氟伏沙明联合无抽搐电休克或喹硫平治疗难治性强迫症

目的研究氟伏沙明联合无抽搐电休克、喹硫平对难治性强迫症患者的临床效果。方法选取2014-09—2016-09新乡医学院第二附属医院治疗的周期≥12周的78例难治性强迫症的患者,按照随机数字表方法分成2组,喹硫平联合氟伏沙明治疗的39例患者为对照组,无抽搐电休克联合氟伏沙明治疗的39例患者为观察组,对比2组临床效果、TESS评分及生活质量。结果观察组耶鲁-布朗强迫量表总分(8.45±7.20)分和汉密尔顿抑郁(29.20±1.10)分、汉密尔顿焦虑(28.50±1.40)分均较对照组低(P0.01);2组8、12周后TESS评分对比均无显著差异(P0.05);观察组总体健康评分(84.55±14.33)分,高于对照组的(65.35±13.02)分(P0.01)。结论难治性强迫症者应用无抽搐电休克联合氟伏沙明治疗,能够缓解强迫症状,改善不良强迫带来的不良情绪,且不良反应少,利于提高生活质量,有一定临床应用价值。     

喹硫平强化氟伏沙明治疗精神分裂症强迫症状1例

患者男,42岁,门诊号784148,住院号61789。主诉自语、头脑有人吵、疑人害己12年,诊断精神分裂症(未定型),住院两次,先后用药最大剂量为奋乃静36mg/d、舒必利600mg/d和氯氮平150mg/d。8年来断续有强迫症状,首次出现强迫症状在用氯氮平之前,强迫表现为反复洗衣服、洗手、洗抹布,洗     

氟伏沙明治疗少年儿童强迫症临床观察

目的:探讨氟伏沙明治疗少年儿童强迫症的疗效和安全性。方法:以氟伏沙明治疗少年儿童强迫症34例。疗程10周。根据临床症状改善和社会功能恢复程度,不良反应及实验室检查评定疗效与安全性。结果:氟伏沙明平均治疗剂量(108±20)mg/d,显效率61.8%,有效率94.1%。不良反应有口干,轻度兴奋。结论:氟伏沙明治疗少年儿童强迫症安全有效,不良反应少。     

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。     

氟伏沙明联合奥氮平治疗难治性强迫症临床观察

目的:研究氟伏沙明联合奥氮平对难治性强迫症的疗效。方法:对难治性强迫症患者75例,随机分为两组,分别为氟伏沙明单用组和联合奥氮平治疗组,治疗8周。采用Yale-Brown强迫症量表(Y-BOCS)、汉密尔顿抑郁量表(HAMD)和治疗中出现的症状量表(TESS)评价疗效和不良反应。结果:氟伏沙明联合奥氮平治疗难治性强迫症的疗效显著,不良反应少。结论:两药联合应用治疗难治性强迫症的疗效显著,值得推广。     

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。     

氟伏沙明治疗难治性强迫症4例

难治性强迫症是临床的难题之一,笔者应用氟伏沙明(商品名:兰释)治疗4例难治性强迫症, 效果较理想,现将结果报道如下.     

氟伏沙明联合思维阻断疗法治疗强迫症的效果观察

目的探讨氟伏沙明联合思维阻断疗法对强迫症的疗效。方法采用随机数字表法将56例存在强迫性思维并符合《国际疾病分类(第10版)》(ICD-10)诊断标准的强迫症患者分为氟伏沙明单一治疗组和氟伏沙明联合思维阻断疗法治疗组,观察12周。于治疗前、治疗第4、8、12周末采用耶鲁布朗强迫症状量表(Y-BOCS)进行评定,并采用生活质量综合评定问卷(GQOLI-74)评估治疗前后的生活质量。结果治疗前两组Y-BOCS和GQOLI-74评分差异无统计学意义(P0.05),治疗4周后两组Y-BOCS评分较治疗前低,差异有统计学意义(P0.05),治疗8周后联合组评分较对照组降低更明显,差异有统计学意义(P0.05);治疗12周后,联合组GQOLI-74心理功能和社会功能评分高于对照组(P0.05)。结论氟伏沙明联合思维阻断疗法治疗有强迫性思维的强迫症患者较单用氟伏沙明疗效更好,并能改善患者的生活质量。     

利培酮与喹硫平联合氯米帕明治疗难治性强迫症的疗效比较

目的比较利培酮和喹硫平分别联合氯米帕明治疗难治性强迫症的疗效。方法将62例难治性强迫症患者随机分为利培酮联合氯米帕明组和喹硫平联合氯米帕明组,于治疗前和治疗后第8、及24周末16分别使用Yale-Brown量表(Y-BOCS)、汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)进行评分,以Y-BOCS减分率评定疗效。结果两组治疗后第8、及24周末各量表评分较疗前均有明显下降,差异具有显16著性(P<0.01);两组同期比较,喹硫平联合氯米帕明组评分明显低于利培酮联合氯米帕明组,差异具有显著性(P<0.01);治疗第24周末喹硫平联合氯米帕明组的显效率明显高于利培酮联合氯米帕明组,差异有显著性(P<0.01)。结论氯米帕明联合利培酮或喹硫平均能有效治疗难治性强迫症,联合喹硫平的疗效优于联合利培酮。     

