强迫症患者的自知力及其影响因素分析

目的探讨强迫症患者的自知力及其影响因素。方法对门诊及住院的110例强迫症患者采用自知力评定表及耶鲁-布朗强迫量表(Y-BOCS)评定其自知力及强迫症状。结果①强迫症患者中自知力不良者占31.8%(35/110),其中绝大部分为轻度自知力不良(34/35);②自知力不良组患者Y-BOCS量表各项得分及总分均高于自知力完整组(t=-2.24～-4.93,P<0.05);③自知力不良组中强迫症状为重度者比率较高(χ2=9.011,P<0.05),强迫症状具有荒谬性的比率也较高(χ2=6.174,P<0.05)。结论部分强迫症患者中存在自知力不良,但基本为轻度;病情的严重程度及强迫思维的荒谬性对自知力的影响较明显。     

强迫症患者元认知、强迫症状和生活质量的关系

目的:探讨强迫症患者元认知、强迫症状和生活质量的关系。方法:对符合DSM-5诊断标准的55例强迫症患者以及性别、年龄相匹配的正常对照组67名,采用元认知问卷(MCQ-30)、耶鲁布朗强迫量表(YBOCS)和生活质量量表(WHOQOL)进行测量。结果:强迫症患者在除了担忧的积极信念外,元认知总分及各因子得分、耶鲁布朗总分及各因子得分上均显著高于正常对照组(t=3.937~24.673,P0.01),而生活质量得分显著低于正常对照组(t=-8.774,P0.01)。强迫症患者耶鲁布朗总分与生活质量呈显著负相关(r=-0.376,P0.05);回归分析表明,认知自信、不可控和危险性的消极信念对生活质量有负向作用。结论:强迫症患者的元认知、症状严重程度和生活质量密切相关,其中认知自信、不可控和危险性的消极信念对生活质量有负向作用。     

执行功能失常问卷中文版在强迫症患者中的应用

目的:评估中文版执行功能失常问卷(Dysexecutive Questionnaire,DEX)在强迫症患者中的信度、效度。方法:145名强迫症患者完成DEX问卷和耶鲁布朗强迫量表(The Yale-Brown Obsessive Compulsive Scale,Y-BOCS),其中20名患者在6个月后接受重测。结果:DEX中文版在强迫症患者中的Cronbach’sα系数为0.888;重测信度为0.488。量表总分与耶鲁布朗强迫总分相关显著(r=0.192,P0.05),与强迫思维相关显著(r=0.223,P0.01),与强迫行为相关不显著。对DEX五因素模型进行验证性因素分析显示,χ2/df=1.508,CFI=0.901,IFI=0.905,TLI=0.879,RMSEA=0.059。结论:DEX中文版在强迫症患者中具有良好的信度和效度,可有效评估强迫症患者的执行功能损伤情况。     

布朗信念评估量表中文版在强迫症患者中的信度和效度

目的:评价布朗信念评估量表(BABS)中文版在中国强迫症患者中的信度和效度。方法:204名强迫症患者完成BABS中文版、耶鲁布朗强迫量表、贝克抑郁量表和状态特质焦虑问卷。结果:BABS中文版在强迫症患者中的α系数为0.80;评分者一致性信度系数为0.93(P0.01),重测信度为0.71(P0.01);量表总分与强迫症状严重程度、抑郁和焦虑程度相关不显著,与耶鲁布朗强迫量表辅助条目中的自知力条目得分相关显著0.70(P0.01);对BABS的单因子模型进行验证性因素分析显示,χ~2/df=2.195,CFI=0.970,IFI=0.971,TLI=0.956,GFI=0.960,RMSEA=0.077。结论:BABS中文版在中国强迫症患者中具有良好的信度和效度,可以用于评估强迫症患者的自知力水平。     

一例严重强迫症的暴露与仪式行为阻止治疗

目的:探讨暴露与仪式行为阻止法对强迫症患者的治疗效果.方法:以1例严重的强迫症患者为对象,进行为期3周的密集型暴露与仪式行为阻止治疗.采用症状自评量表(SCL-90)和耶鲁-布朗强迫症量表(Y-BOCS).对患者治疗前、治疗中期和后期进行了测评,以评估患者症状的改善情况.结果:与治疗前相比.治疗后患者在多数指标上均有改善,其中耶鲁-布朗强迫症量表总分从治疗前38分降低到9分,其强迫清洗的时间和次数显著减少,主观困扰指数减少.结论:暴露与仪式阻止法能够有效治疗该强迫症个案,缓解其主观痛苦,恢复其生活功能.     

