Golier Julia A, Caramanica Kimberly, Demaria Rebecca, Yehuda Rachel
Department of Psychiatry, James J. Peters VA Medical Center, Bronx, NY 10468, USA.
Depress Res Treat. 2012;2012:393251. doi: 10.1155/2012/393251. Epub 2012 Apr 24.
Background. We obtained pilot data to examine the clinical and neuroendocrine effects of short-term mifepristone treatment in male veterans with PTSD. Methods. Eight male veterans with military-related PTSD completed a randomized, double-blind trial of one week of treatment with mifepristone (600 mg/day) or placebo. The primary clinical outcome measures were improvement in PTSD symptoms and dichotomously defined clinical responder status as measured by the CAPS at one-month follow-up. Additional outcome measures included self-reported measures of PTSD symptom severity, CAPS-2 symptom subscale scores, and morning plasma cortisol and ACTH levels. Results. Mifepristone was associated with significant improvements in total CAPS-2 score. At one-month follow-up, all four veterans in the mifepristone group and one of four veterans in the placebo group achieved clinical response; three of four veterans in the mifepristone group and one of four veterans in the mifepristone group remitted. Mifepristone treatment was associated with acute increases in cortisol and ACTH levels and decreases in cytosolic glucocorticoid receptor number in lymphocytes. Conclusions. Further controlled trials of the effects of mifepristone and their durability are indicated in PTSD. If effective, a short-term pharmacological treatment in PTSD could have myriad uses.
背景。我们获取了试点数据，以研究短期米非司酮治疗对患有创伤后应激障碍（PTSD）的男性退伍军人的临床和神经内分泌影响。方法。八名患有与军事相关PTSD的男性退伍军人完成了一项随机双盲试验，接受为期一周的米非司酮（600毫克/天）或安慰剂治疗。主要临床结局指标为PTSD症状的改善情况以及在1个月随访时通过临床医师专用PTSD量表（CAPS）测量的二分法定义的临床反应者状态。其他结局指标包括PTSD症状严重程度的自我报告测量、CAPS-2症状子量表得分以及早晨血浆皮质醇和促肾上腺皮质激素（ACTH）水平。结果。米非司酮与CAPS-2总分的显著改善相关。在1个月随访时，米非司酮组的所有四名退伍军人和安慰剂组的四名退伍军人中的一名实现了临床反应；米非司酮组的四名退伍军人中的三名和米非司酮组的四名退伍军人中的一名症状缓解。米非司酮治疗与皮质醇和ACTH水平的急性升高以及淋巴细胞中细胞溶质糖皮质激素受体数量的减少有关。结论。表明需要对米非司酮的作用及其持久性进行进一步的对照试验。如果有效，PTSD的短期药物治疗可能有多种用途。
