Okai David, Askey-Jones Sally, Samuel Michael, David Anthony S, Brown Richard G
King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Cognitive Neuropsychiatry, Department of Psychosis studies, London, United Kingdom; Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
Mov Disord. 2015 Apr 15;30(5):736-9. doi: 10.1002/mds.26108. Epub 2014 Dec 27.
Limited trial evidence suggests that cognitive-behavioral therapy (CBT) may be effective in managing impulse control behavior (ICBs) in Parkinson's disease.
To examine predictors of outcome in trial, participants (N=42) receiving treatment immediately or after a waiting time.
Dependent variables were Clinical Global Impression of Change (CGI-C) and the Neuropsychiatric Inventory (NPI). Baseline demographic and clinical variables were independent variables.
Better CGI-C was predicted by fewer ICBs, taking a dopamine agonist, lower levodopa (l-dopa) equivalent dose (LEDD), higher social functioning, and lower NPI severity before treatment. Improvement on the NPI was predicted by lower LEDD, lower anxiety, lower baseline global clinical severity, and higher social functioning.
Patients with lower burden of ICBs and other psychiatric symptomatology, better social functioning, and lower dose of antiparkinsonian medication may benefit more from CBT. However, we cannot yet identify individual patients with sufficient confidence at this stage to target treatment.
有限的试验证据表明，认知行为疗法（CBT）可能对帕金森病冲动控制行为（ICB）的管理有效。
研究在试验中，立即接受治疗或经过等待期后接受治疗的参与者（N = 42）的预后预测因素。
因变量为临床总体印象变化量表（CGI-C）和神经精神科问卷（NPI）。基线人口统计学和临床变量为自变量。
ICB较少、服用多巴胺激动剂、左旋多巴（L-dopa）等效剂量（LEDD）较低、社会功能较高以及治疗前NPI严重程度较低可预测更好的CGI-C。LEDD较低、焦虑程度较低、基线总体临床严重程度较低以及社会功能较高可预测NPI的改善。
ICB和其他精神症状负担较低、社会功能较好以及抗帕金森病药物剂量较低的患者可能从CBT中获益更多。然而，在此阶段我们尚不能足够自信地识别出可作为治疗目标的个体患者。
