Pulse-loaded intravenous clomipramine in treatment-resistant obsessive-compulsive disorder.
Pulse-loaded intravenous clomipramine in treatment-resistant obsessive-compulsive disorder.
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脉冲负荷静脉注射氯米帕明治疗难治性强迫症。
DOI：
10.1097/01.jcp.0000195112.24769.b3
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发表时间：
2006
影响因子：
2.9
通讯作者：
Elliott,Michael
中科院分区：
文献类型：
--
作者：
Koran,LorrinM;Aboujaoude,Elias;Ward,Herbert;Shapira,NathanA;Sallee,FloydR;Gamel,Nona;Elliott,Michael
目的：为了验证这些假说，我们进行了一项随机、双盲、双模拟的脉冲式静脉和口服CMI研究，随后进行了为期12周的开放式口服CMI。方法：我们招募了34名志愿者和参照组，这些成年人的初级诊断为《精神障碍诊断和统计手册》，第四版强迫症持续时间为≥1年，耶鲁-布朗强迫量表评分为≥20。符合条件的受试者未通过≥2充分的5-羟色胺再摄取抑制剂试验。受试者第1天静脉或口服CMI 150 mg，第2天口服CMI 200 mg，第6天开始口服CMI 200 mg/d，以后每4天增加25 mg，至耐受性250 mg/d，疗程12周。结果：不良反应导致口服脉冲负荷时停药1例，开放口服时停药5例。在第6天或第12周，静脉脉冲负荷并没有引起比口服脉冲负荷更快或更大的Yale-Brown强迫量表评分下降。第6天和第12周的改善与血浆药物或代谢物浓度无关。脉冲负荷本身对治疗难治性强迫症的改善似乎比预期的更快、更大。结论：口服脉冲负荷方案治疗难治性强迫症值得进一步研究。
Objective:To test these hypotheses, we conducted a randomized, double-blind, double-dummy study of pulse-loaded intravenous versus oral CMI, followed by open-label oral CMI for 12 weeks.Methods:We enrolled a volunteer and referred group of 34 adults with a primary diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition obsessive-compulsive disorder of≥ 1-year duration and Yale-Brown Obsessive Scale score of≥ 20. Eligible subjects had failed≥ 2 adequate serotonin reuptake inhibitor trials. Subjects received pulse loaded CMI 150 mg by vein or by mouth on day 1 and 200 mg on day 2. Oral CMI began on day 6 at 200 mg/d and was increased by 25 mg every 4 days to 250 mg/d, as tolerated, for 12 weeks.Results:Adverse events led to one withdrawal during oral pulse loading and 5 during open-label oral treatment. Intravenous pulse loading did not induce a more rapid or greater Yale-Brown Obsessive Scale score decrease than oral pulse loading at day 6 or by week 12. Day 6 and week 12 improvement were unrelated to plasma drug or metabolite concentrations. Pulse loading itself seemed to induce more rapid and greater improvement than expected in treatment-resistant obsessive-compulsive disorder.Conclusions:Further investigation of oral pulse-loading regimens in treatment-resistant obsessive-compulsive disorder is warranted.