结构式家庭疗法治疗难治性强迫症患者7例

目的:探讨结构式家庭治疗对难治性强迫症患者的干预效果。方法:选择2004-04/2005-02北京回龙观医院心理治疗病房及张山营精神卫生保健院就诊的难治性强迫症患者7例,患者家属或监护人均知情同意。在初次访谈后,邀请患者及家庭成员参加治疗性会谈,每次由家庭治疗师及协同治疗师共同进行1h左右的治疗,每个家庭平均进行4次,治疗间隔2～7d不等,每次治疗均进行录像。治疗期间未服用任何药物及进行其他治疗。治疗前后用家庭环境量表中文版(分为10个分量表,分别评价不同的家庭特征:①亲密度。②情感表达。③矛盾性。④独立性。⑤成功性。⑥知识性。⑦娱乐性。⑧道德宗教观。⑨组织性。⑩控制性)对患者及家庭每位成员进行评价,并用耶鲁布朗强迫症状量表对患者进行评价(总分为40分,0～40分为亚临床～极重度)。治疗后依据录像记录患者家庭在每次治疗中的现场表现,并对患者及家庭对治疗的满意度进行调查,同时调查周围病友对患者进行家庭治疗后所观察到的变化。结果:7例患者全部进入结果分析。①患者及家属的治疗满意度为85.71%。②患者耶鲁布朗强迫症状量表评分:治疗后评分显著低于治疗前10.75±3.06,24.21±3.33(t=3.44,P<0.01)。③患者及家属家庭环境量表评分:治疗后的家庭环境量表亲密度、情感表达因子分显著高于治疗前(7.24±2.05,6.13±2.11);(5.45±1.78,4.62±1.96)(t=3.23,3.67,P<0.01),治疗后的矛盾性、控制性因子分显著低于治疗前(2.44±1.66,3.58±1.87);(4.38±2.23,4.65±2.19)(t=2.98,2.25,P<0.05)。结论:结构式家庭治疗有助于减轻难治性强迫症患者的强迫症状,增进家庭的亲密感及情感交流,减少家庭矛盾,为患者提供更良好的家庭支持系统,进一步促进其社会功能的康复。     

结构式家庭疗法治疗难治性强迫症患者7例

目的：探讨结构式家庭治疗对难治性强迫症患者的干预效果。方法：选择2004—04／2005—02北京回龙观医院心理治疗病房及张山营精神卫生保健院就诊的难治性强迫症患者7例，患者家属或监护人均知情同意。在初次访谈后，邀请患者及家庭成员参加治疗性会谈，每次由家庭治疗师及协同治疗师共同进行1h序右的治疗，每个家庭平均进行4次，治疗间隔2～7d不等，每次治疗均进行录像。治疗期间未服用任何药物及进行其他治疗。治疗前后用家庭环境量表中文版（分为10个分量表，分别评价不同的家庭特征：①亲密度。②情感表达。③矛盾性。④独立性。⑤成功性。⑥知识性。⑦娱乐性？⑧道德宗教观。⑨组织性。⑩控制性）对患者及家庭每位成员进行评价，并用耶鲁布朗强迫症状量表对患者进行评价（总分为40分，0～40分为亚临床～极重度）。治疗后依据录像记录患者家庭在每次治疗巾的现场表现，并对患者及家庭对治疗的满意度进行调查，同时调查周围病友对患者进行家庭治疗后所观察到的变化。结果：7例患者全部进入结果分析。①患者及家属的治疗满意度为85．71％。②患者耶鲁布朗强迫症状量表评分：治疗后评分显著低于治疗前[10．75&;#177;3．06，24．21&;#177;3．33（t=3．44，P〈0．01）]。③患者及家属家庭环境量表评分：治疗后的家庭环境量表亲密度、情感表达因子分显著高于治疗前[（7．24&;#177;2．05，6．13&;#177;2．11）；（5．45&;#177;1．78，4．62&;#177;1．96）（t=3．23，3．67，P〈0．01）]，治疗后的矛盾性、控制性因子分显著低于治疗前[（2．44&;#177;1．66，3．58&;#177;1．87）；（4．38&;#177;2．23．4．65&;#177;2．19）（t=2．98，2．25，P〈0．05）]。结论：结构式家庭治疗有助于减轻难治性强迫症患者的强迫症状，增进家庭的亲密感及情感交流，减少家庭矛盾，为患者提供更良好的家庭支持系统，进一步促进其社会功能的康复。     

