Corregiari Fábio M, Gattaz Wagner F, Bernik Márcio
Ambulatório de Ansiedade, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Brasil.
Psychopharmacology (Berl). 2007 Sep;193(4):487-94. doi: 10.1007/s00213-007-0793-0. Epub 2007 May 10.
Serotonergic pharmacological challenges have failed to produce consensual results in patients with obsessive-compulsive disorder (OCD), suggesting a heterogeneous 5-hydroxytryptamine (5-HT) activity in this disorder.
The aim of this study was to compare the neuroendocrine response to a serotonergic challenge in OCD patient responders (RP) and nonresponders (NR) to serotonin reuptake inhibitors treatment and healthy volunteers.
Thirty OCD treatment NR, 30 RP, and 30 controls (CN) matched for sex and age were included. Each subject received 20 mg of intravenous citalopram. Prolactin, cortisol, and growth hormone plasma concentration were measured at times-20, 0, 20, 40, 60, 80, 100, 120, 140, and 160 min after the onset of citalopram infusion.
Citalopram did not induce anxiety or OCD symptoms in patients. Citalopram was associated with stronger prolactin response in the CN group (maximal percentage variation [max%Delta] = 65.76 +/- 105.1) than in NR (max%Delta = 17.41 +/- 31.06) and RP groups (max%Delta = 15.87 +/- 31.71; p = 0.032; Friedman chi (2) = 6.87; df = 2). On the other hand, cortisol response did not differ between CN and RP groups and was blunted in the NR group (NR max%Delta = 20.98 +/- 58.14 vs RP max%Delta = 47.69 +/- 66.94; CN max%Delta = 63.58 +/- 88.4; p = 0.015; Friedman chi (2) = 8.60; df = 2).
Compared to CN, both treatment RP and NR patients showed blunted prolactin response to citalopram, but only NR patients showed an attenuated cortisol response, suggesting a more disrupted central serotonergic transmission in this group.
血清素能药理学激发试验在强迫症（OCD）患者中未能产生一致的结果，这表明该疾病中5-羟色胺（5-HT）活性存在异质性。
本研究的目的是比较强迫症患者中对5-羟色胺再摄取抑制剂治疗有反应者（RP）和无反应者（NR）以及健康志愿者对血清素能激发试验的神经内分泌反应。
纳入30名强迫症治疗无反应者、30名有反应者和30名年龄及性别匹配的对照者（CN）。每位受试者静脉注射20毫克西酞普兰。在西酞普兰输注开始后的-20、0、20、40、60、80、100、120、140和160分钟测量催乳素、皮质醇和生长激素的血浆浓度。
西酞普兰未在患者中诱发焦虑或强迫症症状。与无反应者（最大百分比变化[max%Delta]=17.41±31.06）和有反应者组（最大百分比变化[max%Delta]=15.87±31.71；p=0.032；Friedman卡方值(2)=6.87；自由度=2）相比，西酞普兰在对照者组中与更强的催乳素反应相关（最大百分比变化[max%Delta]=65.76±105.1）。另一方面，对照者组和有反应者组之间的皮质醇反应无差异，而在无反应者组中皮质醇反应减弱（无反应者最大百分比变化[max%Delta]=20.98±58.14，有反应者最大百分比变化[max%Delta]=47.69±66.94；对照者最大百分比变化[max%Delta]=63.58±88.4；p=0.015；Friedman卡方值(2)=8.60；自由度=2）。
与对照者相比，治疗有反应者和无反应者患者对西酞普兰的催乳素反应均减弱，但只有无反应者患者的皮质醇反应减弱，这表明该组患者的中枢血清素能传递受到更严重的破坏。
