穴位刺激调控法合并氟伏沙明治疗强迫症的疗效观察

目的探讨穴位刺激调控法合并氟伏沙明治疗强迫症的疗效。方法采用随机开放对照研究,将52例符合CCMD-3强迫症诊断标准的患者随机分为研究组（穴位刺激调控法合并氟伏沙明治疗组）与对照组（单纯氟伏沙明治疗组）,分别在治疗后第2、4、8、12周末采用强迫症状评定量表（Y—BOCS）、临床总体印象量表（CGI—I）评定疗效,以临床记录评价副反应。结果治疗第2、4、8、12周末,研究组Y—BOCS的减分率高于对照组（P〈0．05及O．01）;治疗第4、8、12周末,研究组CGI—I总分低于对照组（P〈0．05及O．01）。结论穴位刺激调控法合并氟伏沙明治疗强迫症的疗效明显优于单纯应用氟伏沙明治疗。     

心理剧治疗对强迫症患者焦虑、抑郁及生活质量的影响

目的探讨心理剧治疗对强迫症患者焦虑、抑郁及生活质量的影响。方法将100例强迫症患者随机均分为研究组和对照组，在两组均给予足量足疗程的药物治疗及接受一般健康教育的基础上，仅对研究组辅以心理剧治疗，4周为一个疗程。生活质量测评工具SF-36量表、Yale—Brown强迫症量表（Y—BOCS）、17项汉密顿抑郁量表（HAMD17）、汉密顿焦虑量表（HAMA）对两组患者进行治疗前后效果评定。结果干预后研究组患者的Y—BOCS总分和HAMD17HAMA总分值均显著低于对照组（P〈0．01），而疗效显著高于对照组（P〈0．01），研究组患者的显效率显著高于对照组（P〈0．01），研究组患者的SF-36量表各维度分值显著高于对照组（P〈0．01）。结论心理剧治疗可巩固患者的疗效，并改善其焦虑、抑郁情绪，能显著提高患者的心理健康水平及生活质量，可作为一种有效的心理治疗手段应用于临床。     

认知领悟疗法治疗强迫症的随访对照研究

目的　探讨认知领悟疗法在强迫症治疗中的作用及长期疗效。方法　将 5 0例住院强迫症患者分成两组 ,分别用认知领悟疗法合并氯丙咪嗪 ( 30例为研究组 )和单用氯丙咪嗪 ( 2 0例为对照组 )治疗 ;于入组时、治疗 6周后、半年及 1年后分别用Y BOCS量表、HAMA量表评定病人 ,并于出院 1年后用SDSS量表评定病人。结果　研究组治疗 6周后至出院 1年后强迫症状评分显著低于单一用药组 ,治疗半年后研究组焦虑症状评分较低。出院一年后研究组SDSS评分低于单一用药组。结论　认知领悟疗法不仅能减轻强迫症状 ,而且能改善焦虑症状 ,增强社会功能 ,提高生活质量 ,是全面改善强迫症的治疗方法 ,而且长期应用疗效显著     

利培酮辅助治疗强迫症的临床疗效比较

目的探讨利培酮辅助治疗强迫症的临床疗效和安全性。方法对43例强迫症患者，在服用原抗抑郁药的基础上随机分为合用组和对照组，分别给予合用利培酮和安慰剂，共治疗12周。采用Yale—Brown强迫症量表（Y—BOCS）、Marks恐怖强迫量表（MSCPOR）和不良反应量表（TESS）评定疗效和不良反应。结果合用组Y—BOCS及MSCPOR评分治疗前后比较有显著性差异，对照组则无显著性差异；治疗后两组Y—BOCS及MSCPOR评分比较亦有显著差异。两组TESS评分相近。结论合用利培酮治疗强迫症有一定的辅助作用，不增加不良反应。     

