Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression.
Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression.
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DOI：
10.1002/da.22253
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发表时间：
2014-04
影响因子：
7.4
通讯作者：
Mathew, Sanjay J.
中科院分区：
文献类型：
--
作者：
Price, Rebecca B.;Iosifescu, Dan V.;Murrough, James W.;Chang, Lee C.;Al Jurdi, Rayan K.;Iqbal, Syed Z.;Soleimani, Laili;Charney, Dennis S.;Foulkes, Alexandra L.;Mathew, Sanjay J.
初步证据表明，静脉注射氯胺酮对自杀认知有快速影响，使其成为有自杀危险的抑郁症患者的一个有吸引力的候选药物。在第一个使用麻醉控制条件的氯胺酮随机对照试验中，我们测试了氯胺酮对外显自杀认知的急性影响，以及先前与自杀行为有关的基于表现的内隐自杀认知指数(内隐联想测试；IAT)。采用外显自杀意念综合指数(自杀意念贝克量表、蒙哥马利-阿斯伯格自杀项目量表、抑郁症状自杀项目快速问卷)和≥-3抗抑郁药物疗效不佳的自杀意念综合指数对有症状的单相抑郁症患者进行评估。在基线和单次亚麻醉剂量氯胺酮(n=36)或咪达唑仑(n=21)后24小时采取措施，咪达唑仑是一种精神活性安慰剂，因其类似的快速麻醉效果而被选择。输注24小时后，氯胺酮组的外显自杀认知显著减少，但咪达唑仑组没有。在24小时内，接受氯胺酮治疗的患者中，53%的患者在所有三种显性自杀措施上的得分均为零，而咪达唑仑组的这一比例为24%(χ2=4.6P=0.03)。服用氯胺酮后，自我和逃避相关词汇之间的隐含联系减少(P=.01；D=.58)，但咪达唑仑没有减少(P=.68；D=.09)。在基线自杀认知升高的患者中，明确自杀认知的氯胺酮特异性下降幅度最大，并通过非自杀相关抑郁症状的减少来调节。静脉注射氯胺酮比服用活性安慰剂更能迅速减少自杀认知。有必要进一步研究，在高危样本中测试氯胺酮的抗自杀作用。
Preliminary evidence suggests intravenous ketamine has rapid effects on suicidal cognition, making it an attractive candidate for depressed patients at imminent risk of suicide. In the first randomized controlled trial of ketamine using an anesthetic control condition, we tested ketamine’s acute effects on explicit suicidal cognition and a performance-based index of implicit suicidal cognition (Implicit Association Test; IAT) previously linked to suicidal behavior. Symptomatic patients with treatment-resistant unipolar major depression (inadequate response to ≥3 antidepressants) were assessed using a composite index of explicit suicidal ideation (Beck Scale for Suicidal Ideation, Montgomery-Asberg Rating Scale suicide item, Quick Inventory of Depressive Symptoms suicide item) and the IAT to assess suicidality implicitly. Measures were taken at baseline and 24 hr following a single subanesthetic dose of ketamine (n = 36) or midazolam (n = 21), a psychoactive placebo agent selected for its similar, rapid anesthetic effects. Twenty four hours postinfusion, explicit suicidal cognition was significantly reduced in the ketamine but not the midazolam group. Fifty three percent of ketamine-treated patients scored zero on all three explicit suicide measures at 24 hr, compared with 24% of the midazolam group (χ2 = 4.6; P = .03). Implicit associations between self- and escape-related words were reduced following ketamine (P = .01; d = .58) but not midazolam (P = .68; d = .09). Ketamine-specific decreases in explicit suicidal cognition were largest in patients with elevated suicidal cognition at baseline, and were mediated by decreases in nonsuicide-related depressive symptoms. Intravenous ketamine produces rapid reductions in suicidal cognition over and above active placebo. Further study is warranted to test ketamine’s antisuicidal effects in higher-risk samples.
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DOI：
10.1038/npp.2012.248
发表时间：
2013-04
期刊：
Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
影响因子：
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作者：
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影响因子：
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DOI：
10.1176/appi.ajp.2013.13030392
发表时间：
2013-10
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影响因子：
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DOI：
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发表时间：
2010-12
期刊：
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影响因子：
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