催产素增强型团体心理疗法治疗精神分裂症患者 - 催产素剂量比较 (OXYMIND2)
奥托辛增强型正念团体心理疗法治疗精神分裂症谱系障碍患者 - 奥托辛剂量比较研究(OXYMIND2.0)
研究概览
详细说明
精神分裂症谱系障碍(SCZ)是一种严重的精神疾病,终生患病率为1-2%。SCZ具有三个核心综合征:阳性综合征和阴性综合征(NS),以及认知综合征。目前针对精神分裂症谱系障碍(SSD)阴性症状(NS)和社会认知缺陷的治疗方案效果仍然有限。
NS的成因被认为是社会奖励预期的中脑皮质边缘多巴胺系统与社会情绪过程网络之间的干扰。催产素(OXT)可能增强这些神经元网络之间的功能连接。较低的OXT血浆水平与SSD中NS的严重程度和社会认知缺陷呈负相关。研究表明,鼻内OXT给药可改善健康受试者的社会认知,但在SSD中结果不一致。根据社会显著性假说,OXT的效果因社会背景和个体因素而异。此外,OXT对精神病理学和NS的介导作用可能取决于OXT受体(OXTR)的遗传变异。在一项初步研究中,研究者在SSD的正向社会背景(基于正念的团体心理治疗,MBGT)中通过OXT给药证明了NS的降低。研究还表明,MBGT后NS和其他症状有所改善。一项较新的研究表明,与安慰剂相比,通过MBGT在正向社会背景中给予OXT会导致显著的组间差异,有利于OXT,尤其是在NS、情感和压力方面。基于这些发现,本研究在更大的SSD个体样本中调查了这些效果的稳定性,以及心理和生物标志物。要测试的主要假设是,在SSD患者中,与安慰剂相比,MBGT前使用OXT会导致NS的更大减少,即4周后BNSS(简明阴性症状量表)总分的T0-T8差异。BNSS作为一项经过验证、基于评估者的临床试验工具,将由盲法精神科医生收集。经验丰富的心理治疗师进行的MBGT课程每周一次,持续四周,每组六名患者。它们作为OXT给药的正向社会背景。参与者在MBGT前30分钟接受合成催产素或安慰剂。
还将探讨遗传变异(OXTR基因)对NS治疗效果的作用,以及对各种压力标志物(包括皮质醇水平和内源性大麻素系统)、情感、团体凝聚力和正念的影响。
研究设计基于一项实验性、三盲、随机、安慰剂对照试验。
研究类型
注册 (估计的)
阶段
- 不适用
联系人和位置
学习联系方式
- 姓名:Marco Zierhut, MD
- 电话号码:004930450517547
- 邮箱:marco.zierhut@charite.de
研究联系人备份
- 姓名:Kerem Böge, Prof.
- 电话号码:004930450517789
- 邮箱:kerem.boege@charite.de
学习地点
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State of Berlin
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Berlin、State of Berlin、德国、12203
- 招聘中
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Campus Charité Mitte
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接触:
- Marco Zierhut, MD
- 电话号码:004930450517547
- 邮箱:marco.zierhut@charite.de
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接触:
- Kerem Böge, Prof.
- 电话号码:004930450517789
- 邮箱:kerem.boege@charite.de
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参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
描述
纳入标准:
- 签署知情同意书
- 患者组需符合精神分裂症(ICD-10:F2x.x谱系)的精神科诊断
- 轻度至中度阳性症状(使用P-PANSS评估,单项阳性症状评分≥5)
- 德语应为母语或达到母语水平
- 在研究入组前2周内,系统记录的精神药物治疗方案无变更
排除标准:
- 伴有重度阳性症状的急性精神病发作(ICD-10:F2谱系,使用P-PANSS评估单项阳性症状评分≥6)
- 急性自杀倾向
- 除尼古丁外,处于物质依赖的急性消费期
- 无严重躯体功能障碍、神经系统疾病及严重颅脑创伤(如:婴幼儿期脑损伤)
- 妊娠期与哺乳期
- 当前正在接受急性电休克治疗
若参与者符合以下任一标准,我们将预先进行个体化咨询以评估其参与研究的可行性:
- 超重或体重不足(体重指数(BMI)<17.5或>30)
- 内分泌系统疾病
- 肾功能或肝功能受损
- 代谢性疾病
- 哮喘
- 血钾或血钠水平异常
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:三倍
武器和干预
参与者组/臂 |
干预/治疗 |
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有源比较器:催产素(24国际单位 Syntocinon®)
患者在4周内每周一次接受合成催产素喷雾(24 I.U. Syntocinon®)与正念团体疗法(MBGT)的联合治疗。
由于催产素鼻内给药后30-80分钟才会对社会行为产生影响,因此剂量在50分钟治疗前30分钟给予。
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催产素鼻喷雾剂与基于正念的团体疗法(MBGT)相结合。
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有源比较器:催产素(48国际单位 Syntocinon®)
患者在4周内每周一次接受合成催产素喷雾(48国际单位 Syntocinon®)与基于正念的团体疗法(MBGT)的组合治疗。由于催产素经鼻给药后对社交行为的影响潜伏期为30-80分钟,剂量在50分钟治疗开始前30分钟给予。
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催产素鼻喷雾剂与基于正念的团体疗法(MBGT)相结合。
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安慰剂比较:Placebo
The patients received a placebo nasal spray in combination with mindfulness-based group therapy (MBGT) over 4 weeks once a week.