Clomipramine for obsessive-compulsive disorder

Obsessive-compulsive disorder affects about 2 percent of the U.S. population and can be quite disabling. Clomipramine is the only drug approved for the treatment of obsessive-compulsive disorder. Its efficacy is unique among tricyclic antidepressants and may be related to its relatively high potency in affecting serotonergic neurotransmission. The drug has many anticholinergic effects, but it is relatively well tolerated by the patients for whom it is effective. A 0.4 percent incidence of seizures, a potentially serious side effect, has been observed. Other antidepressants that are relatively selective for serotonergic (as opposed to noradrenergic) transmission may be as effective as clomipramine in the treatment of this disorder; controlled studies are under way. Clomipramine at low doses is also effective in the treatment of panic disorder and has been used successfully in the treatment of premature ejaculation.     

抗抑郁剂联合认知领悟疗法治疗强迫症对照研究

目的 探讨抗抑郁剂联合认知领悟疗法治疗强迫症的临床疗效. 方法 将60例强迫症患者随机分为两组,每组30例,两组均口服抗抑郁剂治疗,研究组联合认知领悟疗法治疗,观察6个月.于治疗前及治疗1个月、2个月、4个月、6个月末采用Yale-Brown强迫量表评定临床疗效. 结果 治疗后两组Yale-Brown强迫量表总分及强迫思维因子分均较治疗前有显著下降（P＜0.01）;研究组治疗各时段Yale-Brown强迫量表总分及强迫思维因子分均显著低于对照组（P＜0.05或0.01）.治疗6个月末研究组有效率为73.33%,对照组为43.33%,研究组疗效显著高于对照组（χ2=5.554,P＜0.05）. 结论 抗抑郁剂联合认知领悟疗法治疗强迫症疗效更显著,起效更快,显著优于单纯药物治疗.     

改良电抽搐治疗难治性强迫症疗效观察

目的　探讨改良电抽搐治疗难治性强迫症的疗效与安全性。方法　将59例难治性强迫症患者随机分为两组,研究组 (24例):无改良电抽搐治疗禁忌症,在给予75～150mg·d-1氯丙咪嗪治疗的同时,联合改良电抽搐治疗,3次·W-1,共治疗 10次;对照组(35例):常规氯丙咪嗪(150～300mg·d-1)治疗,疗程6w;两组在治疗前及治疗第1、2、4、6w末采用Yale Brown 强迫评定量表、临床疗效总评量表评定临床疗效,采用副反应评定量表评定不良反应;Y BOCS减分率≥75%为痊愈,50～ 74%为显著进步,25～49%为进步,<25%为无效。结果　研究组总有效率79.1%,对照组总有效率42.8%,两组差异极显著 (χ2=14.505,P<0.01);治疗6w末强迫评定量表评分,两组差异显著(P<0.05);研究组副反应评定量表总分显著低于对照 组(P<0.05)。结论　改良电抽搐治疗难治性强迫症有效,不良反应较轻。     

精神分析联合箱庭疗法治疗少儿强迫症1例

目的：了解精神分析联合箱庭疗法治疗少儿强迫症的临床疗效。方法对1例13岁少儿强迫症来访者进行动力性分析心理治疗,其间辅以箱庭疗法治疗,采用症状自评量表及耶鲁布朗强迫量表评定临床疗效。结果心理治疗前来访者症状自评量表、耶鲁布朗强迫量表总分分别为168分、27分,心理治疗后分别为130分、15分,情绪状态良好。结论精神分析联合箱庭疗法治疗少儿强迫症疗效显著。     

How to recognize obsessive-compulsive disorder

Your patient is anxious, depressed, and nervous, yet the complaint you are being asked to address is a respiratory infection. You suspect that the real problem may be obsessive-compulsive disorder. What should you do? How do you confidently and accurately reach the diagnosis? Dr Alarcon shares his expertise in recognition and management of this increasingly common disorder.     

