强迫症患者前瞻记忆缺损程度对SSRIs疗效的预测作用

目的 探究强迫症患者前瞻记忆缺损程度对选择性5-羟色胺再摄取抑制剂(SSRIs)疗效的预测作用.方法 选择符合《精神障碍诊断与统计手册(第4版)》修订版(DSM-IV-TR)强迫症诊断标准的30例强迫症患者为研究对象,对患者进行为期4周的SSRIs药物治疗.采用耶鲁布朗强迫症状量表(Y-BOCS)评定患者治疗前后强迫症...     

氟西汀合并利培酮治疗强迫症对照研究

目的评价氟西汀合并利培酮对强迫症的治疗效果。方法将符合CCMD-3诊断标准的60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利培酮治疗,对照组只给予氟西汀治疗,应用汉密尔顿焦虑量表(HAMA)及耶鲁布朗强迫量表(Y-BOCS)定期评定疗效。应用副反应量表(TESS)评定不良反应。疗程8周。结果在治疗第2、4、6、8周末,治疗组疗效优于对照组,尤其是对强迫思维疗效更好,具有显著性统计学意义(P<0.05)。结论氟西汀合并利培酮治疗强迫症效果优于单用氟西汀治疗。     

Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD

Predictors of improvement in obsessive-compulsive symptoms (Y-BOCS) in a randomized clinical trial with adult obsessive-compulsive disorder outpatients were examined. Results of multiple regression analyses revealed that a positive helping alliance was significantly predictive of posttreatment Y-BOCS. Treatment expectancy and high motivation to change were not significantly related to posttreatment outcome. None of the predictors were significantly related to Y-BOCS levels at 12-month follow-up, but positive alliance showed a trend to significance.     

强迫症伴强迫型人格障碍患者的临床表现

目的 评估强迫型人格障碍（OCPD）在强迫症（OCD）中的发病率,探讨伴OCPD的OCD患者的临床特征.方法 采用DSM-Ⅳ人格障碍临床定式检测手册（SCID-Ⅱ）中有关OCPD的诊断项目对260例OCD患者进行评估,据其是否符合OCPD诊断而将患者分为共病组（OCD＋ OCPD）和非共病组（OCD-OCPD）.对两者的临床特征、焦虑、抑郁水平等进行比较.结果 78例（30％）OCD患者符合OCPD的诊断;共病组有更多的物品污染、囤积以及高道德标准强迫思维和更多的检查、囤积和混合强迫行为等强迫症状,且共病组强迫行为严重程度、抑郁及特质焦虑水平显著高于非共病组,但两组首次出现强迫症状的年龄,有精神疾病家族史的比例以及自知力水平、状态焦虑水平等差异无统计学意义.结论 强迫型人格障碍与强迫症的重叠可能增加了其病理心理的严重程度.     

Adjunctive glycine in the treatment of obsessive-compulsive disorder in adults

Background

Recent preclinical findings, case reports and non-blinded studies have suggested that glutamatergic interventions may be efficacious for Obsessive-Compulsive Disorder (OCD).

Methods

We enrolled 24 adult outpatients with OCD on stabilized treatment regimens in a double-blind trial of adjunctive glycine, an NMDA glutamate receptor agonist. Participants were randomly assigned 1:1 to either placebo or glycine titrated to 60 g/day, with follow-up visits scheduled at 4, 8 and 12 weeks. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the principal outcome measure.

Results

Regimen non-adherence, principally related to complaints about the taste and/or nausea, resulted in only 14 individuals who were evaluable by predetermined criteria. Those receiving glycine (n = 5) experienced a mean decrease of 6.04 points in Y-BOCS score, compared with a 1.00 point decrease for those receiving placebo (n = 9). Using a hierarchical linear model, compared with placebo, individuals who received glycine had an average 0.82 decrease in Y-BOCS score for each week they remained in the study, not quite reaching statistical significance (p = 0.053). Two of those receiving glycine were responders, versus none receiving placebo (p = 0.11, ns, Fisher exact). Despite the dropouts, two participants were known to have subsequently continued taking glycine through their regular treating psychiatrist for over a year.

Conclusions

The glycine condition approached efficacy for treatment of OCD in this study, with the high dropout rate related to problems with palatability and small sample size the principal caveats. This may indicate a new strategy for treatment of OCD, although confirmatory studies are clearly needed. (ClinicalTrials.gov NCT00405535.)     

Refining clinical judgment of treatment outcome in obsessive-compulsive disorder

This research aimed to provide clinicians and investigators with optimal treatment outcome criteria for accurately predicting response and remission in both research studies and clinical practice. Data from 153 adult OCD outpatients (ages 18-79) who had participated in a treatment outcome study were examined. Signal detection analysis was conducted to compare levels of Yale-Brown Obsessive Compulsive Scale (Y-BOCS) symptom percent reductions and post treatment absolute scores with Clinical Global Impression (CGI) ratings of symptom improvement and severity. Optimal cutoff criteria were based on sensitivity, specificity and efficiency and were assessed via the Quality Receiver Operating Characteristic curve. A Y-BOCS reduction of 45% was observed to be the most efficient for predicting response in research trials, whereas a reduction of 35% may be optimal for clinical use. A 55% Y-BOCS reduction was determined to be the optimal cutoff for predicting remission in both clinical and research settings. A Y-BOCS absolute raw score of 12 or less was optimal for predicting remission in a clinical setting and a raw score of 14 or below was most favorable in research trials. This research provides the first empirical contrast of optimal outcome criteria in OCD based on differing ideals of both research and practice.     

