创伤后应激 (STEPS) 试验的顺序治疗有效性:与基线结果进行实用比较有效性试验的协议
John C Fortney1, Debra L Kaysen2, Charles C Engel1
1Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA.
Contemporary clinical trials
|June 12, 2024
概括
这项研究比较了初级保健中PTSD的简短创伤专注心理治疗和抗抑郁药. 它还检查了对不响应者进行切换或增强治疗,为临床决策提供了信息.
科学领域:
- 精神病学是一个精神病学.
- 临床心理学 临床心理学
- 主要护理医学 医疗保健
背景情况:
- 有限的对比试验存在,比较创伤后应激障碍 (PTSD) 治疗方法,特别是在初级保健机构.
- 需要实用试验来评估常见治疗在现实世界的临床环境中的有效性.
- 了解治疗顺序和增强对于有效管理PTSD至关重要.
研究的目的:
- 为了比较患有创伤后应激障碍的初级保健患者的结果,随机分配给初始治疗,以简短的创伤为中心的心理治疗或抗抑郁药.
- 评估后续治疗策略的有效性 (切换或增强) 对于那些对初始干预没有反应的患者.
- 为医疗保健系统和临床医生提供基于证据的指导,帮助他们选择PTSD治疗方法.
主要方法:
- 一项实用性试验,涉及700名从联邦合格卫生中心 (FQHC) 和退伍军人事务 (VA) 医疗中心的PTSD查阳性患者.
- 随机分配到三个治疗序列之一:SSRI然后WET,SSRI然后SNRI开关,或WET然后SSRI开关.
- 通过PTSD检查清单 (PCL-5) 测量的主要结局是基线,4个月和8个月的症状严重程度.
主要成果:
- 平均PCL-5评分表明在基线时PTSD症状严重程度相当大.
- 常见的创伤事件类型在VA (战斗) 和FQHC (其他,性侵犯,虐待儿童) 人口之间有所不同.
- 在研究开始时,很少有 (22.4%) 的参与者服用抗抑郁药.
结论:
- 研究结果将为医疗保健系统和临床医生提供有关PTSD最佳治疗途径的信息.
- 这项研究解决了关于初级保健中比较有效性和治疗顺序的证据差距.
- 预计通过指导治疗选择和修改,结果将改善患者的治疗结果.
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