洗涤组、检查组和反刍思维组强迫症患者的心理特征

目的:比较洗涤组、检查组、反刍思维组强迫症患者的人格特质、安全感与厌恶感。方法:采用帕多瓦量表-华盛顿州立大学修订版(中文版)、瑞典大学人格量表、安全感量表和中文厌恶感量表对80例符合ICD-10精神与行为障碍分类中强迫障碍诊断标准的住院和门诊病人,以及80例健康志愿者进行测查。根据帕多瓦量表-华盛顿州立大学修订版(中文版)评分将全部病例分为洗涤、检查和反刍思维三组,对测查结果进行方差分析、K ruskal-W allis H检验和相关分析等统计分析。结果:①洗涤组病例29例,检查组32例,反刍思维组19例;②反刍思维组躯体焦虑和精神焦虑得分[(70.3±11.0)vs.(72.8±9.7)]大于洗涤组[(56.6±11.9)vs.(66.5±8.9)]和检查组[(61.4±10.7)vs.(66.2±7.9)],三组均大于健康对照组[(50.5±8.9)vs.(50.8±9.7),Ps0.05];③反刍思维组安全感得分(37.9±7.1)小于洗涤组(47.0±9.5)和检查组(48.5±8.9),三组均小于健康对照组(62.8±11.3)(Ps0.05);④洗涤组厌恶感得分依次大于检查组、反刍思维组和健康对照组[(103.0±9.5)vs.(89.7±11.0),(85.3±10.8),(86.2±13.5),Ps0.01];⑤污染/洗涤强迫得分与缺乏自信和社交愿望得分呈负相关(r=-0.23,-0.38),与冷漠得分、厌恶感总分呈正相关(r=0.36,0.68);检查强迫得分与躯体焦虑、应激敏感性、冒险探索、社交愿望、怨恨、言语攻击呈正相关(r=0.22~0.42);伤害他人/自己的强迫想法得分与躯体焦虑、精神焦虑、应激敏感性、缺乏自信、冲动性、冒险探索、怨恨、兴奋性、不信任、言语攻击、身体攻击得分呈正相关(r=0.32~0.66),与安全感总分呈负相关(r=-0.57)。结论:洗涤组强迫症患者的厌恶感高于检查组和反刍思维组;反刍思维组强迫症患者的安全感低于洗涤组和检查组,而且神经质人格特质更加突出。     

舍曲林合并认知行为疗法治疗强迫症的对照分析

目的评价舍曲林合并认知行为疗法对强迫症的治疗效果。方法将符合CCMD-3诊断标准的64例强迫症随机分为治疗组(n=32)和对照组(n=32),治疗组给予舍曲林合并认知行为治疗,对照组只给予舍曲林治疗。应用临床疗效标准及耶鲁布朗强迫症状量表(Y-BOCS)定期评定疗效。疗程6个月。结果在治疗第1、2、4和6个月末,治疗组疗效优于对照组,尤其对强迫行为疗效更好,两组差异具有显著性(t=3.19,3.39,3.40和4.39,P0.01)。结论舍曲林合并认知行为疗法治疗强迫症优于单独用舍曲林治疗。     

强迫症患者的人格特质在早年创伤与强迫症状间的中介作用

目的:探讨强迫症患者中不同类型的早年创伤、人格特质与临床症状三者之间的相互作用关系,以及适应不良的人格特质在早年创伤与强迫症状间的中介作用。方法:选取147例符合精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的强迫症患者,使用耶鲁-布朗强迫症状量表(Y-BOCS)测量被试的强迫症状严重度,早年创伤问卷-自评版(ETI-SF)测量其早年创伤经历,NEO大五人格量表(NEO-FFI)测量其人格特质。结果:ETI-SF中情感虐待分量表得分与Y-BOCS总分呈正相关(r=0.19,P0.05),NEO-FFI中神经质人格得分与Y-BOCS总分呈正相关(r=0.31,P0.001),宜人性人格得分与Y-BOCS总分呈负相关(r=-0.18,P0.05)。通径分析显示神经质人格在情感虐待与强迫症状间起完全中介作用,中介作用大小为0.107(95%CI:0.04~0.19,P0.05)。结论:早年情感虐待可能与强迫症状呈正相关,而神经质人格在情感虐待与强迫症状之间发挥了完全中介作用。     

