摘要
创伤后应激障碍是一种慢性精神疾病,危及生命的创伤后可能会出现这种精神障碍。退伍军人和武装部队与平民相比,可能会有不同的健康问题,他们患精神疾病的风险更大,包括创伤后应激障碍,即使在普通人中这种障碍也很频繁。创伤后应激障碍与重大疾病,特别与情绪障碍和药物滥用密切相关。此外,创伤后应激障碍患者的自杀风险比普通人高。选择性5-羟色胺再摄取抑制剂(SSRIs),一种非典型抗精神病药物,与苯二氮卓类药物作为创伤后精神紧张性精神障碍治疗药物,但往往因其副作用严重而导致治疗失败或中断。现已证明,去甲肾上腺素活性可能与创伤后应激障碍患者的过度反应,创伤后做噩梦和睡眠障碍有关,可能是通过刺激位于大脑皮层α-1肾上腺素能受体发挥作用。α-1肾上腺素能受体拮抗剂-哌唑嗪能降低作用在大脑α-1去甲肾上腺素受体的作用,因此,哌唑嗪可能为一种治疗创伤后应激障碍很有前途的药物,一些研究已发现其有效性和耐受性良好。因此,本文旨在探讨肾上腺素能系统对创伤后应激障碍的病理生理作用。此外,我们进行了一项系统回顾评价哌唑嗪在创伤后应激障碍患者治疗过程中的有效性和耐受性。系统分析是用于综合来自多个研究的数据和更好地估计哌唑嗪的疗效。我们发现在减轻PTSD患者痛苦方面,哌唑嗪比安慰剂更有效。由于这方面研究包括定量综合的数据很少,我们应对研究结果谨慎解释,
关键词: 疗效,过度反应,恶梦,创伤后应激障碍,哌唑嗪,去甲肾上腺素系统,耐受性。
图形摘要
Current Drug Targets
Title:Targeting the Noradrenergic System in Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis of Prazosin Trials
Volume: 16 Issue: 10
Author(s): Domenico De Berardis, Stefano Marini, Nicola Serroni, Felice Iasevoli, Carmine Tomasetti, Andrea de Bartolomeis, Monica Mazza, Daniela Tempesta, Alessandro Valchera, Michele Fornaro and Maurizio Pompili, Gianna Sepede, Federica Vellante, Laura Orsolini, Giovanni Martinotti and Massimo Di Giannantonio
Affiliation:
关键词: 疗效,过度反应,恶梦,创伤后应激障碍,哌唑嗪,去甲肾上腺素系统,耐受性。
摘要: Post-traumatic stress disorder (PTSD) is a chronic psychiatric disorder that may develop after exposure to a life-threatening trauma. As veterans and armed forces may deal with diverse health problems compared with civilians, they have a greater risk for psychiatric disorders, including PTSD, than civilians, even if the disorder may be also frequent in the general population. PTSD is associated with significant comorbidity, especially with mood disorders and substance abuse. Moreover, the suicide risk is higher in PTSD patients than in the general population. Selective Serotonin Reuptake Inhibitors (SSRIs), atypical antipsychotics and benzodiazepines are commonly employed in the management of PTSD, but often these treatments fail or are discontinued due to adverse effects. It has been demonstrated that high noradrenergic activity may be associated with hyperarousal, trauma nightmares and sleep disturbances in PTSD subjects, probably through the stimulation of α -1 adrenergic receptors in the brain prefrontal cortex. The α -1 adrenoreceptor antagonist prazosin decreases noradrenaline effects at brain α-1 adrenoreceptors and may be a promising agent in the treatment of PTSD, as some studies have found it effective and well tolerated. Therefore, the present review is aimed to examine the role of noradrenergic system in the pathophysiology of PTSD. Moreover, we conducted a systematic review to evaluate the effectiveness and tolerability of prazosin in PTSD patients. Meta-analysis was used to combine data from multiple studies and better estimate the effect of prazosin on specific outcomes. We found prazosin to be significantly more efficacious than placebo in reducing distressing dreams in PTSD patients, even though our results should be interpreted with caution due to the small number of studies included in our quantitative synthesis.
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Domenico De Berardis, Stefano Marini, Nicola Serroni, Felice Iasevoli, Carmine Tomasetti , Andrea de Bartolomeis, Monica Mazza, Daniela Tempesta, Alessandro Valchera, Michele Fornaro and Maurizio Pompili, Gianna Sepede, Federica Vellante, Laura Orsolini, Giovanni Martinotti and Massimo Di Giannantonio , Targeting the Noradrenergic System in Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis of Prazosin Trials, Current Drug Targets 2015; 16 (10) . https://dx.doi.org/10.2174/1389450116666150506114108
DOI https://dx.doi.org/10.2174/1389450116666150506114108 |
Print ISSN 1389-4501 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5592 |
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