氯胺酮
安慰剂
临床全球印象
评定量表
麻醉
医学
交叉研究
离解的
咪唑安定
重性抑郁障碍
随机对照试验
青少年躁狂量表
不利影响
精神科
内科学
心理学
狂躁
双相情感障碍
镇静
心情
替代医学
病理
发展心理学
作者
Adriana Feder,Michael K. Parides,James W. Murrough,Andrew M. Perez,Julia E. Morgan,Sanjaya Saxena,Katherine Kirkwood,Marije aan het Rot,Kyle Lapidus,Le Ben Wan,Dan V. Iosifescu,Dennis S. Charney
出处
期刊:JAMA Psychiatry
[American Medical Association]
日期:2014-06-01
卷期号:71 (6): 681-681
被引量:461
标识
DOI:10.1001/jamapsychiatry.2014.62
摘要
Few pharmacotherapies have demonstrated sufficient efficacy in the treatment of posttraumatic stress disorder (PTSD), a chronic and disabling condition.To test the efficacy and safety of a single intravenous subanesthetic dose of ketamine for the treatment of PTSD and associated depressive symptoms in patients with chronic PTSD.Proof-of-concept, randomized, double-blind, crossover trial comparing ketamine with an active placebo control, midazolam, conducted at a single site (Icahn School of Medicine at Mount Sinai, New York, New York). Forty-one patients with chronic PTSD related to a range of trauma exposures were recruited via advertisements.Intravenous infusion of ketamine hydrochloride (0.5 mg/kg) and midazolam (0.045 mg/kg).The primary outcome measure was change in PTSD symptom severity, measured using the Impact of Event Scale-Revised. Secondary outcome measures included the Montgomery-Asberg Depression Rating Scale, the Clinical Global Impression-Severity and -Improvement scales, and adverse effect measures, including the Clinician-Administered Dissociative States Scale, the Brief Psychiatric Rating Scale, and the Young Mania Rating Scale.Ketamine infusion was associated with significant and rapid reduction in PTSD symptom severity, compared with midazolam, when assessed 24 hours after infusion (mean difference in Impact of Event Scale-Revised score, 12.7 [95% CI, 2.5-22.8]; P = .02). Greater reduction of PTSD symptoms following treatment with ketamine was evident in both crossover and first-period analyses, and remained significant after adjusting for baseline and 24-hour depressive symptom severity. Ketamine was also associated with reduction in comorbid depressive symptoms and with improvement in overall clinical presentation. Ketamine was generally well tolerated without clinically significant persistent dissociative symptoms.This study provides the first evidence for rapid reduction in symptom severity following ketamine infusion in patients with chronic PTSD. If replicated, these findings may lead to novel approaches to the pharmacologic treatment of patients with this disabling condition.clinicaltrials.gov Identifier: NCT00749203.
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