Efficacy of D-Cycloserine for Enhancing Response to Cognitive-Behavior Therapy for Panic Disorder
Efficacy of D-Cycloserine for Enhancing Response to Cognitive-Behavior Therapy for Panic Disorder
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DOI：
10.1016/j.biopsych.2009.07.036
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发表时间：
2010-02-15
影响因子：
10.6
通讯作者：
Pollack, Mark H.
中科院分区：
文献类型：
--
作者：
Otto, Michael W.;Tolin, David F.;Pollack, Mark H.
背景资料：传统的认知行为治疗加药物治疗的组合策略对焦虑症的治疗效果令人失望。增强的认知行为治疗与d-环丝氨酸（DCS）药物治疗是一种新的策略，用于改善治疗性学习的认知行为治疗，仍然未经测试的panic disorder.Method：这是一个随机，双盲，安慰剂对照增强试验检查除了隔离剂量的50毫克氯环丝氨酸或丸安慰剂，以简短的安全为基础的认知行为治疗。随机参与者是31名符合DSM-IV标准的惊恐障碍伴或不伴广场恐怖症的门诊患者，他们接受了五次手动认知行为治疗，强调暴露于恐惧的内部感觉（内感受性暴露），但也包括信息，认知和情境暴露干预。在认知行为治疗第3 - 5阶段前1小时给予研究药物剂量。主要结果的措施是惊恐障碍的严重程度量表（PDSS）和临床医生的全球immortality的Severity.Results：结果表明大的效应大小的认知行为治疗的认知行为治疗的Cl-环丝氨酸增强的附加效益。在治疗后和1个月随访时，接受cl-环丝氨酸的参与者与安慰剂相比，在PDSS和疾病的总体严重程度方面具有更好的结果，并且更有可能达到临床显著变化状态（77% vs. 33%）。有没有显着的不良反应与DCS administration.Conclusions：这个试点研究扩展支持的作用，Cl-环丝氨酸在提高治疗性学习的认知行为疗法，是第一个这样做的协议，强调暴露于恐惧的内部感觉焦虑恐慌症。
Background: Traditional combination strategies of cognitive-behavior therapy plus pharmacotherapy have met with disappointing results for anxiety disorders. Enhancement of cognitive-behavior therapy with d-cycloserine (DCS) pharmacotherapy represents a novel strategy for improving therapeutic learning from cognitive-behavior therapy that remains untested in panic disorder.Method: This is a randomized, double-blind, placebo-controlled augmentation trial examining the addition of isolated doses of 50 mg cl-cycloserine or pill placebo to brief exposure-based cognitive-behavior therapy. Randomized participants were 31 outpatients meeting DSM-IV criteria for panic disorder with or without agoraphobia, who were offered five sessions of manualized cognitive-behavior therapy emphasizing exposure to feared internal sensations (interoceptive exposure) but also including informational, cognitive, and situational exposure interventions. Doses of study drug were administered 1 hour before cognitive-behavior therapy sessions 3 to 5. The primary outcome measures were the Panic Disorder Severity Scale (PDSS) and Clinicians' Global Impressions of Severity.Results: Results indicated large effect sizes for the additive benefit of cl-cycloserine augmentation of cognitive-behavior therapy for panic disorder. At posttreatment and 1 month follow-up, participants who received cl-cycloserine versus placebo had better outcomes on the PDSS and global severity of disorder and were significantly more likely to have achieved clinically significant change status (77% vs. 33%). There were no significant adverse effects associated with DCS administration.Conclusions: This pilot study extends support for the role of cl-cycloserine in enhancing therapeutic learning from exposure-based cognitive-behavior therapy and is the first to do so in a protocol emphasizing exposure to feared internal sensations of anxiety in panic disorder.