraduate Press，Inc.
Background: Intermittent explosive disorder (IED) is a disorder of impulsive aggression that affects as many as 7.3% of the U.S. population during some period of life. Since central serotonergic (5-HT) system dysfunction is related to impulsive aggressive behavior, pharmacologic enhancement of 5-HT activity should reduce impulsive aggressive behavior in individuals with IED.Method: A double-blind, randomized, placebo-controlled trial of the selective 5-HT uptake inhibitor fluoxetine was conducted in 100 individuals with IED (research diagnostic criteria) and current histories of impulsive aggressive behavior. The primary efficacy measure was the aggression score from the Overt Aggression Scale-Modified (OAS-M) for Outpatient Use. Secondary efficacy measures included the irritability score from the OAS-M and the Clinical Global Impressions-Improvement scale (CGI-I) score. The study took place between July 1990 and July 1999.Results: Fluoxetine treatment resulted in a sustained reduction in OAS-M aggression, and OAS-M irritability scores, apparent as early as week 2 (p < .01 for aggression and p < .001 for irritability at endpoint). Fluoxetine was also superior to placebo in the proportion of responders on the CGI-I (p < .001). Closer examination of the data revealed that full or partial remission of impulsive aggressive behaviors, as reflected by the A criteria for IED, occurred in 46% of fluoxetine-treated subjects. Fluoxetine did not exert an antidepressant or antianxiety effect, and its effects on impulsive aggression were not influenced by presence of current symptoms of depression or anxiety.Conclusion: Fluoxetine treatment has a clear antiaggressive effect in impulsive aggressive individuals with IED. However, while fluoxetine's antiaggressive effects appear robust, they lead to full or partial remission of IED in less than 50% of subjects treated with fluoxetine. J Clin Psychiatry 2009;70(5):653-662 (C) Copyright 2009 Physicians Postgraduate Press, Inc.