精神分裂症伴强迫症状的临床研究

目的 分析伴强迫症状的精神分裂症临床特点及治疗效果，为临床诊断及治疗提供参考。方法 对伴强迫症状的精神分裂症与不伴强迫症状的精神分裂症各38例进行对照分析，使用维思通抗精神病药物治疗，采用阳性及阴性症状量表（PANSS）、强迫症状量表（Y—BOCS）、Hamilton抑郁量表（HAMD）、Hamilton焦虑量表（HAMA）评定疗效。结果 伴强迫症状的精神分裂症起痛年龄早，起病隐袭，病程迁延，以阴性症状为主，住院时间长，治疗效果差，Y—BOCS、HAMD、HAMA等量表评分明显高于不伴强迫症状的精神分裂症，有显著性差异。结论 伴强迫症状的精神分裂症，具有一定的异质性，单一使用抗精神病药物疗效差。     

心理护理对慢性精神分裂症患者强迫症状的效果研究

目的探讨心理护理对慢性精神分裂症患者强迫症状的干预效果。方法将85例伴有强迫症状的慢性精神分裂症患者随机分为研究组（42例）和对照组（43例）,研究组接受共6个月的心理护理,并在基线、干预后3月末、干预后6月末应用耶鲁-布朗强迫量表（Y—BOCS）、汉密尔顿焦虑量表（HAMA）评定疗效。结果干预后6月末,研究组和对照组的Y—BOCS评分以及HAMA评分较干预前均有显著性降低（P〈0．05）。而在干预后3月末、6月末,干预组的Y—BOCS评分和HAMA评分均显著低于对照组,且差异均有显著性意义（P〈0．05）。结论心理护理可有效改善慢性精神分裂症患者的强迫症状。     

奥氮平合并氯丙咪嗪治疗精神分裂症强迫症状的对照研究

目的了解国产奥氮平合并氯丙咪嗪治疗伴强迫症状的分裂症的疗效和副反应。方法对伴强迫症状的分裂症随机分为研究组和对照组，研究组用奥氮平合并氯丙咪嗪，对照组单用奥氮平，治疗周期均为8周。用PANSS、Y—BOCS评定疗效，TESS评定副反应。结果治疗8周末两组PANSS总分和各因子分与治疗前比较均明显下降（P〈0．01），且两组治疗2、4、8周末PANSS总分及其因子分的减分率差异无显著性（P〉0．05），但Y—BOCS总分和其因子分减分率研究组显著高于对照组（P〈0．01）。两组治疗后分裂症症状有效率、显效率、痊愈率比较差异无显著性（P〉0．05），但强迫症状有效率、显效率、痊愈率差异有显著性（P〈0．01）。研究组治疗后TESS总分较对照组高（P〈0．05）。结论奥氮平合并氯丙咪嗪治疗伴强迫症状的分裂症疗效肯定，副反应能够耐受，可作为治疗伴强迫症状分裂症的一个较好选择。     

认知领悟疗法治疗强迫症的对照研究

将符合CCMD—2—R诊断标准的30例强迫症患者,随机对其中15例在抗强迫症药物治疗的基础上联合心理治疗,另15例以单纯的药物治疗为对照组。结果显示前者疗效明显优于后者。本文认为认知领悟疗法结合药物治疗对强迫症能更有效地控制症状,改善预后。     

氟伏沙明合并氯氮平治疗强迫症的疗效比较

目的探讨氟伏沙明合并氯氮平治疗强迫症的疗效。方法45例强迫症患者随机分为氟伏沙明合并氯氮平治疗组和单独氟伏沙明治疗组。疗程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）评定疗效。结果治疗结束时两组Y—BOCS、HAMA、HAMD的评分均显著降低,更以合并氯氮平组明显。结论氟伏沙明合并氯氮平治疗强迫症可以增加疗效。     

氟西汀合并认知行为疗法治疗强迫症对照研究

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：将符合中国精神障碍分类与诊断标准第3版的诊断标准的57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，对照组单用氟西汀治疗，应用临床疗效标准及耶鲁布朗强迫量表(Y—BOCS)定期评定；观察6个月。结果：在治疗1、2、4个月和6个月时，治疗组疗效显著优于对照组，尤其是对强迫行为疗效更好。结论：氟西汀合并认知行为疗法联合治疗强迫症效果优于单用氟西汀治疗。     

