舍曲林对强迫症患者临床症状、执行功能和职业功能的远期效果

目的 探讨舍曲林对强迫症临床症状、执行功能和职业功能的远期效果.方法 对强迫症患者按随机分组原则,研究组48例以舍曲林治疗,对照组44例以氯米帕明治疗,好转后以相对稳定剂量维持,均辅以心理治疗和康复活动.于治疗前、治疗2周末、4周末、6周末、8周末各时点分别调查和比较两组患者的强迫症状检出率;随访2年,以耶鲁布朗强迫症量表（Y-BOCS）总分减分率评估8周末和2年的临床疗效,完成连线测验A和B（TMT-A和TMT-B）、Stroop测验、社会功能缺陷筛选量表（SDSS）以评估执行功能和社会职业功能,并进行组间比较.结果 研究组治疗4周末的强迫观念（62.5％）和6周末的强迫行为检出率（18.8％）均显著低于对照组（分别为81.8％和38.6％,P＜0.05）,但8周末（8.3％～22.9％）和2年的强迫症状检出率（6.3％～12.5％）与对照组（分别为20.5％～40.9％和15.9％～22.7％）之间差异无统计学意义（P＞0.05）.8周末和2年的临床疗效两组之间差异也无统计学意义（P＞0.05）.治疗2年后研究组的连线测验B时间[（46.4±6.4）s]和彩色文字的颜色阅读时间[Stroop-CW（132.2±14.9）s]均显著短于对照组[分别为（49.3±6.5）s和（138.8±15.7）s,P＜0.05].治疗第2年随访显示SDSS总分及职业功能因子分研究组均显著低于对照组（P＜0.01）,而就业率研究组（72.9％）显著高于对照组（47.7％,P＜0.05）.研究组不良反应总发生率（12.5％）显著低于对照组（43.2％,P＜0.05）.结论 舍曲林对强迫症临床症状的效果与氯米帕明相当,但远期对改善执行功能和职业功能显著更优.

Long-term effects of sertraline on clinical symptoms,executive and occupational functions of patients with obsessive-compulsive disorder

Objective To explore the long-term effects of sertraline on clinical symptoms,executive and occupational functions of patients with obsessive-compulsive disorder.Methods By randomly grouped,48 cases with obsessive-compulsive disorder were treated with sertraline as the study group and 44 cases treated with clomipramine as the control one.They were maintained with relative stable drug dosage after ill-condition improving,and all the subjects were also treated with psychological treatment and rehabilitation activities.The incidences of obsessive-compulsive symptoms before and after 2,4,6 and 8 weeks of treatment were investigated and compared.Yale-Brown obsessive-compulsive scale（Y-BOCS） were used to evaluate the efficacy according to the Y-BOCS reducing rate.The trail making test A and B （TMT-A and TMT-B）,Stroop test and the Social Disability Screening Schedule （SDSS） were used at 8th weekend and 2 year＇s follow-up to evaluate and compare the two groups＇ executive and occupational functions.Results The incidences of 4 weeks＇ obsessive symptoms （62.5%）and 6 weeks＇ compulsive symptoms（18.8%） showed significantly lower in the study group than those in the control one （81.8% and 38.6%,P〈0.05）.But the obsessive-compulsive symptoms incidences at 8 weeks（8.3%-22.9%） and 2 years＇ treatment（6.3%-12.5%） in study group showed no statistical meaning differences from the control （20.5%-40.9% and 15.9%-22.7%,P〉0.05）.The clinical efficacy also showed no statistical difference between the two groups （P〉0.05）.After two years＇ treatment,the times of TMT-B （（46.4±6.4） s） and Stroop-CW （（132.2± 14.9） s）of the study group showed significantly shorter than those of the control （（49.3±6.5） s,（138.8± 15.7）s,P〈0.05）,and the total score and occupational function score of SDSS were significantly lower （P〈0.01） but the employment rates （72.9%）higher in the study group than those in the control （47.7%,P〈0.05）.The total side-effect rate