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Dr Capehart replies

机译：Capehart博士回复

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There are, however, important differences between clinical care and the animal research studies cited by Steenen et al.The article by Bustos et al evaluates midazolam in a rodent model of anxiety. Assuming a number of unresolved questions could be answered, Bustos et al suggest a potential future role for benzodiazepines in psychotherapy of PTSD. When animal research protocols have determined the proper dose and time frame for medications to augment psychotherapy, I would welcome a randomized, placebo-controlled clinical trial based on those animal studies.Clinicians need novel treatment approaches for PTSD. In particular, PTSD care would benefit from treatments that integrate psychotherapy and medication to yield a greater magnitude and longer duration of clinical response. To my knowledge, there are no clinical protocols for benzodiazepines and psychotherapy in routine clinical practice. The preclinical study published by Bustos et al2 does not guide the clinician on if, how, when, or how long to prescribe a benzodiazepine for PTSD, and their findings should not be used to justify routine benzodiazepine prescribing in PTSD.The article by Lund et al and my accompanying commentary both describe clinical practice for PTSD. Until we see results from properly controlled clinical trials that support a change in clinical practice guidelines, benzodiazepines are best avoided when treating patients with PTSD.
机译：但是，临床护理与Steenen等人引用的动物研究之间存在重要差异.Bustos等人的文章评估了啮齿动物焦虑模型中的咪达唑仑。假设可以回答许多未解决的问题，Bustos等人建议苯二氮卓类药物在PTSD的心理治疗中有潜在的未来作用。当动物研究方案确定适当的药物剂量和时间表以加强心理治疗时，我欢迎根据这些动物研究进行的随机，安慰剂对照临床试验。临床医生需要针对PTSD的新颖治疗方法。特别是，PTSD护理将从结合心理治疗和药物治疗的治疗中受益，以产生更大的幅度和更长的临床反应持续时间。据我所知，在常规临床实践中尚无苯二氮卓类和心理疗法的临床方案。 Bustos等人[2]发表的临床前研究并未指导临床医生是否为苯丙二氮类药物开处方，何时，何时或多长时间开处方，他们的发现不应被用来证明在苯丙二氮中进行常规苯二氮卓处方。等人和我随附的评论都描述了PTSD的临床实践。在我们看到适当控制的临床试验的结果支持改变临床实践指南的结果之前，在治疗PTSD患者时最好避免使用苯二氮卓类药物。

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