Traitements pharmacologiques dans le trouble de stress post-traumatique : la nécessité d’une stratégie globale

IF 0.5 4区医学 Q4 PSYCHIATRY

Annales medico-psychologiques Pub Date : 2025-06-01 DOI:10.1016/j.amp.2023.06.010

Arnaud Leroy , Frédérique Warembourg , Stéphane Duhem , Thomas Fovet , Nicolas Gaud-Le Pierres , Amélie Porte , Emilie Veerapa , Fabien D’Hondt , Guillaume Vaiva

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引用次数: 0

Abstract

International guidelines indicate that trauma-focused psychotherapeutic treatments are the recommended approach for first line treatment of post-traumatic stress disorder (PTSD). However, the guidelines concerning drug-focused treatment are less consistent and contradictory. Although trauma-focused therapy combined with cognitive-behavioral therapy is effective in treating PTSD, many patients do not respond adequately to this treatment, which stresses the need to develop effective adjuvant therapeutic treatments. In addition, most randomized controlled trials investigating psychological treatments for PTSD exclude patients with psychosis, addiction, bipolar disorder, and suicidal thoughts, and it is crucial to offer effective treatments for these patients. Off-label medication is frequently used in treating these populations, but there is a need to clarify these practices. We thus propose an evidence-based algorithm for the management of PTSD, based on current international literature and taking into consideration suicidal tendencies, the presence of psychiatric disorders (psychotic disorders, bipolar disorders, borderline personality disorders) or addictive disorders, the severity of PTSD, and resistance to treatment.

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创伤后应激障碍的药物治疗：全球战略的必要性

国际指南指出，创伤为重点的心理治疗是创伤后应激障碍（PTSD）一线治疗的推荐方法。然而，关于以药物为重点的治疗的指导方针缺乏一致性和矛盾性。虽然以创伤为中心的治疗与认知行为治疗相结合对治疗PTSD是有效的，但许多患者对这种治疗没有充分的反应，这就强调了开发有效的辅助治疗的必要性。此外，大多数调查PTSD心理治疗的随机对照试验排除了患有精神病、成瘾、双相情感障碍和自杀念头的患者，为这些患者提供有效的治疗是至关重要的。标签外药物经常用于治疗这些人群，但有必要澄清这些做法。因此，我们基于当前的国际文献，并考虑到自杀倾向、精神障碍（精神障碍、双相情感障碍、边缘型人格障碍）或成瘾障碍的存在、创伤后应激障碍的严重程度以及对治疗的抵抗，提出了一种基于证据的创伤后应激障碍管理算法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annales medico-psychologiques 医学-精神病学

CiteScore

1.30

自引率

33.30%

发文量

196

审稿时长

4-8 weeks

期刊介绍： The Annales Médico-Psychologiques is a peer-reviewed medical journal covering the field of psychiatry. Articles are published in French or in English. The journal was established in 1843 and is published by Elsevier on behalf of the Société Médico-Psychologique. The journal publishes 10 times a year original articles covering biological, genetic, psychological, forensic and cultural issues relevant to the diagnosis and treatment of mental illness, as well as peer reviewed articles that have been presented and discussed during meetings of the Société Médico-Psychologique.To report on the major currents of thought of contemporary psychiatry, and to publish clinical and biological research of international standard, these are the aims of the Annales Médico-Psychologiques.