囤积障碍共病抑郁症强迫症患者的认知功能比较

目的:比较囤积障碍共病抑郁症强迫症患者的认知功能。方法:选取2016年2月至2017年1月在山西省精神卫生中心门诊及病房就诊的抑郁症、强迫症、囤积障碍患者,采用汉密尔顿抑郁量表(HAMD-17)、耶鲁-布朗强迫症状量表(Y-BOCS)及计算机版威斯康星卡片分类测验(WCST)进行评估。结果:囤积障碍组、囤积共病抑郁症组、囤积共病强迫症组、抑郁症组、强迫症组的认知功能得分差异显著(F=8.689,P0.01);5组间抑郁、强迫症状严重程度得分差异显著(F=6.006,P0.01;F=7.786,P0.01)。结论:囤积障碍共病抑郁症强迫症患者的认知功能受损较单纯囤积障碍患者更为严重。     

1例强迫症患者的主客观分析心理治疗

以主客观分析的方法对1例经精神科医生诊断为强迫症的患者进行16周13次心理治疗,采用耶鲁-布朗强迫量表(Y-BOCS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)对症状的严重程度进行基线和治疗后评估。结果显示,治疗后患者强迫症状缓解,焦虑、抑郁情绪均有下降,社会功能改善。提示本案中主客观分析心理治疗对强迫症起到较好的治疗效果。     

Clinical characteristics in patients with anorexia nervosa and obsessive-compulsive disorder

BACKGROUND: The purpose of this study was to assess clinical characteristics, including co-morbid personality disorders in patients with both anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) in comparison with age- and sex-matched patients with OCD. METHODS: Fifty-three female patients with AN were divided into two groups based on the presence or absence of a current diagnosis of OCD, as assessed by the Structured Clinical Interview for DSM-III-R Patient version (SCID-P). Twenty-one women (40 %) who met the DSM-III-R criteria for both AN and OCD were compared with 23 female patients with OCD, using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the SCID Axis II disorders. RESULTS: There were no significant differences on the mean Y-BOCS severity scores between these groups. However, AN patients with OCD were significantly more likely than OCD patients to have obsessions with need for symmetry or exactness and ordering/arranging compulsions, whereas both aggressive obsessions and checking compulsions tended to be more frequently identified in OCD patients compared with AN patients with OCD. AN patients with OCD were significantly more likely than OCD patients to meet the criteria for obsessive-compulsive personality disorder (OCPD). CONCLUSIONS: These results suggest that there are some differential characteristics of the OCD symptomatology between these disorders, although many patients with AN manifest significant impairment from primary OCD symptoms with similar magnitude in severity to that found in OCD patients.     

强迫症患者生活质量及相关因素分析

目的:了解强迫症患者生活质量的现状,探讨其相关影响因素。方法:采用自编一般情况调查表、健康状况问卷(SF-36),Yale-Brown强迫量表(Y-BOCS)、汉密尔顿抑郁量表(HAMD),对60例强迫症患者进行调查。结果:除外生理健康和疼痛,强迫症患者总体生活质量其它各维度均低于中国常模(P<0.001);强迫症患者汉密尔顿抑郁分、强迫症严重程度分、强迫思维分与SF-36各维度均相关(P<0.05,或P<0.01);而强迫行为仅与SF-36中的社会功能、情感职能、精神健康和精力四个维度相关;就业状况与生理职能相关;合并躯体疾病的患者在一般健康、社会功能和精神健康维度得分更低,合并其它精神障碍的患者在疼痛、一般健康、社会功能和精神健康维度得分更低。结论:强迫症患者的生活质量明显低于正常人群,强迫的严重程度,尤其是强迫思维、同时是否合并其它躯体和精神障碍及就业状况对患者的生活质量有很大的影响。     

利培酮合并舍曲林对强迫症患者疗效的影响

目的 探讨利培酮合并舍曲林治疗强迫症的疗效.方法 将符合条件的80例强迫症患者随机分成利培酮合并舍曲林组和单用舍曲林组,各40例,观察8周.采用耶鲁-布郎强迫量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评定疗效.结果 治疗结束后两组Y-BOCS、HAMA、HAMD的评分均显著降低...     