氯米帕明联合认知领悟疗法治疗强迫症对照研究

目的探讨氯米帕明联合认知领悟疗法治疗强迫症的临床疗效。方法将58例强迫症患者随机分为两组，研究组30例，对照组28例，两组均服用氯米帕明治疗，研究组在此基础上联合认知领悟疗法治疗，观察10周。于治疗前及治疗10周末采用耶鲁-布朗强迫量表对两组进行测评分析。结果治疗10周末两组耶鲁-布朗强迫量表总分均较治疗前显著下降（P〈0.01），且研究组较对照组下降更显著（P〈0.01）；研究组有效率为83．3％，对照组为78．6％，两组有效率比较差异无显著性（χ^2=0．21，P〉0.05）。结论氯米帕明联合认知领悟疗法治疗强迫症疗效更显著，优于单用氯米帕明治疗。     

心理剧治疗对强迫症患者生命质量的影响

目的 探讨心理剧治疗对强迫症患者生命质量的影响.方法 将64例强迫症患者随机分为观察组和对照组各32例.两组均予以帕罗西汀系统治疗,观察组在此基础上予以心理剧治疗,疗程均为3个月.采用Yale-Brown强迫量表(Y-BOCS)及生命质量表(LQS)分别于治疗前及治疗3个月末进行评定.结果 治疗3个月末,观察组患者的Y-BOCS总分及强迫思维、强迫行为评分均显著低于对照组(t=2.77、2.48、2.46,P＜0.05或P＜0.01);而生命质量总分及身体方面、心理方面、社会方面、尽职的能力、自我健康意识5个因子评分则均显著高于对照组(t=2.83、2.49、2.09、2.31、2.26、2.80,P＜0.05或P＜0.01).结论 心理剧治疗有助于改善强迫症患者的强迫症状,并提高其生命质量.     

Occupational therapy with patients with multiple personality disorder: personal reflections

Patients with multiple personality disorder are being admitted to acute care psychiatric units with increasing frequency. Occupational therapists have been confronted with setting treatment goals and designing interventions for this population with little information available in the occupational therapy literature. This paper describes how one therapist, the author, reviewed psychiatric and psychological literature on multiple personality disorder to delineate a role for occupational therapists who are working with this special population on an acute care psychiatric unit within the context of existing programs.     

未服药强迫症患者抑制功能研究

目的 探讨未服药强迫症患者抑制功能特点.方法 运用Go/Nogo测验、Stroop色词测验及情绪Stroop测验对30例未服药强迫症患者进行抑制功能评定,并与30例健康对照者进行比较.结果 （1）Stroop色词测验任务中,强迫症组在冲突和一致条件下反应时间差值、错误率差值较对照组差异无统计学意义（t =0.055、1.675,P=0.956、0.099）;（2）情绪Stroop任务中,强迫症组对中性词、负性词及厌恶词反应时间分别较对照组延长,差异有统计学意义（t =5.381、5.545、7.548,P=0.000、0.000、0.000）;强迫症组内不同词性之间反应时间有差异（F=11.829,P=0.000）,两两比较提示厌恶词的反应时间较中性词、负性词延长,差异有统计学意义（P=0.00、0.000）,中性词和负性词之间差异无统计学意义（P=0.451）;强迫症组对中性词、负性词和厌恶词错误率较对照组差异无统计学意义（t=2.002、0.323、1.922,P=0.051、0.748、0.053）;（3） Go/Nogo任务中,强迫症组对标准刺激和新异刺激的错误率较对照组增加,差异有统计学意义（t=2.628、3.928,P=0.011、0.000）;强迫症组内新异刺激的错误率较标准刺激增加,差异有统计学意义（t=2.934,P=0.006）.结论 强迫症患者抑制功能损害具有选择性,行为抑制损害存在,认知抑制损害仅在情绪加工的情况下出现.     

fMRI pattern recognition in obsessive-compulsive disorder

Patients suffering from obsessive-compulsive disorder (OCD) are characterized by dysregulated neuronal processing of disorder-specific and also unspecific affective stimuli. In the present study, we investigated whether generic fear-inducing, disgust-inducing, and neutral stimuli can be decoded from brain patterns of single fMRI time samples of individual OCD patients and healthy controls. Furthermore, we tested whether differences in the underlying encoding provide information to classify subjects into groups (OCD patients or healthy controls). Two pattern classification analyses were conducted. In analysis 1, we used a classifier to decode the category of a currently viewed picture from extended fMRI patterns of single time samples (TR=3s) in individual subjects for several pairs of categories. In analysis 2, we used a searchlight approach to predict subjects' diagnostic status based on local brain patterns. In analysis 1, we obtained significant accuracies for the separation of fear-eliciting from neutral pictures in OCD patients and healthy controls. Separation of disgust-inducing from neutral pictures was significant in healthy controls. In analysis 2, we identified diagnostic information for the presence of OCD in the orbitofrontal cortex, and in the caudate nucleus. Accuracy obtained in these regions was 100% (p<10(-6)). To summarize our findings, by using multivariate pattern classification techniques we were able to identify neurobiological markers providing reliable diagnostic information about OCD. The classifier-based fMRI paradigms proposed here might be integrated in future diagnostic procedures and treatment concepts.     

