创伤后应激障碍初级护理治疗的实用比较有效性:一项随机临床试验
John C Fortney1,2, Debra L Kaysen3, Charles C Engel1,2
1Department of Psychiatry and Behavioral Sciences, Division of Population Health, School of Medicine, University of Washington, Seattle.
JAMA psychiatry
|October 15, 2025
概括
选择性血清素再吸收抑制剂 (SSRI) 和书面暴露疗法 (WET) 在初级保健中对创伤后应激障碍 (PTSD) 有效. 转换为一种血清素 - 上腺素再吸收抑制剂 (SNRI) 可能比 WET 增强对不响应者更好.
科学领域:
- 精神病学和行为健康
- 主要护理医学 医疗保健
- 临床心理学 临床心理学
背景情况:
- 有限的对头试验比较了PTSD的药物治疗和心理治疗.
- 很少有研究检查了初级保健机构中不响应患者的连续治疗方法.
研究的目的:
- 为了比较简短的以创伤为重点的心理治疗 (书面暴露疗法 (WET)) 与选择性血清素再吸收抑制剂 (SSRI) 对PTSD的有效性.
- 评估是否WET增强或切换到一种血清素-上腺素再吸收抑制剂 (SNRI) 对那些对SSRI无反应的患者更有效.
主要方法:
- 实用性比较有效性试验涉及700名患有PTSD的初级保健患者.
- 随机将患者分为三个序列:SSRI然后WET增强,SSRI然后切换到SNRI,或WET然后SSRI.
- 使用DSM-5 PTSD检查清单 (PCL-5) 评估PTSD症状严重程度.
主要成果:
- 无论是SSRI还是WET都显示出在初级保健中治疗PTSD的可行性和有效性.
- 在最初的SSRI和WET治疗之间,PCL-5降低没有显著差异.
- 对于SSRI不响应者,切换到SNRI导致PCL-5降低明显更大,而不是WET增强.
结论:
- 用SSRI或WET治疗PTSD在初级保健中是可行的和有效的.
- 切换到SNRI是一种潜在的更有效的策略,比WET增强对于初始SSRI反应不足的患者.
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