条件性药效：初步研究。
Conditioned pharmacotherapeutic effects: a preliminary study.
机构信息
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
出版信息
Psychosom Med. 2010 Feb;72(2):192-7. doi: 10.1097/PSY.0b013e3181cbd38b. Epub 2009 Dec 22.
OBJECTIVE
To test the hypothesize that psoriasis patients treated under a partial schedule of pharmacologic (corticosteroid) reinforcement would show less severe symptoms and relapse than those given the same amount of drug under standard conditions. Behavioral conditioning as an inherent component of many pharmacotherapeutic protocols has never been examined.
METHODS
A double-blind, simple randomization intervention was conducted with 46 patients from California and New York. Initially, lesions were treated with 0.1% acetonide triamcinolone under standard treatment conditions. Thereafter, a Standard Therapy group continued on continuous reinforcement (active drug every treatment) with 100% of the initial dose; Partial Reinforcement patients received a full dose 25% to 50% of the time and placebo medication other times; Dose Control patients received continuous reinforcement with 25% to 50% of the initial dose.
RESULTS
Severity of disease scores in California neither supported nor refuted the hypothesis. In New York, where there was no difference between Partial Reinforcement and Dose Control groups at baseline, partial reinforcement effected a greater reduction in lesion severity than Dose Control conditions and did not differ from Standard Therapy patients receiving two to four times more drug. For the entire population, the frequency of relapse under partial reinforcement (26.7%) was lower than in Dose Control patients (61.5%) and did not differ from full-dose treatment (22.2%).
CONCLUSIONS
A partial schedule of pharmacotherapeutic reinforcement could maintain psoriasis patients with a cumulative amount of corticosteroid that was relatively ineffective when administered under standard treatment conditions. Conceivably, corticosteroid administration only one quarter or half as frequently as currently prescribed is sufficient to treat psoriasis. We posit, however, that these preliminary observations implicate conditioning processes in-and for the design of-regimens of pharmacotherapy.
目的
验证下述假说，即接受部分药物强化治疗（皮质类固醇）的银屑病患者的症状和复发程度会轻于接受标准条件下相同药物剂量治疗的患者。行为矫正作为许多药物治疗方案的固有组成部分，尚未得到检验。
方法
对来自加利福尼亚州和纽约州的 46 名患者进行了一项双盲、简单随机干预研究。最初，所有患者的皮损均接受 0.1%醋酸曲安奈德的标准治疗。此后，标准治疗组继续接受连续强化治疗（每次治疗均使用初始剂量的 100%）；部分强化治疗组在 25%至 50%的时间内接受全剂量治疗，而在其余时间内接受安慰剂治疗；剂量控制组接受 25%至 50%初始剂量的连续强化治疗。
结果
加利福尼亚州的疾病严重程度评分既不支持也不反驳该假说。在纽约州，部分强化治疗组和剂量控制组在基线时无差异，与剂量控制条件相比，部分强化治疗使皮损严重程度显著降低，且与接受 2 至 4 倍药物剂量的标准治疗组无差异。对于整个研究人群，部分强化治疗组（26.7%）的复发频率低于剂量控制组（61.5%），但与全剂量治疗组（22.2%）无差异。
结论
与标准治疗条件下相比，药物强化治疗的部分方案可维持银屑病患者的皮质类固醇累积量，该累积量的治疗效果相对较差。可以设想，皮质类固醇的给药频率仅为目前规定的四分之一或一半，就足以治疗银屑病。然而，我们推测，这些初步观察结果暗示了在药物治疗方案的设计中存在条件作用过程。
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