强迫症的亚型探讨与疗效比较

目的：探讨认知行为心理治疗（CBT）在强迫症（OCD）患者各亚型治疗中的有效性和规律性。方法：本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果：认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表在6个月两组有显著性差异（P〈0.05）。其中强迫症亚型（怕脏型、反复检查型和反复担心型）的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异（P〈0.05）;反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异（P〈0.05）;反复检查型两组间无统计学差异。结论：认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为：反复担心型〉怕脏型〉反复检查型。

Exploration and the comparison of the clinical effect of the treatment of the subtypes of the obsessive-compulsive disorder

Objective:To explore the effect and the regularity of the cognitive behavioral therapy(CBT) in treating all the subtypes of obsessive-compulsive disorder.Methods:after defining the diagnosis,we divided the patients into two groups according to their own will,and we treated the two groups separately and observed in 3,6 months.We use Yale-Brown obsessive-compulsive scale,self-assessed scale made by ourselves and the assessment of the clinical effect to assess.Results: the group of cognitive behavioral therapy combining pharmacological therapy is 31 cases,and the clinical effective rate is 70.9% and the cure rate is 1.8%.The group of simple pharmacological therapy is 24 cases,and the clinical effective rate is 33.3%.In the 6 months,there is significant difference in the marks of Yale-Brown obsessive-compulsive scale of the two groups(P<0.05).In the comparison of effectiveness of the subtypes of the OCD(dirty-feared,repeated-checked and repeated-concerned),there is a significant difference in the marks of self-report scale in dirty-feared group in 3 months(P<0.05);there is significant difference in the marks of Yale-Brown scale in repeated-concerned group in 6 months(P<0.05);there is no significant difference in the marks of the scales in repeated-checked group.Conclusions: the effectiveness of the CBT combining pharmacological therapy is better than simple pharmacological therapy.The sequence of the effect of treatment for the subtypes of OCD is: repeated-concerned > dirty-feared > repeated-checked.