The dose was administered 30 min before the 50 min session for blinding reasons.
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安慰剂鼻喷雾剂与基于正念的团体疗法(MBGT)相结合。
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Change in BNSS Brief Negative Symptom Scale
大体时间:Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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The Brief Negative Symptom Scale (BNSS) is a 13-item rater-based instrument designed for clinical trials and other studies that measures 5 domains: blunted affect, alogia, asociality, anhedonia, and avolition.
The interrater, test-retest, and internal consistency of the instrument were strong, with respective intraclass correlation coefficients of 0.93 for the BNSS total score and values of 0.89-0.95
for individual subscales.
The minimal score is 0 and the maximal score is 78.
Higher scores indicate a worse outcome.
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Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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SMQ南安普顿正念问卷的变化与组间差异
大体时间:基线评分(T0)、干预后第4周评分(T8)、随访1(第8周,T9)和随访2(第16周,T10)
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《南安普顿正念问卷》(SMQ)包含16个项目,采用七点李克特量表进行评分,范围从(6)“完全同意”到(0)“完全不同意”。因此,总分范围为0至96分,分数越高表示正念水平越高。SMQ德语版本的内部一致性为Cronbach's α = 0.89。
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基线评分(T0)、干预后第4周评分(T8)、随访1(第8周,T9)和随访2(第16周,T10)
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内源性大麻素水平的变化与组间差异
大体时间:第1周干预前和干预后(T0、T1)、第4周干预后(T7)以及随访1(第8周,T9)
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将采集静脉血样以测定内源性大麻素水平,从而获取个体基线值和对比水平。
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第1周干预前和干预后(T0、T1)、第4周干预后(T7)以及随访1(第8周,T9)
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白细胞介素水平的变化和组间差异
大体时间:第1周干预前(T0)与第4周干预后(T7)
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将采集静脉血样本以测定白细胞介素水平,从而获得个体基线值和比较水平。
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第1周干预前(T0)与第4周干预后(T7)
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催产素水平的变化与组间差异
大体时间:干预前和干预后第1周(T0,T1)以及干预后第4周(T7)
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将采集静脉血样本以测定催产素水平,以获得个体基线值和对比水平。
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干预前和干预后第1周(T0,T1)以及干预后第4周(T7)
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PBMC水平的改变与组间差异
大体时间:干预前第1周(T0)和干预后第4周(T7)
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将采集静脉血样本以测定PBMC水平,从而获得个体基线和比较水平。
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干预前第1周(T0)和干预后第4周(T7)
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唾液皮质醇水平的变化及组间差异
大体时间:第1-4周(T0-T7)干预前与干预后
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唾液样本将在每次MBGT会话前后采集,以测定唾液皮质醇水平
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第1-4周(T0-T7)干预前与干预后
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Change and group differences in PANSS Positive and Negative Syndrome Scale
大体时间:Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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The Positive and Negative Syndrome Scale (PANSS) is one of the most widely used rater instruments for the assessment of the presence and severity of psychotic symptoms. Each scale comprises seven statements which are rated by the interviewer using a seven-point Likert format (from 1= absent to 7= extreme). The minimal score is 30 and the maximal score is 210. Higher scores indicate a worse outcome. The PANSS is reported to have satisfactory internal consistency, good interrater reliability and construct validity. |
Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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Change and group differences in SNS Self-Evaluation of Negative Symptoms
大体时间:Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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The Self-Evaluation of Negative Symptoms (SNS) is a 20-item self-reported questionnaire with five subscales, namely alogia, avolition, anhedonia, social withdrawal and diminished emotional range.
These subscales cluster on two factors, the apathy and emotional components.
Participants can estimate the answer to each question on a scale from 0 (strongly disagree) to 2 (strongly agree).
The minimal score is 0 and the maximal score is 40.
Higher scores indicate a worse outcome.
The scale was shown to have good internal consistency with Cronbach's alpha = .87.
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Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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Change and group differences in CDSS Calgary Depression Scale of Schizophrenia
大体时间:Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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The Calgary Depression Scale for Schizophrenia (CDSS) is a nine item clinician rated outcome measure that assesses the level of depression in people with schizophrenia.
It is the only depression scale designed to assess depression in people with a schizophrenia spectrum disorder.
It distinguishes depressive symptoms from negative symptoms and is sensitive to change.