Peer Victimization in Children With Obsessive–Compulsive Disorder: Relations With Symptoms of Psychopathology

This study examined the frequency of peer victimization and psychological symptom correlates among youth with obsessive-compulsive disorder (OCD). The Schwartz Peer Victimization Scale, Children's Depression Inventory, and Asher Loneliness Scale were administered to 52 children and adolescents diagnosed with OCD. The child's parent or guardian completed the Child Behavior Checklist, and a trained clinician administered the Children's Yale-Brown Obsessive–Compulsive Scale (CY– BOCS). Fifty-two healthy controls and 52 children with Type 1 diabetes (T1D) who were administered the Schwartz Peer Victimization Scale as part of another study were included for comparison purposes. Greater rates of peer victimization were reported in youth with OCD relative to healthy controls and children with Type 1 diabetes (T1D). Peer victimization in the OCD sample was positively related to loneliness, child-reported depression, parent-reported internalizing and externalizing symptoms, and clinician-rated OCD severity. Peer victimization fully mediated the relation between OCD severity and both depression and parent reports of child externalizing behaviors and partially mediated the relation between OCD severity and loneliness. Recognition of the magnitude of the problem and contribution problematic peer relations may play in comorbid psychological conditions is important for clinicians who see children with OCD.     

门诊式森田疗法连续治疗性强迫障碍的研究

目的评价森田疗法对性强迫相关联想障碍的辅助治疗效果。方法本研究患者为2005年10月～2009年10月为河北医科大学第一医院精神科门诊的32例性强迫相关联想障碍患者。所有患者接受为期8个月的连续性治疗。疗前和治疗终点进行Yale-Brown强迫量表(Y-BOCS)、自评焦虑量表(SAS)和自评抑郁量表(SDS)的评估。结果 29例完成了全部治疗,3例患者因不能坚持而中断治疗(男1例,女2例)。29例患者在治疗前后Y-BOCS,SAS和SDS评分的差异均有统计学意义[(16.3±8.4)vs.(12.1±5.6),(58.7±10.8)vs.(32.5±6.1),(45.3±9.6)vs.(38.6±7.4),P0.05]。其中8例患者痊愈,14例好转,7例无明显变化。结论森田疗法对神经质症的性强迫观念的辅助治疗是有效的。     

阿立哌唑作为增效剂治疗强迫症的疗效观察

目的 探讨阿立哌唑作为增效剂治疗强迫症的疗效.方法 40例强迫症患者随机分为阿立哌唑合并氯米帕明组和氯米帕明组,治疗8周.采用强迫症量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、副反应评定量表在治疗前及治疗第8周末各评定1次,并进行对比分析,评定疗效.结果 治疗第8周末,Y-BOCS强迫量表、汉密尔顿焦虑量表、副反应评定量表总分与治疗前比较均有极显性差异(P＜0.01);更以合用阿立哌唑组明显.结论 小剂量阿立哌唑可作为常规抗抑郁剂的增效剂治疗强迫症.     

Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome

The study aimed to examine the course of obsessive-compulsive disorder (OCD) across pregnancy and its impact on obstetric and neonatal outcomes. Women enrolled prior to 20-week gestation in a prospective, observational study. The Structured Clinical Interview for DSM-IV was completed to obtain lifetime Axis I diagnoses. A total of 56 women with OCD were followed at 1 to 3-month intervals through 52 weeks postpartum. Each visit, the Yale-Brown Obsessive Compulsive Scale (YBOCS), clinical assessment, and medication/exposure tracking were performed. Obstetric and neonatal data were abstracted from the medical record. In subjects with OCD, associations between perinatal obsessive-compulsive symptoms (OCSs) and outcomes were examined. Additionally, outcomes were compared to 156 matched psychiatric patients without OCD. Maternal age inversely correlated with the YBOCS scores across the study period (β?=??0.5161, p?=?.0378). Cesarean section was associated with increased OCSs in the postpartum period compared to vaginal delivery (β?=?5.3632, p?=?0.043). No associations were found between severity of perinatal obsessions or compulsions and any specific obstetric or neonatal complications. Subjects without OCD had higher frequency of fetal loss compared to mothers with OCD (χ ²?=?4.03, p?=?0.043). These novel prospective data fail to identify an association of OCSs with adverse outcomes. In contrast, there is an association of delivery method and younger maternal age with increased postnatal symptoms of OCD. Psychiatric subjects without OCD may have a higher risk of miscarriage and intrauterine fetal demise compared to subjects with OCD.     

