在安慰剂治疗期间的负面影响:系统性审查和元分析
Tom Bschor1,2, Josephine Unger3, Lea Nagel1,4
1Department of Psychiatry and Psychotherapy, University Hospital, Technical University of Dresden, Dresden, Germany.
JAMA psychiatry
|April 16, 2025
概括
假药治疗的负面影响在各个精神病诊断中存在显著差异. 精神分裂症显示出最高的退学率,而主要抑郁症则是最低的,这表明临床试验中的差异性nocebo效应.
科学领域:
- 精神病学和临床心理学
- 药理学和治疗学 药理学和治疗学
背景情况:
- 临床试验中的安慰剂组提供了一个独特的跨诊断比较点.
- 以前的元分析表明,安慰剂反应在精神病诊断中有所不同.
- 缺乏与安慰剂相关的负面影响 (nocebo效应) 的综合性跨诊断比较.
研究的目的:
- 为了比较9个主要精神疾病中安慰剂组的研究过早终止率.
- 分析总学,由于不良事件而学,由于缺乏效果而学.
主要方法:
- 对九种精神病诊断的高质量,最近的安慰剂受控随机临床试验 (RCT) 的系统审查.
- 每个诊断选择10个RCT,共计90个RCT.
- 使用随机效应模型,对95%CI的聚合脱学率 (DRs) 的元分析.
主要成果:
- 在诊断的不同情况下,退学率有显著差异 (Q=82.2,P<.001).
- 精神分裂症 (DR=0.41) 和躁狂症的总学率和由于缺乏效果而学率最高.
- 重度抑郁症 (MDD) 和注意力缺陷/多动症 (ADHD) 的学率最低,而MDD在安慰剂下显示出最有利的过程.
结论:
- 安慰剂治疗与诊断特定的不良影响有关,主要是缺乏效果.
- 在安慰剂下,精神分裂症表现出最不有利的过程,而MDD表现出最有利的过程.
- 这些发现强调了考虑安慰剂反应和无效果效应的诊断变异的重要性.
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