舍曲林与氯丙咪嗪治疗强迫症的对照研究

目的比较舍曲林与氯丙咪嗪治疗强迫症的疗效和不良反应。方法应用舍曲林和氯丙咪嗪治疗强迫症各30例，应用Yale-Brown强迫量表、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)及临床4级标准评定疗效。结果舍曲林与氯丙咪嗪治疗后Yale-Brown强迫量表分值、HAMD、HAMA分值均显著下降，两组间减分比较，差异无显著性，舍曲林不良反应发生率明显少于氯丙咪嗪。结论舍曲林治疗强迫症疗效与氯丙咪嗪相当，不良反应较轻，值得推广。     

抗抑郁药物联合短程团体认知行为疗法治疗强迫症临床观察

目的探讨抗抑郁药物联合短程团体认知行为疗法治疗强迫症的临床疗效。方法将201例强迫症患者采用随机数字表法分为研究组101例及对照组100例。治疗前后分别采用YaleBrown强迫症量表(Y-BOCS)及汤旦林生活质量量表评定两组患者的强迫症状及生活质量。结果治疗后两组Yale-Brown强迫症量表评分显著低于治疗前(P0.01),研究组显著低于对照组(P0.01);两组汤旦林生活质量量表评分显著高于治疗前(P0.01),研究组显著高于对照组(P0.01)。治疗后研究组汤旦林生活质量量表身体方面、心理方面、社会方面、尽职的能力、自我健康意识评分均显著高于对照组(P0.01)。结论抗抑郁药物联合短程认知行为团体治疗可有效改善强迫症患者的强迫症状,提高生活质量,值得推广应用。     

氟西汀合并认知行为疗法治疗强迫症的对照分析

目的　评价氟西汀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 5 7例强迫症患者随机分为治疗组和对照组 ,治疗组给予氟西汀合并认知行为治疗 ,对照组只给予氟西汀治疗。应用临床疗效标准及耶鲁布朗强迫量表 (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 ,尤其是对强迫行为疗效更好 ,具有极显著性统计学意义 (P <0 0 1)。结论　氟西汀合并认知行为疗法治疗强迫症效果优于单独用氟西汀治疗。     

氯丙咪嗪、SSRIs及两者合并治疗强迫症的临床对照研究

目的观察氯丙咪嗪、5-羟色胺再摄取抑制剂(SSRIs)及SSRIs合并小剂量氯丙咪嗪治疗强迫症的远期疗效及其对社会功能的影响。方法分别使用氯丙咪嗪、SSRIs、SSRIs联合小剂量氯丙咪嗪治疗84例门诊强迫症患者,分别在治疗3月末和6月末应用Yale-Brown强迫量表、临床疗效总评(CGI)和Sheehan残疾量表进行疗效评定,并自编问卷了解患者的一般资料。结果与治疗前相比,氯丙咪嗪组(N=31)、SSRIs组(N=22)及SSRIs联合小剂量氯丙咪嗪组(N=31)在3月和6月的Yale-Brown强迫量表、CGI评分均有显著性差异(P<0.01)。治疗前和治疗6月末,三组在Sheehan残疾量表评分均有显著差异。结论氯丙咪嗪和SSRIs对强迫症均有效,长期治疗可改善社会功能,SSRIs联合使用小剂量氯丙咪嗪可能与病情较重的患者有潜在的临床应用价值。     

儿茶酚-邻-甲基转移酶基因多态性与强迫症

目的：探索儿茶酚-邻-甲基转移酶(COMT)基因多态性同强迫症临床特征的关系。方法：采用聚合酶链反应扩增技术与限制性片段长度多态(PCR-RFLP)测定120例强迫症(OCD)患者和130例健康对照者的基因型；根据Yale-Brown强迫量表评分将强迫症划分亚型。结果：强迫症患者COMT基因型与等位基因分布与健康对照者之间无显著差异；强迫行为组与强迫思想组的COMT基因型分布存在差异；G／A基因型多见于强迫行为组。结论：COMT基因多态可能对强迫症的发病没有直接的作用，但G／A基因型可能对症状是否表现为强迫动作有一定的影响。     

帕罗西汀与氯丙咪嗪治疗强迫症对照研究

目的探讨帕罗西汀治疗强迫症的疗效和不良反应。方法应用帕罗西汀和氯丙咪嗪治疗强迫症各30例,应用Yale-Brown强迫量表(Y-BOCS)、汉密顿抑郁量表(HAMD),汉密顿焦虑量表(HAMA)及临床4级标准评定疗效,用副反应量表(TESS)评定副反应。结果帕罗西汀与氯丙咪嗪疗效相似,两组显效率及有效率差异无显著性,帕罗西汀不良反应发生率明显少于氯丙咪嗪。结论帕罗西汀治疗强迫症疗效与氯丙咪嗪相当,不良反应较轻,值得推广。     