氟伏沙明与氯米帕明治疗青少年强迫症的对照研究

目的 比较氟伏沙明与氯米帕明治疗青少年期强迫症的疗效和不良反应.方法 共纳入强迫症患者42例,随机分为氟伏沙明组和氯米帕明组,疗程8周.应用耶鲁-布朗强迫症量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)评定疗效,治疗中需处理的不良反应症状量表(TESS)评价不良反应.结果 氟伏沙明组治疗总有效率86.4％,氯米帕明组治疗总有效率86.4％,两组比较差异无统计学意义(P＞0.05).两组治疗后第4、8周末Y-BOCS评分、HAMA评分与治疗前比较差异有显著统计学意义(P＜0.01).氟伏沙明组与氯米帕明组不良反应发生率差异有统计学意义(P＜0.05).结论 氟伏沙明对于青少年期强迫症状的治疗是安全有效的.     

舍曲林联合喹硫平对强迫症的疗效分析

目的评价舍曲林联合喹硫平治疗强迫症的疗效及安全性。方法采用Excel将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研究组和对照组各48例。研究组采用舍曲林联合喹硫平治疗,对照组单用舍曲林治疗,两组均治疗8周,于治疗前后采用耶鲁布朗强迫症状量表(Y-BOCS)和汉密尔顿焦虑量表(HAMA)评定疗效,采用药物不良反应量表(TESS)评估不良反应。结果治疗后,研究组总有效率高于对照组(95.83%vs.68.75%,P0.05);研究组Y-BOCS和HAMA评分均低于对照组,差异有统计学意义[(8.4±1.6)分vs.(15.4±2.1)分、(6.5±1.1)分vs.(10.8±1.2)分,P均0.05];研究组与对照组不良反应发生率差异无统计学意义(6.25%vs.8.33%,P0.05)。结论舍曲林联合喹硫平治疗强迫症疗效优于单用舍曲林,安全性相当。     

Sleep in obsessive compulsive disorder

Several lines of evidence suggest that brain serotonergic systems may be disturbed in obsessive compulsive disorder (OCD). The serotonergic system strongly affects sleep and characteristic abnormalities of sleep are documented in depression. This study, therefore, aimed to investigate sleep structure of OCD patients in order to evaluate whether similar changes as in depression are present. Up to now, this issue has been addressed only in few studies with small numbers of patients. Sleep patterns of 62 unmedicated patients with primary OCD and 62 age- and sex-matched healthy controls were investigated by polysomnography. Additionally, the impact of tryptophan depletion on sleep was studied in a subgroup of 12 OCD patients and 12 controls. The OCD patients exhibited moderate, but significant disturbances of sleep continuity measures but no abnormalities of slow wave sleep or REM sleep, except a significant elevation of 1st REM density. Tryptophan depletion induced a worsening of sleep continuity, but no changes of REM sleep or slow wave sleep. Assuming that changes of sleep architecture indicate underlying neurobiological abnormalities, this study indicates that neurobiological disturbances are different in primary OCD as compared with primary depression.     

Correlates of comorbid anxiety and externalizing disorders in childhood obsessive compulsive disorder

The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5–17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed.     

Hypochondriasis and obsessive compulsive disorder.

Hypochondriasis and OCD differ conceptually in the degree to which the patient's disease concerns are experienced as an intrusive mental event or a reasonable psychological response to a realistic health threat, in the degree to which the ideation is resisted, and in the presence of somatic sensations and medical help-seeking. There are, however, some similarities between the conditions, including the development of excessive, stereotyped, repetitive behaviors in an attempt to allay their anxiety. Empirical data on the degree of overlap between the conditions are too limited to permit definitive conclusions. The little that we do know, however, suggests that (1) the prevalence of OCD in hypochondriasis is probably elevated, but not extraordinarily so; (2) the prevalence of hypochondriasis in OCD is unknown; (3) fears about disease, illness, and injury are one of the more common forms of obsessions seen in OCD; and (4) there are several ill-defined and largely unexplored conditions, such as disease phobias, which appear to be very similar to both OCD and hypochondriasis. Clinical experience suggests that there may be a subgroup of hypochondriacal patients who are closer to the anxiety disorders in general and to OCD in particular. This subgroup might respond to the newer, antiobsessional, serotonin reuptake blocking agents.