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。     

双侧扣带前回毁损术治疗难治性强迫症患者的长期随访效果

背景 强迫症是一种较为常见的慢性、致残的疾病,患者出现无法自控的强迫思维及强迫行为.10%以上的强迫症病人对药物和行为治疗无效.对一些常规治疗无效的难治性强迫症患者,神经外科已经开展一些手术治疗,例如扣带前回毁损、脑白质切断术、尾状核下束切断、内囊前支毁损.扣带前回毁损相对来说比较安全同时没有明显的副作用,但是也有术后存在认知障碍的报道.为判断立体定向双侧扣带前回毁损是否是一种适合难治性强迫症的治疗,我们评价了立体定向双侧扣带前回毁损术的长期疗效及其副作用.方法 患者筛选在1999年3月至2003年4月间,17例难治性强迫症患者(男10例,女7例)接受了双侧扣带前回毁损术,并且接受了超过2年的随访.患者的选择标准如下患者符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)强迫症的诊断标准,病程超过3年,疾病导致社会心理功能降低.每位患者皆由两位精神科医师依照DSM-Ⅳ的Axis Ⅰ和Axis Ⅱ的疾病诊断标准行临床诊断.如伴有精神病性症状,就先用一线药物彻底治疗.手术方法立体定向的靶点通过与MRI配套的Leksell适配器,在GE Sigma 1.5 T的机器上得以确认.局部麻醉下,在两侧的冠状缝中线外20 mm颅骨钻孔.将尖端直径1.8 mm,长度10 mm的电极插至靶点,用85℃,90 s进行射频毁损.在双侧扣带前回,每侧各4个射频毁损灶,2个针道.第一个射频毁损灶在两侧侧脑室前角后缘15 mm,侧脑室顶部上2 mm,旁开中线7 mm处.射频电极接着回撤8 mm,制作第二个射频毁损灶.第三个射频毁损处在两侧侧脑室前角后缘22 mm,侧脑室顶部上2 mm,旁开中线7 mm处.再往上8 mm,制作第四个射频毁损灶.结果是出现类似椭圆柱形的射频毁损灶,大约高18 mm、前后径13 mm,横径6 mm.术前和术后随访评估两位精神科医师用Yale-Brown强迫症量表(YBOCS)、临床总体印象量表(CGI)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA),分别在手术前1个月、术后12个月、术后24个月对患者进行评估.评估的精神科医师接受了培训,Kappa值超过0.75,以确保评估的准确性.在我们研究中,患者的Y-BOCS得分改善35%或更高、CGI评分为1(极其显著改善)或者2(显著改善);由专业的临床精神科医生对患者进行一套固定的神经心理测试,测试分别在术前1个月、术后12个月、24个月进行.这些测试包括K-WAIS测验,视觉空间功能(RCFT),Hopkins语言学习测验(HVLT),威斯康星卡片分类测验(WCST),口语流畅测验(COWAT).K-WAIS评分由韦氏成人智力量表(WAIS-R)改编而来,以产生总智商(IQ)、言语IQ和行为IQ来测量智力水平.RCFT评分用于测试空间构建能力.记忆力也包括回忆的精确性、瞬时回忆、延迟回忆和识别指数等的得分.HVLT用于测量口头记忆能力和学习能力.使用WCST和COWAT评分来检查认知的灵活性和执行功能.在WCST中,正确、错误反应的总数,完成的项目数,持续的反应,持续的错误数都用于评分.COWAT评分采用字母翻译和目录翻译的单词数目,字母翻译用来检查语音的流利,目录翻译用来评价语义流利性.使用Wilcoxon符号秩检验对术前的Y-BOCS,HAMD,HAMA评分和术后6、12个月的评分进行比较,使用Wilcoxon符号秩检验对手术前和手术后12个月的K-WAIS,RCFT,HVLT,WCST,COWAT评分进行比较.统计软件采用SPSS 10.结果 扣带回毁损术后强迫、抑郁、焦虑症状均改善Y-BOCS,CGI、HAMD,HAMA评分显示了扣带回毁损术的有效性,在12个月的随访中,与术前Y-BOCS评分相比,改善率为36%,在24个月的随访中,改善率升至48%.术前、术后认知功能和记忆的改变手术前和手术后24个月的K-WAIS,RCFT,HVLT,COWAT评分没有显著性差异.在WCST评分中,与术前基线相比,术后的错误总数、持续错误数和反应数明显减少.术后的错误总数、持续错误数和反应数的改变说明在扣带回毁损术后执行功能的提高.在术后2～3个月,3例患者有记忆障碍,但持续时间少于2个月.结论 强迫症的扣带回毁损术术后24个月的随访结果显示症状明显改善,但没有认知功能的改变,包括智商、言语、视觉空间记忆和执行功能等均没有改变.     

