神经影像学研究检查创伤后应激障碍的病理生理学是否需要非药物治疗的患者？
Does neuroimaging research examining the pathophysiology of posttraumatic stress disorder require medication-free patients?
机构信息
Department of Psychiatry, University of Western Ontario, London, Ont., Canada.
出版信息
J Psychiatry Neurosci. 2010 Mar;35(2):80-9. doi: 10.1503/jpn.090047.
BACKGROUND
In an attempt to avoid unknown influence, most neuroimaging studies examining the pathophysiology of posttraumatic stress disorder (PTSD) exclude patients taking medications. Here we review the empirical evidence for relevant medications having a confounding effect on task performance or cerebral blood flow (CBF) in this population. The evidence for potentially confounding effects of psychotherapy in PTSD are also discussed.
METHODS
The literature that we reviewed was obtained through a PubMed search from 1980 to 2009 using the search terms posttraumatic stress disorder, PTSD, psychotropic medications, neuroimaging, functional magnetic resonance imaging, positron emission tomography, cerebral blood flow, CBF, serotonin-specific reuptake blocker, benzodiazepine, ketamine, methamphetamine, lamotrigine and atypical antipsychotic agents.
RESULTS
The empirical evidence for relevant medications having a confounding effect on task performance or CBF in relevant areas remains sparse for most psychotropic medications among patients with PTSD. However, considerable evidence is accumulating for 2 of the most commonly prescribed medication classes (serotonin-specific reuptake inhibitors and benzodiazepines) in healthy controls. Compelling data for the potentially confounding effects on brain areas relevant to PTSD for psychotherapeutic interventions are also accumulating.
CONCLUSION
Neuroimaging studies examining the pathophysiology of PTSD should ideally recruit both medicated (assuming that the medication treatment has not resulted in the remission of symptoms) and unmedicated participants, to allow the findings to be generalized with greater confidence to the entire population of patients with PTSD. More research is needed into the independent effects of medications on task performance and CBF in regions of interest in PTSD. Neuroimaging studies should also take into account whether patients are currently engaged in psychotherapeutic treatment.
背景
为了避免未知的影响，大多数研究创伤后应激障碍（PTSD）病理生理学的神经影像学研究都排除了服用药物的患者。在这里，我们回顾了相关药物对该人群任务表现或脑血流（CBF）产生混杂影响的实证证据。还讨论了 PTSD 中潜在的心理治疗混杂作用的证据。
方法
我们通过使用术语创伤后应激障碍、PTSD、精神药物、神经影像学、功能磁共振成像、正电子发射断层扫描、脑血流、CBF、5-羟色胺特异性再摄取抑制剂、苯二氮䓬类、氯胺酮、苯丙胺、拉莫三嗪和非典型抗精神病药物，从 1980 年到 2009 年在 PubMed 上进行了搜索，获得了我们审查的文献。
结果
对于 PTSD 患者的大多数精神药物，关于相关药物对任务表现或相关区域 CBF 产生混杂影响的实证证据仍然很少。然而，在健康对照者中，两种最常开处方的药物类别（5-羟色胺特异性再摄取抑制剂和苯二氮䓬类）的证据正在不断积累。对于心理治疗干预对 PTSD 相关脑区可能产生的混杂作用，也有大量数据。
结论
检查 PTSD 病理生理学的神经影像学研究理想情况下应招募服用药物的（假设药物治疗未导致症状缓解）和未服用药物的参与者，以便更有信心地将发现推广到 PTSD 的整个患者群体。需要对药物对 PTSD 中感兴趣区域的任务表现和 CBF 的独立影响进行更多研究。神经影像学研究还应考虑患者是否正在接受心理治疗。
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