McCall W V, Shelp F E, McDonald W M
Department of Psychiatry, Duke University School of Medicine, Durham, N.C.
Am J Psychiatry. 1992 Feb;149(2):202-6. doi: 10.1176/ajp.149.2.202.
Clinical reports over the last 60 years suggest that the amobarbital interview is effective in relieving catatonic symptoms. This has never been substantiated with methodologically sound trials. The authors postulated that a randomized blind comparison of intravenous amobarbital and saline would demonstrate the superiority of amobarbital in relieving catatonic mutism.
The subjects were 20 inpatients with catatonic mutism. They were randomly assigned to either saline (N = 10) or a 5% amobarbital solution (N = 10), and the infusions were administered intravenously at a rate of 1 cc/min or less over 10 minutes by a blinded physician. A second blinded physician administered a semistructured interview during the infusion to control for the effect of suggestion. A third blinded physician rated patient responsiveness, reactivity, and arousal. Any patient who was unresponsive to the initial infusion was crossed over to the other infusion. Interviews were videotaped for determination of interrater reliability.
In the initial infusions, six of 10 patients responded to amobarbital and zero of 10 responded to saline. Four of the saline nonresponders responded when given amobarbital. Response was evident by the 4th minute of the amobarbital infusion. Interrater reliability was high. The responders and nonresponders differed significantly in the variance of the weight-adjusted amobarbital dose, and the responders tended to be older and female.
Intravenous amobarbital is superior to saline in relieving catatonic mutism, although only 50% of these patients responded. The nonresponders were distinguished from the responders by a greater variance in the weight-adjusted dose of amobarbital.
过去60年的临床报告表明，异戊巴比妥试验对缓解紧张症症状有效。但这从未在方法学上合理的试验中得到证实。作者推测，静脉注射异戊巴比妥和生理盐水的随机双盲比较将证明异戊巴比妥在缓解紧张性缄默方面的优越性。
研究对象为20例紧张性缄默住院患者。他们被随机分为生理盐水组（N = 10）或5%异戊巴比妥溶液组（N = 10），由一位不知情的医生以每分钟1毫升或更低的速度在10分钟内静脉输注。另一位不知情的医生在输注过程中进行半结构化访谈，以控制暗示的影响。第三位不知情的医生对患者的反应性、反应能力和觉醒程度进行评分。任何对初始输注无反应的患者都换用另一种输注。访谈过程被录像，以确定评分者间的可靠性。
在初始输注中，10例接受异戊巴比妥治疗的患者中有6例有反应，而10例接受生理盐水治疗的患者中无1例有反应。4例接受生理盐水治疗无反应的患者在给予异戊巴比妥后有反应。在异戊巴比妥输注第4分钟时反应明显。评分者间的可靠性很高。反应者和无反应者在体重调整后的异戊巴比妥剂量差异方面有显著不同，反应者往往年龄较大且为女性。
静脉注射异戊巴比妥在缓解紧张性缄默方面优于生理盐水，尽管只有50%的患者有反应。无反应者与反应者的区别在于体重调整后的异戊巴比妥剂量差异更大。