The minimal score is 0 and the maximal score is 27.
Higher scores indicate a worse outcome.
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Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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Change and group differences in PSS Perceived Stress Scale
大体时间:Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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The Perceived Stress Scale (PSS) is a well-established, reliable, and valid 10-item self-report scale that measures perceived stress on a 5-point response scale (0 = "never", 1 = "almost never", 2 = "sometimes", 3 = "fairly often", 4 = "very often").
The German version of the PSS has demonstrated good internal consistency (Cronbach's α = 0.84).
The minimal score is 10 and the maximal score is 50.
Higher scores indicate a worse outcome.
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Baseline rating (T0), post-intervention rating at week 4 (T8), follow-up 1 (week 8, T9) and follow-up 2 (week 16, T10)
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Change and group differences in PANAS Positive and Negative Affect Scale
大体时间:Pre- and post-intervention in week 1-4 (T0-T7)
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The Positive and Negative Affect Scale (PANAS) contains 20 items, each consisting of an adjective describing an emotion. The participants have to select how applicable this adjective is to their current state from 1 (not at all) to 5 (extremely). The minimal score is 20 and the maximal score is 100. Higher scores indicate a worse outcome. Ten items are assigned to the positive (e.g. "Excited") as well as the negative scale (e.g. "Fearful"). The reliability of the PANAS ranges from .86 to .93. |
Pre- and post-intervention in week 1-4 (T0-T7)
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Change and group differences in stress via visual analogue scale (Bubbles)
大体时间:Pre- and post-intervention in week 1-4 (T0-T7)
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Stress via visual analogue scale.
Self-rating instrument to measure stress through four items on a seven-point Likert-scale ranging from "not at all" (0) to "extreme" (6) visualized through bubbles increasing in size.
The minimal score is 0 and the maximal score is 24.
Higher scores indicate a worse outcome.
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Pre- and post-intervention in week 1-4 (T0-T7)
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Change and group differences in GCQ-S Group Climate Questionnaire (Short Version)
大体时间:Post-intervention in week 1-4 (T1, T3, T5, T7)
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The Group Climate Questionnaire [Short Version] (GCQ-S) is a 12 item questionnaire designed to assess individual group members' perceptions of the group's therapeutic environment.
It consists of three domains: Engaged, conflict and avoiding and will be used as a self-report, such as a rater-based instrument.
The minimal score is 0 and the maximal score is 72.
Higher scores indicate a worse outcome.
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Post-intervention in week 1-4 (T1, T3, T5, T7)
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Change and group differences in PSP Personal and Social Performance scale
大体时间:Baseline rating (T0) and post-intervention rating at week 4 (T8)
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The Personal and Social Performance Scale (PSP) is a rater-based questionnaire used to assess social functioning in patients with SSD.
The minimal score is 1 and the maximal score is 100.
Higher scores indicate a better outcome.
The PSP showed good test-retest reliability (ICC = 0.79) in patients with schizophrenia.
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Baseline rating (T0) and post-intervention rating at week 4 (T8)
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合作者和调查者
调查人员
- 首席研究员:Marco Zierhut, MD、Charite University, Berlin, Germany
- 首席研究员:Eric Hahn, PD、Charite University, Berlin, Germany
- 首席研究员:Kerem Böge, Prof.、Charite University, Berlin, Germany
出版物和有用的链接
一般刊物
- Boge K, Bergmann N, Zierhut M, Hahne I, Braun A, Kraft J, Conell I, Ta TMT, Thomas N, Chadwick P, Ripke S, Hahn E. The relationship between mindfulness and empathy with the oxytocinergic system in persons with schizophrenia spectrum disorders - A proof-of-concept randomized controlled trial (OXYGEN). Int J Clin Health Psychol. 2024 Jul-Sep;24(3):100503. doi: 10.1016/j.ijchp.2024.100503. Epub 2024 Sep 10.
- Zierhut M, Bergmann N, Hahne I, Wohlthan J, Kraft J, Braun A, Tam Ta TM, Hellmann-Regen J, Ripke S, Bajbouj M, Hahn E, Boge K. The combination of oxytocin and mindfulness-based group therapy for empathy and negative symptoms in schizophrenia spectrum disorders - A double-blinded, randomized, placebo-controlled pilot study. J Psychiatr Res. 2024 Mar;171:222-229. doi: 10.1016/j.jpsychires.2024.01.014. Epub 2024 Jan 9.
- Boge K, Hahne I, Bergmann N, Wingenfeld K, Zierhut M, Thomas N, Ta TMT, Bajbouj M, Hahn E. Mindfulness-based group therapy for in-patients with schizophrenia spectrum disorders - Feasibility, acceptability, and preliminary outcomes of a rater-blinded randomized controlled trial. Schizophr Res. 2021 Feb;228:134-144. doi: 10.1016/j.schres.2020.12.008. Epub 2021 Jan 9.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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