Uhlenhuth E H, Matuzas W, Glass R M, Easton C
Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque 87131.
J Affect Disord. 1989 Nov-Dec;17(3):261-70. doi: 10.1016/0165-0327(89)90009-8.
This paper reports the results of a double-blind comparison of fixed daily doses of 6 mg of alprazolam, 2 mg of alprazolam, 225 mg of imipramine, and placebo for 8 weeks in 81 patients who met DSM-III criteria for panic disorder with or without agoraphobia. Final scores on eight clinical measures were analyzed from all patients who entered the study and from the subset who completed at least 4 weeks of treatment. Eighty-six percent of the high-dose alprazolam patients completed the study. Only 50% of the imipramine patients completed 8 weeks of treatment, apparently because of activation early in treatment and slow onset of therapeutic effects. This study confirmed the therapeutic effectiveness and safety of alprazolam, especially at the higher dose, in panic disorder. It also confirmed the therapeutic effectiveness of imipramine among patients who tolerated the drug. It suggested the usefulness of a flexible, individual approach to dose escalation with imipramine. Methodologically the study underscored the importance of using multiple approaches to the analysis of clinical data from therapeutic trials of psychotropic agents with complex effects that may contribute to patients' premature termination.
本文报告了81名符合DSM-III惊恐障碍伴或不伴广场恐怖症标准的患者，接受每日固定剂量6毫克阿普唑仑、2毫克阿普唑仑、225毫克丙咪嗪及安慰剂治疗8周的双盲比较结果。对所有进入该研究的患者以及至少完成4周治疗的亚组患者的八项临床指标最终得分进行了分析。86%的高剂量阿普唑仑患者完成了研究。只有50%的丙咪嗪患者完成了8周治疗，显然是因为治疗早期出现激越且治疗效果起效缓慢。本研究证实了阿普唑仑在惊恐障碍治疗中的有效性和安全性，尤其是高剂量时。还证实了丙咪嗪在能耐受该药的患者中的治疗有效性。提示了丙咪嗪剂量递增采用灵活个体化方法的有用性。从方法学上看，该研究强调了在对具有可能导致患者提前终止治疗的复杂效应的精神药物治疗试验临床数据进行分析时，采用多种方法的重要性。