认知行为疗法在强迫症患者中的应用效果观察

目的探讨认知行为疗法在强迫症患者中的应用效果。方法选择强迫症患者52例,随机均分为A组和B组,每组各26例,两组患者给予常规护理,在此基础上B组患者实施认知行为疗法。在就诊时及治疗后(治疗第4周和第8周),采用耶鲁布朗强迫症状量表(Y-BOCS)对两组患者进行测评。结果治疗第4周和第8周,两组患者Y-BOCS总评分比较,均P<0.05,差异具有统计学意义。结论在强迫症患者的治疗过程中,实施认知行为疗法,可提高临床疗效,促进疾病的康复。     

氟西汀与氯丙咪嗪治疗强迫症的比较分析

目的　比较氟西汀与氯丙咪嗪治疗强迫症的疗效及不良反应。方法　将 6 6例患者随机分为两组 ,氟西汀组 34例 ,氯丙咪嗪组 32例 ,疗程 8w。采用强迫量表、汉密顿抑郁量表、汉密顿焦虑量表评定疗效 ,副反应量表评定副反应。结果　氟西汀组有效率 5 8.82 % ,氯丙咪嗪组有效率 5 9.38% ,两组比较差异无显著性 (P >0 .0 5 ) ;氯丙咪嗪组副反应较氟西汀组多。结论　氟西汀治疗强迫症疗效肯定 ,且副反应少而轻     

Diagnosis and treatment of obsessive-compulsive disorder and related disorders

Obsessive-compulsive disorder (OCD) is currently recognised as one of the most common psychiatric disorders as well as one of the most disabling of all medical disorders. Obsessive-compulsive related disorders (OCRDs), often comorbid with OCD, include many distinct psychiatric conditions (i.e. some somatoform disorders, eating disorders, impulse control disorders and some neurological conditions) which have overlapping symptoms and compulsive qualities with OCD. Although effective treatments exist, OCD and related disorders are often underdiagnosed and undertreated. Serotonin reuptake inhibitors (SRIs) and cognitive behavioural therapy (CBT) represent the first-line treatment for OCD and related disorders. However, the time and the doses of the medications used in the treatment of OCD and related disorders differ from those recommended in depressive disorders. In addition, remission is not common for patients with OCD and related disorders in clinical practice, and poor responders as well as refractory cases may benefit from different treatment strategies including integrated treatment, pharmacological augmentation and brain stimulation techniques.     

Current treatment approaches to obsessive-compulsive disorder.

The two most useful treatments in obsessive-compulsive disorder are pharmacotherapy with potent serotonin reuptake-blocking agents and behavioral techniques, such as exposure and response prevention. Based on the authors' cumulative clinical experience, it is suggested that patient education, cognitive therapy, and psychodynamic psychotherapy are helpful adjuncts during various treatment stages of obsessive-compulsive disorder. The patient's strengths and knowledge of the illness can be used by the nurse-therapist to determine the implementation and timing of these therapeutic measures. Specific behavioral and cognitive techniques that may be useful in treating specific symptoms of obsessive-compulsive disorder are highlighted. Suggestions for future nursing research are outlined.     

Clomipramine for obsessive-compulsive disorder: prescribing guidelines

Clomipramine is a newly marketed tricyclic antidepressant drug prescribed for obsessive-compulsive disorder (OCD). It selectively blocks neuronal uptake of serotonin. Clomipramine has been prescribed in Europe and Canada for 20 years in management of depression. Studies have now shown clomipramine to be effective in treating OCD. Dry mouth, visual disturbances, constipation, sexual dysfunction, somnolence, tremors, and dizziness are among the commonly reported side effects. Like other tricyclics, clomipramine exhibits a potential for cardiotoxicity, especially by impairing conduction and/or orthostasis. It also has the effect of lowering seizure threshold. Overdose risk is considerable. Careful medical supervision and adherence to prescribing guidelines are presumed to reduce medication risk factors. The outstanding benefit of this drug is its proved efficacy in the management of obsessive-compulsive disorder, as the first pharmacotherapy approved for this previously rather treatment-resistant condition.