文拉法辛与舍曲林治疗强迫症的对照研究

目的比较文拉法辛与舍曲林治疗强迫症的疗效及不良反应。方法将符合CCMD-3强迫症诊断标准的72例患者随机分为两组，分别给予文拉法辛与舍曲林治疗8周。采用Yale-Brown强迫量表、汉密尔顿抑郁量表（HAMD）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、不良反应量表（TESS）和临床疗效评定标准评定疗效和不良反应。结果文拉法辛与舍曲林疗效相当，两组显效率及有效率比较无显著性差异，两组不良反应发生率及其严重程度亦无显著性差异。结论文拉法辛治疗强迫症有较好的疗效，且不良反应轻微。     

一例多维整合治疗成人重度强迫症的案例

概述:强迫症(OCD)是一种慢性、痛苦和进行性损害的神经精神疾病,其特点是存在强迫意念或强迫动作.本文报道的一名44岁成年女性强迫症的病例.之前3年治疗中,患者对数个选择性5-羟色胺再摄取抑制剂(SSRIs)疗效不佳,生活质量受到严重影响.经过6个月的多维整合治疗,包括认知行为治疗(CBT)、舍曲林和低剂量抗精神病药物(阿立哌唑),以及家庭支持和网络支持.每两个月Yale-Brown Obsessive-Compulsive Scale(Y-BOCS)标准化量表评估显示,强迫意念或强迫动作明显减少,其社会功能和生活质量得到明显改善.本病例初步显示OCD多维整合治疗有助于达到最佳治疗疗效较好治疗效果,期待今后更严格的临床试验验证.     

一例多维整合治疗成人重度强迫症的案例（英文）

概述:强迫症(OCD)是一种慢性、痛苦和进行性损害的神经精神疾病,其特点是存在强迫意念或强迫动作。本文报道的一名44岁成年女性强迫症的病例。之前3年治疗中,患者对数个选择性5-羟色胺再摄取抑制剂(SSRIs)疗效不佳,生活质量受到严重影响。经过6个月的多维整合治疗,包括认知行为治疗(CBT)、舍曲林和低剂量抗精神病药物(阿立哌唑),以及家庭支持和网络支持。每两个月Yale-Brown Obsessive-Compulsive Scale(Y-BOCS)标准化量表评估显示,强迫意念或强迫动作明显减少,其社会功能和生活质量得到明显改善。本病例初步显示OCD多维整合治疗有助于达到最佳治疗疗效较好治疗效果,期待今后更严格的临床试验验证。     

舍曲林合并奎硫平治疗难治性强迫症对照研究

目的:探讨舍曲林合并奎硫平治疗难治性强迫症的疗效和安全性。方法:64例难治性强迫症患者随机分为舍曲林合并奎硫平组和单用舍曲林组,疗程8周。采用Yale-Brown强迫症量表(Y-BOCS),汉密尔顿焦虑量表(HAMA)评定疗效,用治疗中出现的症状量表(TESS)评定安全性。结果:治疗后合用组的显效率为56.3%,单用组的显效率为25.8%,两组比较差异有统计学意义(χ2=6.021,P=0.014);两组治疗后Y-BOCS、HAMA评分以合用组下降更明显(P<0.05或P<0.01);两组TESS评分差异无统计学意义(P>0.05)。结论:舍曲林合并小剂量奎硫平治疗难治性强迫症可提高疗效,安全性较好。     

Early childhood OCD: preliminary findings from a family-based cognitive-behavioral approach

ObjectiveTo examine the relative efficacy of family-based cognitive-behavioral therapy (CBT) versus family-based relaxation treatment (RT) for young children ages 5 to 8 years with obsessive-compulsive disorder (OCD).MethodForty-two young children with primary OCD were randomized to receive 12 sessions of family-based CBT or family-based RT. Assessments were conducted before and after treatment by independent raters blind to treatment assignment. Primary outcomes included scores on the Children's Yale-Brown Obsessive Compulsive Scale and Clinical Global Impressions-Improvement.ResultsFor the intent-to-treat sample, CBT was associated with a moderate treatment effect (d = 0.53), although there was not a significant difference between the groups at conventional levels. For the completer sample, CBT had a large effect (d = 0.85), and there was a significant group difference favoring CBT. In the intent-to-treat sample, 50% of children in the CBT group achieved remission as compared to 20% in the RT group. In the completer sample, 69% of children in the CBT group achieved a clinical remission compared to 20% in the RT group.ConclusionsResults indicate that children with early-onset OCD benefit from a treatment approach tailored to their developmental needs and family context. CBT was effective in reducing OCD symptoms and in helping a large number of children achieve a clinical remission.     

