Labbate Lawrence A, Sonne Susan C, Randal Carrie L, Anton Raymond F, Brady Kathleen T
Mental Health Service, VA Medical Center, and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA.
Compr Psychiatry. 2004 Jul-Aug;45(4):304-10. doi: 10.1016/j.comppsych.2004.03.015.
Post-traumatic stress disorder (PTSD) is commonly comorbid with other psychiatric disorders, including substance use disorders. In spite of this, pharmacologic treatment trials for PTSD often exclude individuals with significant psychiatric comorbidity. This study is a post hoc analysis of a 12-week double-blind placebo-controlled trial investigating sertraline in the treatment of patients with comorbid PTSD and an alcohol use disorder. Individuals with additional anxiety and affective disorders were included. Patients (N = 93) were stratified into four groups depending on presence or absence of additional anxiety or depressive disorders and evaluated for the effects of comorbidity on PTSD symptoms, depressive symptoms, and drinking behaviors. We hypothesized that additional comorbidity would be associated with poorer outcomes. Patients in all four subgroups showed marked and clinically significant improvement in alcohol drinking behaviors over the course of the study. For the entire sample, over the course of the 12 weeks, mean drinks per drinking day fell from 13.0 +/- 8.4 (SD) to 3.0 +/- 5.0 (SD); t = 10.2, df = 92, P <.000. There were, however, no significant differences among groups. Patients in all four groups showed moderate improvement in Hamilton Depression Rating Scale (HAMD) scores and Clinician-Administered PTSD scale (CAPS) scores at endpoint. For the entire sample, mean CAPS scores fell from 59.3 +/- 19.4 (SD) to 40.8 +/- 26.0, t = 8.9, df = 92, P <.000. Mean HAMD scores fell from 17. 9 +/- 6.7 (SD) at baseline to 11.8 +/- 9.4 (SD) at endpoint; t = 6.7, df = 92, P <.000. There were, however, no significant differences among groups for change in HAM-D or CAPS scores. Hence, contrary to our hypothesis, having additional anxiety or mood disorder comorbidity did not decrease treatment response in individuals with comorbid PTSD and an alcohol use disorder.
创伤后应激障碍（PTSD）通常与其他精神障碍共病，包括物质使用障碍。尽管如此，针对PTSD的药物治疗试验往往将有显著精神共病的个体排除在外。本研究是一项对一项为期12周的双盲安慰剂对照试验的事后分析，该试验调查了舍曲林在治疗共病PTSD和酒精使用障碍患者中的作用。纳入了患有其他焦虑和情感障碍的个体。患者（N = 93）根据是否存在其他焦虑或抑郁障碍被分为四组，并评估共病对PTSD症状、抑郁症状和饮酒行为的影响。我们假设额外的共病会与更差的结果相关。在研究过程中，所有四个亚组的患者在饮酒行为方面均表现出显著且具有临床意义的改善。对于整个样本，在12周的过程中，每个饮酒日的平均饮酒量从13.0±8.4（标准差）降至3.0±5.0（标准差）；t = 10.2，自由度 = 92，P <.000。然而，各组之间没有显著差异。所有四组患者在终点时汉密尔顿抑郁量表（HAMD）评分和临床医生评定的PTSD量表（CAPS）评分均有中度改善。对于整个样本，平均CAPS评分从59.3±19.4（标准差）降至40.8±26.0，t = 8.9，自由度 = 92，P <.000。平均HAMD评分从基线时的17.9±6.7（标准差）降至终点时的11.8±9.4（标准差）；t = 6.7，自由度 = 92，P <.000。然而，各组在HAMD或CAPS评分变化方面没有显著差异。因此，与我们的假设相反，患有额外的焦虑或情绪障碍共病并不会降低共病PTSD和酒精使用障碍个体的治疗反应。