Treatment of obsessive-compulsive disorder in older patients - case studies

BACKGROUND: Five patients aged 64 to 74 years with obsessive-compulsive disorder were treated successfully, one with cognitive behavioural therapy and four with a combination of antidepressants and cognitive behavioural therapy. The current multidisciplinary guidelines on anxiety treatment, which cover the age-range 18 to 65 years, are a good starting point for the treatment of obsessive compulsive disorder in older patients.     

An update on body dysmorphic disorder

PURPOSE OF REVIEW: The present review provides an update on current research into body dysmorphic disorder. RECENT FINDINGS: Recent findings can be considered under four groupings: the classification of body dysmorphic disorder, its current inclusion under the somatoform disorders, and its relationship to obsessive compulsive disorder and other obsessive compulsive spectrum disorders; the psychotic 'variant' of body dysmorphic disorder, and whether it is simply a more severe form of the nonpsychotic type; the cognitive aspects of body dysmorphic disorder; and the treatment of body dysmorphic disorder, both in terms of pharmacological and psychological parameters. SUMMARY: Body dysmorphic disorder does not sit comfortably in the somatoform disorder category, and there is a good case for it being considered part of the obsessive compulsive spectrum, although it is not merely a subtype of obsessive compulsive disorder. Insight into the illness suggests that it represents a spectrum of disorders, and a categorical delineation of 'psychotic' and 'nonpsychotic' variants cannot be supported. We are beginning to understand more about the neurocognitive aspects of body dysmorphic disorder, but more research is required to assess which deficits/aberrations (if any) are exclusive to body dysmorphic disorder as an entity, and which are a reflection of broader phenomenological manifestations. Finally, the mainstay of treatment for body dysmorphic disorder remains behaviour/cognitive behaviour therapy and serotonin reuptake inhibitors; much more work is required to identify effective interventions for those patients who fail to respond to these treatment modalities.     

帕罗西汀联合认知行为疗法治疗强迫症的临床对照研究

目的比较单用帕罗西汀与帕罗西汀联合认知行为疗法对强迫症的临床疗效。方法采用半随机法将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)强迫症诊断标准的86例患者分为研究组和对照组各43例,两组均给予帕罗西汀治疗,研究组在此基础上给予每周1次的认知行为治疗,均观察12周。于治疗前和治疗后第4、8、12周分别采用耶鲁-布朗强迫量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)评定临床疗效,于治疗第4、8、12周采用副反应量表(TESS)评定不良反应。结果治疗4周末起两组Y-BOCS总评分均较治疗前低(P均0.01),研究组HAMA评分低于对照组(P0.01),第8周末起研究组Y-BOCS评分低于对照组(P0.05);治疗12周末,研究组强迫行为因子评分低于对照组(P0.05),且研究组总有效率高于对照组(86.05%vs.62.79%,P0.05),研究组和对照组不良反应发生率差异无统计学意义(16.28%vs.20.93%,P0.05)。结论单用帕罗西汀与帕罗西汀联合认知行为疗法均可缓解强迫障碍患者症状,但帕罗西汀联合认知行为疗法的效果优于单用帕罗西汀治疗,尤其对强迫行为的改善更为突出。     

Stereotactic treatment of refractory obsessive compulsive disorder by bilateral capsulotomy with 3 years follow-up.