Manual-Driven group cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a pilot study.

OBJECTIVE: Concerns about isolation, compromised development, partial pharmacotherapy response, therapist scarcity, and inadequate cognitive-behavioral therapy (CBT) adherence led the authors to adapt a CBT protocol to a group format for adolescents with obsessive-compulsive disorder (OCD). A naturalistic, open trial of group CBT for adolescent OCD is described. The authors predicted symptom improvement and format acceptability. METHOD: Over a 1 -year period, 18 adolescents aged 13 to 17 years with OCD received 14-week group CBT based on March and Mulle's OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual in four consecutive sessions of five to nine patients. Eighty-three percent had undergone at least one medication trial, and 78% had previous CBT experience. RESULTS: OCD symptoms measured by the Children's Yale-Brown Obsessive Compulsive Scale improved significantly, both statistically and clinically. Adolescents consistently shared information and designed exposure interventions for themselves and others during sessions. Repeated self-report measures confirmed adolescents' satisfaction with therapy. CONCLUSIONS: This pilot study demonstrates that a manual-based treatment protocol may be exported for clinical use, adaptable for the end-user's needs, and palatable to adolescent patients. Clinical improvement and patient satisfaction justify further investigation in a controlled study.     

西酞普兰联合认知行为疗法治疗强迫症对照观察

目的：比较西酞普兰联合认知行为治疗与单用西酞普兰治疗强迫症的临床疗效。方法：将Yale-Brown强迫量表（Y-BOCS）评分≥16分的64例强迫症患者随机分为研究组（西酞普兰联合认知行为治疗）和对照组（单用西酞普兰治疗）,每组各32例,疗程6个月。于治疗前及治疗1、2、4和6个月时采用Y-BOCS评定疗效。结果：治疗后研究组和对照组Y-BOCS评分分别为（9.41±3.87）分和（12.37±5.34）分,较治疗前（25.26±5.38）分和（24.23±4.25）分显著下降（P〈0.05或P〈0.01）;以研究组下降更为显著（P〈0.05或P〈0.01）,其中强迫性思维和强迫性行为因子评分在治疗6个月时仍维持降分（P〈0.01）。结论：西酞普兰联合认知行为治疗强迫症较单用西酞普兰疗效更好。     

Symptom dimensions in obsessive-compulsive disorder: prediction of cognitive-behavior therapy outcome

OBJECTIVE: A significant number of patients with obsessive-compulsive disorder (OCD) fail to benefit sufficiently from treatments. This study aimed to evaluate whether certain OCD symptom dimensions were associated with cognitive-behavioral therapy (CBT) outcome. METHOD: Symptoms of 104 CBT-treated in-patients with OCD were assessed with the clinician-rated Yale-Brown Obsessive-Compulsive Scale symptom checklist. Logistic regression analyses examined outcome predictors. RESULTS: The most frequent OCD symptoms were aggressive and contamination obsessions, and compulsive checking and cleaning. Patients with hoarding symptoms at baseline (n = 19) were significantly less likely to become treatment responders as compared to patients without these symptoms. Patients with sexual and religious obsessions tended to respond less frequently, although this failed to reach statistical significance (P = 0.07). Regression analyses revealed that higher scores on the hoarding dimension were predictive of non-response, even after controlling for possible confounding variables. CONCLUSION: Our results strongly indicate that in-patients with obsessive-compulsive hoarding respond poorly to CBT.     

Tics moderate treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder.

BACKGROUND: The presence of a comorbid tic disorder may predict a poorer outcome in the acute treatment of pediatric obsessive-compulsive disorder (OCD). METHODS: Using data from the National Institute of Mental Health (NIMH)-funded Pediatric OCD Treatment Study (POTS) that compared cognitive-behavior therapy (CBT), medical management with sertraline (SER), and the combination of CBT and SER (COMB), to pill placebo (PBO) in children and adolescents with OCD, we asked whether the presence of a comorbid tic disorder influenced symptom reduction on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) after 12 weeks of treatment. RESULTS: Fifteen percent (17 of 112) of patients exhibited a comorbid tic disorder. In patients without tics, results replicated previously published intent-to-treat outcomes: COMB > CBT > SER > PBO. In patients with a comorbid tic disorder, SER did not differ from PBO, while COMB remained superior to CBT and CBT remained superior to PBO. CONCLUSIONS: In contrast to CBT outcomes, which are not differentially impacted, tic disorders appear to adversely impact the outcome of medication management of pediatric OCD. Children and adolescents with obsessive-compulsive disorder and a comorbid tic disorder should begin treatment with cognitive-behavior therapy alone or the combination of cognitive-behavior therapy plus a serotonin reuptake inhibitor.     

