心理干预对成人创伤后应激障碍有效，与同时服用精神药物无关：一项随机对照试验的荟萃分析。
Psychological Interventions for Adult Post-Traumatic Stress Disorder Are Effective Irrespective of Concurrent Psychotropic Medication Intake: A Meta-Analysis of Randomized Controlled Trials.
机构信息
Institute of Psychology, University of Münster, Münster, Germany.
出版信息
Psychother Psychosom. 2023;92(1):27-37. doi: 10.1159/000527850. Epub 2022 Dec 9.
BACKGROUND
Participants are allowed to stay on their prescribed psychotropic medication in most trials examining psychological interventions for adult post-traumatic stress disorder (PTSD).
OBJECTIVES
We aimed to conduct the first meta-analysis investigating the potential influence of such concurrent medication on efficacy.
METHOD
To this end, we searched Medline, PsycINFO, Web of Science, and PTSDpubs from inception to April 21, 2022, for trials meeting the following criteria: (1) randomized controlled trial (RCT), (2) PTSD as primary treatment focus, (3) interview-based PTSD baseline rate ≥70%, (4) N ≥ 20, (5) mean age ≥18 years. Trials were excluded when intake of psychotropics was not (sufficiently) reported.
RESULTS
Most published trials did not report on the intake of psychotropic medication. A total of 75 RCTs (N = 4,901 patients) met inclusion criteria. Trauma-focused cognitive behavior therapy (TF-CBT) was the most well-researched intervention. Short-term efficacy of psychological treatments did not differ by the proportion of participants taking concurrent psychotropic medication during psychological treatment in all but one analysis. In trials comparing TF-CBT and active control conditions at posttreatment, TF-CBT was more effective when most participants were concurrently medicated (g = 0.87, 95% CI 0.53-1.22) rather than unmedicated (g = 0.27; 95% CI 0.01-0.54, p = 0.017), with younger age (b1 = -0.04, p = 0.008) and higher proportion of females (b1 = 0.01, p = 0.014) being associated with higher efficacy only in trials with high proportions of medicated participants. No differences in efficacy by proportions of participants taking concurrent psychotropic medication were found at follow-up.
CONCLUSIONS
Results suggest that psychological interventions are effective for PTSD irrespective of concurrent intake of psychotropics.
背景
在大多数针对成人创伤后应激障碍（PTSD）的心理干预试验中，参与者可以继续服用规定的精神药物。
目的
我们旨在进行第一项荟萃分析，以研究这种同时用药对疗效的潜在影响。
方法
为此，我们从 2022 年 4 月 21 日开始，在 Medline、PsycINFO、Web of Science 和 PTSDpubs 上搜索符合以下标准的试验：（1）随机对照试验（RCT），（2）PTSD 作为主要治疗重点，（3）基于访谈的 PTSD 基线率≥70%，（4）N≥20，（5）平均年龄≥18 岁。当未（充分）报告精神药物摄入情况时，试验被排除在外。
结果
大多数已发表的试验都没有报告精神药物的摄入情况。共有 75 项 RCT（N=4901 名患者）符合纳入标准。以创伤为中心的认知行为疗法（TF-CBT）是研究最多的干预措施。除一项分析外，在所有分析中，心理治疗的短期疗效均不因心理治疗期间服用同时服用精神药物的参与者比例而有所不同。在比较 TF-CBT 和积极对照条件的治疗后试验中，当大多数参与者同时接受药物治疗时，TF-CBT 的效果更好（g=0.87，95%CI 0.53-1.22）而不是未接受药物治疗（g=0.27；95%CI 0.01-0.54，p=0.017），年龄较小（b1=-0.04，p=0.008）和女性比例较高（b1=0.01，p=0.014）仅与高比例接受药物治疗的参与者的试验中与更高的疗效相关。在随访时，未发现疗效因同时服用精神药物的参与者比例而异。
结论
结果表明，心理干预对 PTSD 有效，无论同时服用精神药物与否。
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