Pae Chi-Un, Lim Hyn-Kook, Peindl Kathleen, Ajwani Neena, Serretti Alessandro, Patkar Ashwin A, Lee Chul
Department of Psychiatry, The Catholic University of Korea, College of Medicine, Seoul, South Korea.
Int Clin Psychopharmacol. 2008 Jan;23(1):1-8. doi: 10.1097/YIC.0b013e32825ea324.
Posttraumatic stress disorder (PTSD) is a prevalent and disabling mental illness. Small studies found atypical antipsychotics (AAs) to be beneficial in the treatment of patients with PTSD regardless of psychotic symptoms who are unresponsive to conventional pharmacological treatments such as serotonin selective reuptake inhibitors. This study reports the results of a meta-analysis of existing randomized, double-blind, placebo-controlled clinical trials (RCTs) of AAs as a monotherapy or augmentation therapy for the treatment of patients with PTSD. Seven RCTs were identified through extensive scans of databases, which included PubMed, MedLine, the National PTSD Center Pilots database, PsycINFO, Cochrane Central Register of Controlled Trials, and the Abstracts Library of the American Psychiatric Association with predefined inclusion criteria. Dichotomous and continuous measures were performed using a fixed effects model, heterogeneity was assessed, and subgroup analyses were done. Data from seven RCTs involving a total of 192 PTSD patients (102 randomized to AAs and 90 randomized to placebo) were analyzed. The results show that AAs may have a beneficial effect in the treatment of PTSD, as indicated by the changes from baseline in Clinician Administered PTSD Scale total scores [standardized mean difference (SMD)=-0.45, 95% confidence interval (CI) (-0.75, -0.14), P=0.004]. In addition, the overall SMD of the mean changes in the three Clinician Administered PTSD Scale subscores was statistically significant (P=0.007) between AAs and placebo groups, favoring AAs over placebo (SMD=-0.27, 95% CI=-0.47, -0.07). In particular, the symptom of 'intrusion' was mainly responsible for this significance. Clinical significance of the results, however, should be carefully interpreted and translated into clinical practice, given that the quality and availability of currently existing RCTs included in the analysis.
创伤后应激障碍（PTSD）是一种常见且致残的精神疾病。小型研究发现，非典型抗精神病药物（AAs）对PTSD患者的治疗有益，无论其是否有精神病性症状，且对诸如5-羟色胺选择性再摄取抑制剂等传统药物治疗无反应。本研究报告了一项荟萃分析的结果，该分析针对现有将AAs作为单一疗法或增效疗法治疗PTSD患者的随机、双盲、安慰剂对照临床试验（RCTs）。通过广泛检索数据库确定了7项RCTs，这些数据库包括PubMed、MedLine、国家PTSD中心试点数据库、PsycINFO、Cochrane对照试验中央登记库以及美国精神病学协会摘要库，并采用了预定义的纳入标准。使用固定效应模型进行二分法和连续性测量，评估异质性，并进行亚组分析。分析了来自7项RCTs的数据，共涉及192例PTSD患者（102例随机分配至AAs组，90例随机分配至安慰剂组）。结果显示，AAs在治疗PTSD方面可能具有有益效果，这由临床医生实施的PTSD量表总分相对于基线的变化所表明[标准化均数差（SMD）=-0.45，95%置信区间（CI）（-0.75，-0.14），P=0.004]。此外，临床医生实施的PTSD量表三个子分数的平均变化的总体SMD在AAs组和安慰剂组之间具有统计学意义（P=0.007），表明AAs优于安慰剂（SMD=-0.27，95%CI=-0.47，-0.07）。特别是，“侵入性”症状是这一显著性的主要原因。然而，鉴于分析中纳入的现有RCTs的质量和可获取性，应谨慎解释结果的临床意义并将其转化为临床实践。