米氮平与氯丙咪嗪治疗强迫症的对照研究

目的　探讨米氮平与氯丙咪嗪治疗强迫症疗效及副作用比较。方法　选择符合诊断标准的强迫症60例,随机分为米氮平与氯丙咪嗪两组　米氮平组平均(53.6±5.1)mg/d;氯丙咪嗪组平均(215.6±37.6)mg/d。观察8周。结果　两组疗效比较无显著差异,米氮平组第1 周末起效,氯丙咪嗪组第4 周末起效,起效时间两组比较差异显著(P<0.05);副反应两组比较米氮平显著较低(P<0.01)。结论　米氮平是一种安全有效的抗强迫症药物。     

强迫障碍对患者生活质量影响的研究

目的探讨强迫障碍对患者生活质量的影响。方法采用TDL生活质量量表评估强迫障碍患者的生活质量。结果强迫障碍组的身体方面、心理方面、社会方面、尽职的能力、自我健康意识及TDL量表总分均显著地低于对照组(P<0.05)。结论强迫障碍对患者的生活质量影响很大,应积极治疗。     

Suicidality in schizophrenic patients with and without obsessive-compulsive disorder

This report examines the suicidal behaviour in subjects with schizophrenia who have (N = 24) and do not have comorbid Obsessive-Compulsive Disorder (OCD) (N = 33). The patients with OCD-schizophrenia were more likely to have a previous history of suicidal attempts, and ideations. The number of previous suicidal attempts were significantly higher in patients with OCD-schizophrenia than in patients with non-OCD schizophrenia. The patients with a history of previous suicide attempts were more likely to have a comorbid diagnosis of OCD. Compulsive symptoms were significant predictors of suicide attempt among patients with schizophrenia. Our preliminary findings may suggest that obsessive-compulsive symptoms may account for the emergence of suicidality in patients with OCD-schizophrenia.     

舍曲林与氯丙咪嗪治疗强迫症的对照研究

目的比较舍曲林与氯丙咪嗪治疗强迫症的疗效和不良反应。方法应用舍曲林和氯丙咪嗪治疗强迫症各30例，应用Yale-Brown强迫量表、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)及临床4级标准评定疗效。结果舍曲林与氯丙咪嗪治疗后Yale-Brown强迫量表分值、HAMD、HAMA分值均显著下降，两组间减分比较，差异无显著性，舍曲林不良反应发生率明显少于氯丙咪嗪。结论舍曲林治疗强迫症疗效与氯丙咪嗪相当，不良反应较轻，值得推广。     

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。     

强迫症患者持续性注意功能的相关性研究

目的了解强迫症（OCD）持续性注意功能损害情况及其相关因素。方法对65例OCD患者在入组时进行连续操作试验（CPT）测试,以65例正常健康人进行对照,采用耶鲁-布朗强迫量表（Y—BOCS）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评定病情与情绪,并对测试结果与病程、年龄、病情严重度和焦虑、抑郁情绪等进行回归分析。结果OCD患者CPT视觉单目标持续性注意测验（VOT）、视觉连续目标持续性注意测验（VST）、听觉持续性注意测验（ET）均高于正常对照组（z=3．79～8．62,P〈0．05）,CPT评分与病程、年龄无关（标准化回归系数Beta=0．012—0．198,P〉0．05）,与病情严重度和情绪有相关性（VOTCV Beta=0．566,VOTHAMA Beta=0．382,VOTHAMD Beta0．294,P〈0．05）。结论OCD患者存在一定的注意损害,注意损害与病情严重度和情绪有关。     

Outcome of a psychotherapeutic programme for patients with severe personality disorders

A specialized psychotherapeutic day treatment programme was established in a Danish clinical setting on the basis of recent research and advances in treatment for severe personality disorders. This study analyses treatment effectiveness by comparing the day treatment programme with a treatment as usual (TAU) situation as given to personality-disordered patients on a waiting list. The sample consisted of 66 personality-disordered patients consecutively referred and diagnosed according to standardized criteria. The intervention group comprised 38 patients. There was no selection made for the intervention group: when the programme capacity was reached, a waiting list of 28 consecutive patients formed the comparison group; none of these patients figured in the intervention group. Intervention included psychodynamic and cognitive-based therapy in a group/individual setting and lasted 5 months. Outcome measures were self-rated and observer-rated multidimensional evaluation of functioning relevant to personality-disordered patients. The day treatment programme did significantly better in reducing acute and prolonged hospitalizations and suicide attempts, in stabilizing the psychosocial functioning and in reducing complaints that lead to treatment. The intensive day treatment programme stabilized patient functioning but did not lead to changes on personality traits for which more extended treatment might be necessary.     

