同时使用心理药物与创伤后应激障碍创伤集中心理治疗的结果降低有关
Serge A Steenen1,2, Roos van Westrhenen3,4,5, Camilo C Steenen6
1Department of Oral Public Health, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
Psychotherapy and psychosomatics
|November 10, 2025
概括
用于创伤为重点的PTSD心理治疗的精神药物与较差的治疗结果有关. 优化药物管理可能会改善接受心理治疗的PTSD患者的结果.
科学领域:
- 精神病学和临床心理学
- 药理学 药理学是指药理学的学科.
- 心理健康研究 心理健康研究
背景情况:
- 创伤后应激障碍 (PTSD) 的治疗通常涉及心理治疗和精神药物.
- 心理药物联合治疗对PTSD心理治疗有效性的影响尚不清楚.
- 需要现实世界的数据来澄清心理药物使用与PTSD治疗反应之间的关联.
研究的目的:
- 调查治疗开始时与心理治疗结果之间的心理药物联合治疗之间的关联,在大型PTSD队列中.
- 模拟目标试验,对药物对PTSD症状减轻的影响进行可靠估计.
- 确定可能影响创伤重点心理治疗有效性的特定精神药物.
主要方法:
- 一组6125名患有PTSD的成年人接受了以创伤为重点的心理治疗 (长期暴露和EMDR).
- 使用双重机器学习和治疗权重的逆概率的目标试验模拟.
- 该研究评估了从治疗前到治疗后的DSM-5 (CAPS-5) 临床医生管理的PTSD评分尺度的变化.
主要成果:
- 总体而言,心理治疗显著改善了PTSD症状 (CAPS-5平均得分减少25.7分).
- 精神药物联合治疗与明显减少的症状改善有关 (估计差异为-2.52点,相对减少为-9.4%).
- 包括抗抑郁药物 (整体,阿米特利普提林,米尔塔扎平),抗药和抗精神病药物在内的特定药物显示出较差的结果;这种联系在6个月的随访中持续存在.
结论:
- 几种精神药物联合治疗与基于证据的创伤为焦点的PTSD心理治疗的结果降低有关.
- 识别和潜在地修改精神药物联合药物使用可能会优化心理治疗的有效性.
- 建议进行进一步的临床试验,以评估逐渐减少或替换这些药物的益处,以改善PTSD治疗结果.
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