In order to study the clinical effect of bilateral capsulotomy in patients with refractory obsessive compulsive disorder (OCD), 35 patients with refractory obsessive compulsive disorder for whom anti-OCD medications and psychological/behavior therapy had failed, underwent MRI-guided stereotactic bilateral anterior capsulotomy. Pre- and post-operative Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) scores were determined by psychiatrists. All patients underwent fluorodeoxyglucose positron emission tomography evaluation before and 6 months after the operation. Twenty patients became OCD symptom-free (57%), 10 experienced significant improvement (29%) and five experienced no significant improvement (14%). There were significant decreases in Y-BOCS, HAMD and HAMA scores. Our results show that MRI-guided stereotactic bilateral capsulotomy is a precise, safe and effective therapy for refractory obsessive compulsive disorder. This promising technique may also improve anxiety and depression in addition to OCD. OCD patients who have not responded to medication, psychotherapy or behavioral therapy might benefit from MRI-guided stereotactic bilateral capsulotomy.     

Prospective Relationship Between Obsessive–Compulsive and Depressive Symptoms During Multimodal Treatment in Pediatric Obsessive–Compulsive Disorder

The present study examined the prospective relationship between obsessive–compulsive and depressive symptoms during a multimodal treatment study involving youth with obsessive–compulsive disorder (OCD). Participants included fifty-six youth, aged 7–17 years (M = 12.16 years) who were enrolled in a two-site randomized controlled pharmacological and cognitive behavioral therapy treatment trial. Obsessive–compulsive severity was measured using the Children’s Yale-Brown Obsessive–Compulsive Scale, and depressive symptoms were rated using the Children’s Depression Rating Scale-Revised. Multi-level modeling analyses indicated that, on average over the course of treatment, variable and less severe obsessive–compulsive symptoms significantly predicted a decrease in depressive symptoms. Additionally, week-to-week fluctuations in OCD severity did not significantly predict weekly changes in depressive symptom severity. Level of baseline depressive symptom severity did not moderate these relationships. Findings suggest that when treating youth with OCD with co-occurring depression, therapists should begin by treating obsessive–compulsive symptoms, as when these are targeted effectively, depressive symptoms diminish as well.     

Glutamatergic dysfunction--newer targets for anti-obsessional drugs

Despite widespread use and validation of their efficacy, about 40-60% of obsessive compulsive disorder (OCD) sufferers do not respond to appropriate courses of treatment with serotonin reuptake inhibitors (SRI) and even with the combination of pharmacotherapy and cognitive behaviour therapy a substantial number of patients remain dramatically symptomatic. Recently, there has been increasing interest in investigating glutamatergic dysfunction in OCD. Multiple lines of evidence point toward glutamatergic dysfunction being related to the pathophysiology of OCD, with glutamate modulating drugs being an alternative pharmacological strategy for treating OCD. In this article we focus in detail on the rationale for targeting glutamatergic agents as well as review the recent important patents for compounds that have emerged from these studies.     

Potential role of anticonvulsants in the treatment of obsessive–compulsive and related disorders

We reviewed the extant literature to evaluate the current evidence regarding the efficacy and safety of anticonvulsants in the treatment of obsessive–compulsive and related disorders. Relevant literature was accessed using the Cochrane database, embase and PubMed on 29 October 2013. Prospective studies examining the efficacy of anticonvulsants in obsessive–compulsive and related disorders were included. Case reports, case series, and retrospective studies were excluded. A total of 10 studies were included in this review. The studies of obsessive–compulsive disorder, except for two negative studies, showed favorable efficacy results of anticonvulsants. In one study on body dysmorphic disorder, levetiracetam showed favorable efficacy. In two lamotrigine studies for pathologic skin‐picking, the efficacy findings were inconsistent. In one trichotillomania study, topiramate had reduced hair‐pulling symptoms. Despite limited evidence, our review suggests that anticonvulsants have a potential role in the treatment of obsessive–compulsive and related disorders.