■治疗离解的临床指南主要集中在心理治疗上。然而,在临床实践中使用不同的精神药物。基于解离可能是由内源性阿片样物质系统失调介导的现象的理论,已提出使用阿片样物质拮抗剂作为治疗选择。
■回顾和荟萃分析阿片类药物拮抗剂纳曲酮疗效的现有证据,纳洛酮,和纳美芬用于治疗分离症状和疾病。
■遵循了PRISMA指南,这篇综述在Prospero注册,参考号为CRD42021280976。搜索是在PubMed中进行的,Scopus,WebofScience,EMBASE,PsycINFO,和PubPsych数据库。
■获得了1,798次引用。删除重复项并应用纳入和排除标准后,我们纳入了5项比较研究和9项分离措施,共包括154名参与者,其中134人接受过阿片类药物拮抗剂治疗。荟萃分析的结果表明,使用阿片类药物拮抗剂时,对解离的治疗效果[汇总d=1.46(95%CI:0.62-2.31)]。然而,我们纳入的研究非常不均匀[Q=66.89(p<.001)],可能存在发表偏倚.
■尽管需要更多的研究,并且由于研究的数据量和异质性及其方法学质量有限,因此必须谨慎解释结果,阿片样物质拮抗剂(特别是纳曲酮)是治疗分离症状的有希望的候选药物,并且在减轻这些症状方面表现出中等-大的效应大小。
荟萃分析的结果显示,当使用阿片类药物拮抗剂时,对解离的治疗效果[汇总d=1.46(95%CI:0.62-2.31)]。由于研究中的数据量和异质性及其方法学质量有限,因此必须谨慎解释结果。阿片类拮抗剂(特别是纳曲酮)是治疗解离性症状的有希望的候选药物,并在减轻这些症状方面表现出中等-大的效果。
The clinical guidelines for the treatment of
dissociation focus primarily on psychotherapy. However, different psychoactive drugs are used in clinical practice. The use of opioid antagonists has been proposed as a therapeutic option based on the theory that
dissociation might be a phenomenon mediated by dysregulation of the endogenous opioid system.
To
review and meta-analyse the available evidence on the efficacy of the opioid antagonists naltrexone, naloxone, and nalmefene as treatments for dissociative symptoms and disorders.
The PRISMA guidelines were followed, and this
review was registered in Prospero with reference number CRD42021280976. The search was performed in the PubMed, Scopus, Web of Science, EMBASE, PsycINFO, and PubPsych databases.
1,798 citations were obtained. After removing duplicates and applying inclusion and exclusion criteria, we included 5 comparative studies with 9 dissociation measures that had included a total of 154 participants, of whom 134 had been treated with an opioid antagonist. The results of the meta-analysis showed a treatment effect for
dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62-2.31)]. However, the studies we included were very heterogeneous [Q = 66.89 (p < .001)] and there may have been publication bias.
Although more research is needed and the results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities, opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate - large effect size in reducing these symptoms.
The results of the meta-analysis showed a treatment effect for
dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62–2.31)].The results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities.Opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate – large effect size in reducing these symptoms.