Convergent and discriminant validity of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist

BACKGROUND: The factor structure of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (Y-BOCS-SC) has been well established, but its convergent and divergent reliability have yet to be studied. METHODS: Fifty-six obsessive-compulsive disorder (OCD) patients were administered the clinician-administered Y-BOCS-SC and Hamilton Rating Scale for Depression (HRSD), together with the self-administered Maudsley Obsessive Compulsive Inventory (MOCI), Padua Inventory (PI), State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). RESULTS: Overall, the correspondence between the Y-BOCS-SC and self-administered measures of OCD symptoms was poor to moderate. Its convergent validity was adequate for its washing dimension but poor for its other dimensions. The discriminant validity of the Y-BOCS-SC was adequate, showing little overlap with overall illness severity (total Y-BOCS) and state measures (BDI, STAI, HRSD). In contrast, self-administered OCD measures were significantly correlated with overall illness severity and state measures. CONCLUSIONS: The convergent validity of the Y-BOCS-SC was generally poor and this could only be partially explained by the incomplete coverage of some OCD symptoms in the self-administered scales. Its discriminant validity was good. Both self- and clinician-administered measures should be used in OCD research, as they seem to measure relatively non-overlapping constructs. Further research on the psychometric properties of the Y-BOCS-SC is needed.     

Symptom-specific EEG power correlations in patients with obsessive-compulsive disorder.

Neurophysiological studies in patients with obsessive-compulsive disorder (OCD) consistently revealed frontal alterations of cortical activity but otherwise showed inhomogeneous results, conceivably due to variable subgroups with diverse pathomechanisms involved. The aim of this study was to investigate quantitative electroencephalography (EEG) in patients with OCD as compared to healthy controls and to correlate neurophysiological data with clinical variables. EEGs were digitally recorded from 18 unmedicated patients (8 male, mean age 32.4+/-11.8 years, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) 15.3+/-7.9) and 18 matched healthy controls, and analysed quantitatively. The mean frequency of EEG background activity and absolute power in delta, theta, alpha and beta frequency bands were calculated. Mean frequency of background activity was significantly lower in patients as compared to controls (-1.44/s, p<0.01), predominantly for the frontal electrode positions. Power spectra revealed increased delta- and decreased alpha-/beta-power in the group of patients (p<0.05, patients vs. controls). Correlation analyses showed significant positive correlations of EEG-power with the Y-BOCS sub-scores "obsessions", and negative correlations with the sub-scores "compulsions" (Spearman's correlations, r(s)=+0.48 to +0.70, and -0.47 to -0.6, respectively, p<0.05). The data provide evidence of a dysfunction of frontal cortical activity in patients with OCD. The opposite correlations of neurophysiological data and clinical features, i.e. obsessions and compulsions, are suggestive of pathophysiological differences based on the presence of the respective cardinal symptoms of OCD.     

氟伏沙明合并利培酮治疗儿童强迫症的随机对照研究

目的探讨氟伏沙明合并利培酮治疗儿童强迫症的疗效和安全性。方法 96例符合国际疾病分类第10版(ICD-10)诊断标准的强迫症患者随机分为氟伏沙明合并利培酮组(简称合用组,n=48)和单用氟伏沙明组(简称单用组,n=48),治疗6周。采用耶鲁-布朗强迫症量表(Y-BOCS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)评定疗效,采用不良反应症状量表(TESS)评定安全性。结果治疗前,两组在一般人口学资料、病程、Y-BOCS、SDS、SAS各项评分差异均无统计学意义(P>均0.05)。治疗6周末,合用组使用氟伏沙明平均剂量(150.37±23.92)mg,单用组氟伏沙明平均剂量((153.61±21.32)mg,差异无统计学意义(P>0.05)。治疗6周后,合用组的显效率(66.7%)高于单用组(45.8%),差异有统计学意义(χ2=5.671,P<0.05);合用组Y-BOCS评分(12.66±4.41)较单用组(14.53±4.11)低,差异有统计学意义(P<0.05);合用组SDS评分[(41.12±5.69)vs(42.58±6.32),P>0.05]及SAS评分[(45.83±7.76)vs(48.37±9.13),P>0.05]与单用组比较差异无统计学意义;两组TESS评分在治疗后第2、4、6周末差异均无统计学意义(P均>0.05)。结论氟伏沙明合并小剂量利培酮治疗儿童强迫症可提高疗效,安全性较好。