Rapid benefit of intravenous pulse loading of clomipramine in obsessive-compulsive disorder.
Rapid benefit of intravenous pulse loading of clomipramine in obsessive-compulsive disorder.
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DOI：
10.1176/ajp.154.3.396
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发表时间：
1997-03
期刊：
影响因子：
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通讯作者：
L. Koran;F. Sallee;S. Pallanti
中科院分区：
文献类型：
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作者：
L. Koran;F. Sallee;S. Pallanti
目的：作者进行了一项随机、双盲、安慰剂对照试验，比较了强迫症患者静脉与口服氯丙咪嗪脉冲负荷治疗，以检验两个假设：1）静脉脉冲负荷治疗比口服脉冲负荷治疗立即改善更大，2）对脉冲负荷治疗有反应的患者在8周的口服氯丙咪嗪治疗期间将继续改善。方法15例病程至少1年的DSM-III-R强迫症患者，基线Yale-Brown强迫量表评分≥ 17分。在双盲口服或静脉脉冲负荷氯丙咪嗪后4.5天进行Yale-Brown量表评分，然后给予患者150 mg/天口服氯丙咪嗪，每4天增加25 mg至250 mg/天，或者在两例病例中给予其他选择性5-羟色胺再摄取抑制剂（SSRI）。结果第一个假设得到证实：第二次脉冲负荷剂量后4.5天，静脉注射氯丙咪嗪的7名患者中有6名，但口服药物的8名患者中只有1名对药物有反应。口服氯丙咪嗪8周后，结果部分支持第二个假设：6名对静脉注射氯丙咪嗪有反应的患者中有4名继续改善，但对脉冲负荷有反应的患者的改善在统计学上并不显著高于那些没有反应的患者。结论：氯丙咪嗪静脉脉冲负荷治疗可能是一种有价值的新的治疗强迫症的方法，特别是对于口服治疗试验失败的患者。
OBJECTIVE The authors conducted a randomized, double-blind, placebo-controlled trial of intravenous versus oral pulse loading of clomipramine in patients with obsessive-compulsive disorder to test two hypotheses: 1) intravenous pulse loading will cause greater immediate improvement than oral pulse loading and 2) patients who respond to pulse loading will continue to improve during 8 weeks of oral clomipramine treatment. METHOD Fifteen patients with DSM-III-R obsessive-compulsive disorder of at least 1 year's duration and baseline Yale-Brown Obsessive Compulsive Scale scores of 17 or higher were enrolled in the study. Yale-Brown scale ratings were made 4.5 days after double-blind oral or intravenous pulse loading of clomipramine, and patients were then given 150 mg/day of oral clomipramine with increases of 25 mg every 4 days to 250 mg/day as tolerated or, in two cases, other selective serotonin reuptake inhibitors (SSRIs). RESULTS The first hypothesis was confirmed: 4.5 days after the second pulse-loaded dose, six of seven patients given intravenous clomipramine but only one of eight given oral medication responded to the drug. After 8 weeks of oral clomipramine, the results partially supported the second hypothesis: four of six patients who had responded to intravenous clomipramine continued their improvement, but those who had responded to pulse loading did not improve statistically significantly more than those who had not. CONCLUSIONS Intravenous pulse loading of clomipramine may be a valuable new treatment for obsessive-compulsive disorder, particularly for patients who have failed oral treatment trials.