Blanco Carlos, Heimberg Richard G, Schneier Franklin R, Fresco David M, Chen Henian, Turk Cynthia L, Vermes Donna, Erwin Brigette A, Schmidt Andrew B, Juster Harlan R, Campeas Raphael, Liebowitz Michael R
Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University,1051 Riverside Dr, Box 69, New York, NY 10032, USA.
Arch Gen Psychiatry. 2010 Mar;67(3):286-95. doi: 10.1001/archgenpsychiatry.2010.11.
Medication and cognitive behavioral treatment are the best-established treatments for social anxiety disorder, yet many individuals remain symptomatic after treatment.
To determine whether combined medication and cognitive behavioral treatment is superior to either monotherapy or pill placebo.
Randomized, double-blind, placebo-controlled trial.
Research clinics at Columbia University and Temple University.
One hundred twenty-eight individuals with a primary DSM-IV diagnosis of social anxiety disorder.
Cognitive behavioral group therapy (CBGT), phenelzine sulfate, pill placebo, and combined CBGT plus phenelzine.
Liebowitz Social Anxiety Scale and Clinical Global Impression (CGI) scale scores at weeks 12 and 24.
Linear mixed-effects models showed a specific order of effects, with steepest reductions in Liebowitz Social Anxiety Scale scores for the combined group, followed by the monotherapies, and the least reduction in the placebo group (Williams test = 4.97, P < .01). The CGI response rates in the intention-to-treat sample at week 12 were 9 of 27 (33.3%) (placebo), 16 of 34 (47.1%) (CBGT), 19 of 35 (54.3%) (phenelzine), and 23 of 32 (71.9%) (combined treatment) (chi(2)(1) = 8.76, P < .01). Corresponding remission rates (CGI = 1) were 2 of 27 (7.4%), 3 of 34 (8.8%), 8 of 35 (22.9%), and 15 of 32 (46.9%) (chi(2)(1) = 15.92, P < .01). At week 24, response rates were 9 of 27 (33.3%), 18 of 34 (52.9%), 17 of 35 (48.6%), and 25 of 32 (78.1%) (chi(2)(1) = 12.02, P = .001). Remission rates were 4 of 27 (14.8%), 8 of 34 (23.5%), 9 of 35 (25.7%), and 17 of 32 (53.1%) (chi(2)(1) = 10.72, P = .001).
Combined phenelzine and CBGT treatment is superior to either treatment alone and to placebo on dimensional measures and on rates of response and remission.
药物治疗和认知行为疗法是治疗社交焦虑障碍最成熟的方法，但许多患者在治疗后仍有症状。
确定联合药物治疗和认知行为疗法是否优于单一疗法或丸剂安慰剂。
随机、双盲、安慰剂对照试验。
哥伦比亚大学和天普大学的研究诊所。
128名初步诊断为DSM-IV社交焦虑障碍的个体。
认知行为团体治疗（CBGT）、硫酸苯乙肼、丸剂安慰剂以及联合CBGT与硫酸苯乙肼治疗。
第12周和第24周时的利博维茨社交焦虑量表和临床总体印象（CGI）量表评分。
线性混合效应模型显示了特定的效应顺序，联合治疗组的利博维茨社交焦虑量表评分下降幅度最大，其次是单一疗法组，安慰剂组下降幅度最小（威廉姆斯检验=4.97，P<.01）。意向性治疗样本在第12周时的CGI缓解率分别为：安慰剂组27例中的9例（33.3%）、CBGT组34例中的16例（47.1%）、硫酸苯乙肼组35例中的19例（54.3%）以及联合治疗组32例中的23例（71.9%）（χ²(1)=8.76，P<.01）。相应的缓解率（CGI=1）分别为：安慰剂组27例中的2例（7.4%）、CBGT组34例中的3例（8.8%）、硫酸苯乙肼组35例中的8例（22.9%）以及联合治疗组32例中的15例（46.9%）（χ²(1)=15.92，P<.01）。在第24周时，缓解率分别为：安慰剂组27例中的9例（33.3%）、CBGT组34例中的18例（52.9%）、硫酸苯乙肼组35例中的17例（48.6%）以及联合治疗组32例中的25例（78.1%）（χ²(1)=12.02，P=.001）。缓解率分别为：安慰剂组27例中的4例（14.8%）、CBGT组34例中的8例（23.5%）、硫酸苯乙肼组35例中的9例（25.7%）以及联合治疗组32例中的17例（53.1%）（χ²(1)=10.72，P=.001）。
硫酸苯乙肼与CBGT联合治疗在维度测量、缓解率和反应率方面优于单一治疗和安慰剂。
