Jemma E Reid, Luca Pellegrini, Lynne Drummond, Yana Varlakova, Sonia Shahper, David S Baldwin, Christopher Manson, Samuel R Chamberlain, Trevor W Robbins, David Wellsted, Naomi A Fineberg
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Forty-five patients were tested at baseline (sertraline n = 14; CBT n = 14; sertraline + CBT n = 17) and 23 patients at week 16 (sertraline n = 6; CBT n = 7; sertraline + CBT n = 10). The mean dosage of sertraline was numerically higher in those taking sertraline as a monotherapy (166.67 mg) compared with those taking sertraline in combination with CBT (100 mg). Analysis of pre-post treatment scores using an intent-to-treat-analysis found a significant reduction in the SSRT in those treated with sertraline, whilst there was no significant change on this task for those treated with CBT or the combination. This study found that motor inhibition improved significantly following sertraline monotherapy. Suboptimal sertraline dosing might explain the failure to detect an effect on motor inhibition in the group receiving combination of sertraline + CBT. 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引用次数: 0
摘要
强迫症(OCD)患者随机接受舍曲林、人工认知行为疗法(CBT)或组合疗法(舍曲林 + CBT)治疗,并接受认知评估。认知测试在基线和第16周进行。停止信号反应时间任务(SSRT)用于评估运动冲动性,而注意力灵活性则通过内部/外部维度集合转移任务进行评估。采用配对样本 t 检验或非参数变体来比较各治疗组的基线和治疗后得分。45名患者接受了基线测试(舍曲林 n = 14;CBT n = 14;舍曲林 + CBT n = 17),23名患者接受了第16周测试(舍曲林 n = 6;CBT n = 7;舍曲林 + CBT n = 10)。与舍曲林联合 CBT(100 毫克)相比,舍曲林单药治疗患者的平均用量更高(166.67 毫克)。采用意向治疗分析法对治疗前和治疗后的得分进行分析后发现,接受舍曲林治疗的患者的SSRT显著降低,而接受CBT或联合治疗的患者在这项任务上没有显著变化。这项研究发现,在接受舍曲林单药治疗后,运动抑制能力明显改善。舍曲林剂量不够理想可能是接受舍曲林+CBT联合治疗组未能检测到运动抑制效果的原因。大剂量舍曲林对强迫症的认知效果可能比CBT更广泛,运动冲动性可能具有衡量治疗效果的价值,推而广之,SSRT可作为个性化护理的生物标志物。
Differential effects of sertraline and cognitive behavioural therapy on behavioural inhibition in patients with obsessive compulsive disorder.
Patients with obsessive compulsive disorder (OCD) randomised to sertraline, manualised cognitive behavioural therapy (CBT), or combination (sertraline + CBT), underwent cognitive assessment. Cognitive testing was conducted at baseline and at week 16. The stop signal reaction time task (SSRT) was used to evaluate motor impulsivity and attentional flexibility was evaluated using the intra/extra-dimensional set shifting task. Paired-samples t-tests or nonparametric variants were used to compare baseline and posttreatment scores within each treatment group. Forty-five patients were tested at baseline (sertraline n = 14; CBT n = 14; sertraline + CBT n = 17) and 23 patients at week 16 (sertraline n = 6; CBT n = 7; sertraline + CBT n = 10). The mean dosage of sertraline was numerically higher in those taking sertraline as a monotherapy (166.67 mg) compared with those taking sertraline in combination with CBT (100 mg). Analysis of pre-post treatment scores using an intent-to-treat-analysis found a significant reduction in the SSRT in those treated with sertraline, whilst there was no significant change on this task for those treated with CBT or the combination. This study found that motor inhibition improved significantly following sertraline monotherapy. Suboptimal sertraline dosing might explain the failure to detect an effect on motor inhibition in the group receiving combination of sertraline + CBT. Higher dose sertraline may have broader cognitive effects than CBT for OCD, motor impulsivity may have value as a measure of treatment outcome and, by extension, the SSRT could serve as a biomarker for personalising care.
期刊介绍:
International Clinical Psychopharmacology provides an essential link between research and clinical practice throughout psychopharmacology. It reports on studies in human subjects, both healthy volunteers and patients, which relate the effects of drugs on psychological processes.
A major objective of the journal is to publish fully refereed papers which throw light on the ways in which the study of psychotropic drugs can increase our understanding of psychopharmacology. To this end the journal publishes results of early Phase I and II studies, as well as those of controlled clinical trials of psychotropic drugs in Phase II and IV. Other topics covered include the epidemiology of psychotropic drug prescribing and drug taking, the sociology of psychotropic drugs including compliance, and research into the safety and adverse effects of these compounds.