帕罗西汀与氯米帕明治疗难治性强迫症对照研究

目的：观察帕罗西汀和氯米帕明对难治性强迫症的疗效和不良反应。方法：对难治性强迫症患者60例,随机分为两组,分别用帕罗西汀和氯米帕明治疗8周。采用强迫症量表（Y-BOCS）和副反应量表（TESS）评价疗效及不良反应。结果：两药的总体疗效相仿。帕罗西汀对强迫行为疗效较好,不良反应小,尤其是心血管系统及抗胆碱能不良反应少。结论：帕罗西汀尤适用于以强迫行为为主的难治性强迫症患者。     

氯米帕明与认知疗法治疗青少年强迫症临床探讨

目的研究氯米帕明合并认知疗法对青少年强迫症的疗效。方法对30例服用氯米帕明效果不佳的青少年强迫症患者,采用氯米帕明合并认知疗法治疗,应用Hamilton焦虑量表(HAMA)、Yale-Brown强迫量表(Y-BOCS)和临床疗效量表(CGI-SI)于治疗前及治疗第2、4、8周末进行测评。以Y-BOCS减分率来评定疗效。结果疗程结束后,有效率80%,各量表评分均明显下降。结论氯米帕明合并认知疗法对青少年强迫症有较好疗效。     

Neurochemical analyses in pediatric obsessive-compulsive disorder in patients treated with cognitive-behavioral therapy

OBJECTIVE: To investigate neurochemical changes in the caudate nucleus of pediatric obsessive-compulsive disorder (OCD) patients before and after cognitive-behavioral therapy (CBT), and to examine corresponding changes in symptom severity. METHOD: Single-voxel proton magnetic resonance spectroscopic (1H-MRS) examination of the left caudate was conducted in 21 treatment-na?ve children, aged 6 to 16 years, before and after 12 weeks of CBT. Subjects were measured at baseline and posttreatment by the Yale-Brown Obsessive Compulsive Scale for Children, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale. RESULTS: No significant changes in caudate neurochemistry were observed in OCD patients before and after CBT despite unambiguous improvement in OCD symptoms, depression, and anxiety. CONCLUSIONS: Findings suggest that reduction in caudate Glx may be specific to SSRI treatment and not due to a more generalized treatment response or spontaneous improvement of symptoms. Differential sets of pathophysiologic and treatment response markers may moderate/mediate the effects of particular treatments on outcome.     

Benefits of cognitive-behavioural therapy for children and youth with obsessive-compulsive disorder: re-examination of the evidence

The aim of the present paper was to critically examine evidence about the benefits of cognitive-behavioural therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) from controlled and single group studies, including its benefits relative to medication are critically reviewed. Selected studies were categorized by study type and by risk of bias classification. Standardized mean differences (Hedges' g or Cohen d) and, where appropriate, weighted mean difference (WMD) were calculated. All five comparison and 14 one-group studies showed a significant benefit for CBT within a wide range (ES = .78 to 4.38). Low risk of bias studies produced the lower adjusted effect sizes. The best available estimate of CBT efficacy relative to no treatment is about 1 standardized mean difference, equivalent to a treatment effect of 8 points on the Children's Yale-Brown Obsessive-Compulsive Scale. This represents a reduction in the risk of continuing to have OCD post-treatment of about 37% (95% CI 14% to 54%). Evidence from 3 studies indicates that the efficacy of CBT and medication do not differ significantly. CBT combined with medication is significantly more efficacious than non-active controls or medication alone but not relative to CBT alone. CBT should be regarded as a first line equivalent to anti-OCD medication with the potential to lead to better outcomes when combined with medication than medication alone can provide. Additional studies are needed to further clarify CBT's benefits and to investigate how it can be made more available as a treatment option for children and youth who suffer from OCD.     

强迫症患者父母的教养方式

目的：探讨强迫症患者父母对患者的教养方式。方法：采用自编一般情况问卷和父母教养方式评价量表（egna minnen av barndoms uppfostran,EMBU）对88名强迫症患者的父母（研究组）和54名健康志愿者（对照组）进行评估。结果：研究组患者的父亲EMBU量表中的拒绝否认因子分平均（10.75±4.08）分明显高于对照组男性（8.78±1.80）分（t=3.928,P〈0.01）;研究组患者的母亲EMBU量表中过分干涉和保护因子分平均（39.30±6.80）分显著高于对照组女性（29.15±5.10）分（t=2.175,P〈0.05）;两组其他各因子评分差异无统计学意义（P〉0.05）。结论：强迫症患者的父母在对子女的教养方式上缺乏情感温暖和理解,有过多的惩罚、拒绝和否认。及早对患者父母亲进行心理辅导,改善对子女的教养方式,有利于子女的健康成长。