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舍曲林联合强化药物管理、舍曲林联合心理教育、心理教育联合安慰剂治疗后 PTSD 的残留症状。

Residual symptoms of PTSD following Sertraline plus enhanced medication management, Sertraline plus PE, and PE plus placebo.

机构信息

VA San Diego Healthcare System, 3350 Villa La Jolla Drive, San Diego, CA 92161, USA; University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92037, USA.

VA San Diego Healthcare System, 3350 Villa La Jolla Drive, San Diego, CA 92161, USA; University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92037, USA; National Center for PTSD, 215 N. Main St., White River Junction, VT 05009, USA; VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., MC116B, San Diego, CA 92161, USA.

出版信息

Psychiatry Res. 2020 Sep;291:113279. doi: 10.1016/j.psychres.2020.113279. Epub 2020 Jul 4.

Abstract

Although prolonged exposure (PE) and SSRI antidepressants are effective in treating posttraumatic stress disorder (PTSD), previous studies have shown that some symptoms tend to persist. The current study compared sertraline hydrochloride plus enhanced medication management (EMM), PE plus placebo, or PE plus sertraline hydrochloride in the likelihood of each individual PTSD symptom persisting in veterans with a PTSD diagnosis. We compared the likelihood of individual PTSD symptoms persisting in those with versus without a PTSD diagnosis at posttreatment. We found no significant differences across conditions in which symptoms were likely to persist posttreatment. Among those without a PTSD diagnosis at posttreatment, sleeping difficulties (63.0%), hypervigilance (47.3%), and nightmares (45.0%) were most likely to persist. Findings indicate no consistent differences in residual symptoms between PE and medications, and shared decision making with patients is encouraged in selecting treatments. Gold standard treatments (e.g., CBT-I) may be warranted for residual symptoms like insomnia.

摘要

虽然延长暴露(PE)和 SSRI 抗抑郁药在治疗创伤后应激障碍(PTSD)方面有效,但先前的研究表明,一些症状往往会持续存在。本研究比较了舍曲林盐酸盐加强化药物管理(EMM)、PE 加安慰剂或 PE 加舍曲林盐酸盐治疗 PTSD 诊断退伍军人中每个个体 PTSD 症状持续存在的可能性。我们比较了治疗后 PTSD 诊断个体与非 PTSD 诊断个体中持续存在的个体 PTSD 症状的可能性。我们没有发现治疗后症状持续存在的情况下,不同条件之间存在显著差异。在治疗后没有 PTSD 诊断的个体中,睡眠困难(63.0%)、过度警觉(47.3%)和噩梦(45.0%)最有可能持续存在。研究结果表明,PE 和药物之间的残留症状没有一致的差异,鼓励与患者共同决策选择治疗方法。对于失眠等残留症状,可能需要进行金标准治疗(如 CBT-I)。

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