氟西汀合并认知行为疗法治疗强迫症的对照分析

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CCMD - 3诊断标准的 5 7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 ,对照组只给予氟西汀治疗。应用临床疗效标准及耶鲁布朗强迫量表 (Y -BOCS)定期评定疗效。疗程 6个月。结果　在治疗第 1、2、4和 6个月末 ,治疗组疗效优于对照组 ,尤其是对强迫行为疗效更好 ,具有极显著性统计学意义 (P <0 0 1)。结论　氟西汀合并认知行为疗法治疗强迫症效果优于单独用氟西汀治疗。     

帕罗西汀单用与帕罗西汀合并喹硫平对强迫症疗效的对照研究

目的探讨帕罗西汀合并喹硫平治疗强迫症的疗效。方法50例强迫症患者随机分为帕罗西汀组和帕罗西汀合并喹硫平组,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的评分均显著下降,而合并喹硫平组更明显。结论帕罗西汀合并喹硫平治疗强迫症可以提高疗效。     

双相障碍共病强迫症的临床特征与治疗

本文目的是对双相障碍共病强迫症的临床特征与治疗进行综述,以期为临床早期识别和干预提供参考.双相障碍共病强迫症的临床现象并不少见,但两者的治疗原则存在差异甚至互斥,导致治疗困境.本文就双相障碍共病强迫症的流行病学特征、临床特征及治疗进行探讨.     

口吃共病强迫症的访谈与治疗

本文目的是通过报道病例诊疗过程,呈现口吃共病强迫症的临床诊疗思路及治疗方案的制定。咨客是一位23岁的未婚男性,自幼口吃,在应激和焦虑状态下加重,影响工作和社交。咨客自高中二年级开始时出现反复数钱、反复计算的行为,被诊断为强迫症,予以SSRIs类药物联合第二代抗精神病药物治疗,强迫思维和强迫行为得到改善,但出现嗜睡、情绪烦躁等,减少思瑞康剂量后,出现失眠,焦虑加重影响口吃,伴有心慌、紧张、进食后腹泻等。咨客被诊断为口吃共病强迫症,建议采用生物-心理-社会综合干预方法,通过积极运动缓解压力,继续服用百忧解,降低思瑞康剂量,减轻嗜睡,予以β-受体阻断剂普萘洛尔弥补思瑞康减量带来的焦虑。心理治疗推荐认知行为治疗和正念减压;社会学方面,继续从事会计等人际交往较少的工作。     

Decision-making heterogeneity in obsessive-compulsive disorder: ventromedial prefrontal cortex function predicts different treatment outcomes

Certain clinical aspects of patients with Obsessive-Compulsive Disorder (OCD) appear similar to those of patients with damage to the ventromedial sector of the prefrontal cortex. The hypothesis for the involvement of the frontal region in OCD is also supported by neuropsychological findings. Building on this evidence, we assessed the performance of a group of 34 OCD patients on a measure indexing with orbitofrontal cortex functioning and compared it with the performance of two other subject groups, one consisting of 34 healthy control subjects and the other 16 patients with panic disorder. All study subjects performed a neuropsychological task, which is sensitive to frontal lobe dysfunction and simulating real-life decision-making. Significant differences were found between the neuropsychological profiles of the OCD and of other groups, pointing to a possible specificity of decision-making deficit in OCD. Comparison of the performance of the OCD patients grouped according to response to antiobsessive drug treatment showed that poor neuropsychological task performance predicted poor outcome of pharmacological treatment. Task behavior did not correlate with severity of illness or demographic characteristics of the subjects. Results support the role of the ventromedial prefrontal cortex in OCD.     

无抽搐电休克合并氯丙咪嗪治疗难治性强迫症对照研究

目的探讨无抽搐电休克治疗难治性强迫症的疗效及安全性.方法 39例经氯丙咪嗪(＞150mg/d)治疗8周效果差的强迫症患者,分为两组.一组加用无抽搐电休克治疗,每周3次共10次,期间氯丙咪嗪减量;另一组继续服用原有氯丙咪嗪治疗.进行临床疗效、Y-BOCS、TESS评定并作比较.结果合用无抽搐电休克治疗组显效率71.43%,与单用氯丙咪嗪组(5.56%)相比有非常显著性差异.疗程结束时两组Y-BOCS评分有非常显著性差异.TESS评分无差异.结论并用无抽搐电休克治疗难治性强迫症有效、安全.     

Zimeldine treatment of obsessive-compulsive disorder

ABSTRACT– Six patients with Obsessive-Compulsive Disorder (DSM III) were treated in an open uncontrolled trial with Zimeldine, for 8 weeks. All six patients had cognitive deficits before treatment. Five patients improved on the clinical symptoms. Four of these showed pronounced amelioration of their cognitive deficits.