强迫症的精神病理学研究☆

】　目的　探讨强迫症临床过程的基本特征,强迫症状之间的相互关系及症状形成的病理心理机制,筛选出本病病理心理上相对独立的症状群,为本病今后在特殊领域里的深入研究提供筛选同源性病例的方法,也为本病的临床分型诊断和治疗提供症状学依据。方法　采用自制研究调查表和量表评定的方法,对90例未服药的强迫症患者进行临床研究。结果　强迫症的平均发病年龄为(21.2±8.3)岁,男∶女为1.7∶1,平均病程为(6.4±6.0)年,93.4%的患者出现2个以上的强迫症状,强迫症状出现频率及症状之间的相关性显示,有4组相对独立的症状群分别为①单纯强迫观念;②强迫怀疑/强迫检查;③强迫恐惧/强迫洗涤、强迫回避;④单纯强迫行为。4组症状群相应的病理心理分别为①联想过程的强迫性体验;②病理性怀疑;③对危险的过高的非现实估计;④不确定与不完美感。各组症状群之间共同的基本的病理心理机制涉及意志过程障碍。结论　强迫症是一组症状涉及多维度的异源性障碍。     

强迫症的临床症状与亚型稳定性研究

目的 探讨强迫症临床症状与亚型的稳定程度。方法 自拟强迫症调查表，对93例强迫症患的症状内容与亚型的演变过程进行调查。结果 临床以混合型(54．8％)和强迫思维型(32．3％)为主；洗涤、穷思竭虑、强迫怀疑、反复检查、强迫情绪、强迫回忆等是常见的表现形式，同时出现两种以上强迫症状占78．5％；28％的患强迫症状内容多变，11．8％的患临床亚型发生改变，且多由思维型或动作型向混合型转化，强迫动作最易改变。在整个病程中，强迫思维的前后一致率(80．5％)明显高于强迫动作的前后一致率(55．6％)P＜0.01。结论 绝大多数强迫患症状内容与亚型稳定，强迫思维是核心症状。     

认知疗法治疗强迫症

本文对认知疗法治疗强迫症的理论研究、治疗技术和临床研究进行综述。     

强迫症与多巴胺能作用

本文综述了强迫症多巴胺能作用的动物模型、遗传多态性、脑神经影像学和神经生化、神经药理等方面的证据。     

强迫症症状分类量表(修订版)中文版的信效度研究

目的:评价中文版强迫症症状分类量表(修订版)(OCI-R)在正常人群和强迫症患者中的信、效度。方法:采用中文版耶鲁-布朗强迫症量表(Y-BOCS)对299例在校大学生及90例强迫症患者进行评定,同时要求每位被试者自行完成OCI-R中文版的评估。其中44名强迫症患者于4周后进行再次测试。结果:OCI-R中文版Cronbach’salpha=0.88,重测信度r=0.690(P<0.05)。OCI-R验证性因素分析结果:χ2=403.07,ν=120,n=299;拟合优度指数(GFI)=0.87;近似误差均方根(RMSEA)=0.086;比较拟合指数(CFI)=0.96;非标准拟合参数(NNFI)=0.95。OCI-R各条目在总量表中的负荷值r=0.450～0.660(P<0.01),各维度在总量中的负荷值r=0.662～0.782(P<0.01)。强迫症患者中OCI-R总分与Y-BOCS总分之间相关系数r=0.422(P<0.01)。结论:OCI-R(修订版)中文译本具有良好的信效度,符合心理测试要求,可适用于中国人群强迫症状的测量。     

强迫症病人的心理护理

强迫症的基本特征是反复出现的强迫思维和动作，这类病人往往试图抑制，但不成功，所以病程长，思想负担比较重，常伴有抑郁症状，所以，心理护理就显得尤为重要。     

强迫症的神经病理学及遗传研究进展

弗洛伊德早已注意到强迫症有素质和遗传倾向：“在能够回答是何种因素导致了这种障碍之前，精神分析却不得不止步，将它留给生物学研究者去探讨。”尽管强迫症的生物学研究还相当年轻，但很多学者的研究发现颇具深远意义，最令人兴奋的是研究表明强迫症症状是受大脑某一区域和一些神经递质调节。     

强迫症病理心理机制危险因子研究

目的:应用心理解剖的方法探讨强迫症的危险因素。方法:选择60例强迫症患者作为强迫症组,另选取相匹配的健康人群60名作为对照组,对他们进行问卷调查。采用条件Logistic回归方程对结果进行分析。结果:有3个因素作为强迫症的重要危险因素保留在最后方程中,分别为童年创伤性经历(OR=2.001,95%CI=1.696~3.005),不当的养育方式(OR=1.024,95%CI=1.005~1.044),负性生活事件(OR=0.962,95%CI=0.934~0.992)。结论:强迫症是不同的危险因素同时存在和相互作用的结果。     

对1例强迫症病人的心理护理体会

强迫症病人在被潜在的无意识动机驱使,而自我不能觉察、不能意识到他的病和心理冲突的关系,却在影响其工作、学习、生活,以及现实情感被破坏,主观意志无法解决它,为了保护自己,常以症状为代价来缓和内在冲突。我们通过精神分析法,扩通和破除病人的阻抗,让病人体验和感受症．状的幼稚、可笑、愚蠢性,真正情感上的感悟,使症状失去存在的意义而消除。     

Lifetime-comorbidity of obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany

Objective Inspite of the worldwide relevance of obsessive-compulsive disorder (OCD), there is a substantial lack of data on comorbidity in OCD and subclinical OCD in the general population. Methods German versions of the DSM-IV adapted Composite International Diagnostic Interview were administered to a representative sample of 4075 persons aged 18–64 years, living in a northern German region. Results In both genders, high rates of comorbid depressive disorders were found in OCD and subclinical OCD, whereas somatoform pain disorder was only associated with OCD. In female subjects, OCD was additionally associated with social and specific phobias, alcohol, nicotine and sedative dependence, PTSD and atypical eating disorder. Conclusion Due to low comorbidity rates, subclinical OCD seems to represent an independent syndrome not restricted to the presence of other axis-I diagnoses. Comorbidity patterns show a disposition to anxiety and to depressive disorders in OCD and subclinical OCD. A broad association with obsessive-compulsive spectrum disorders could not be confirmed in our general population sample. Received: 24 July 2000 / Accepted: 16 May 2001     

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。     

强迫症与分裂型障碍共病的临床研究

目的调查强迫症患者的分裂型症状以及分裂型障碍共病发生比率并探讨伴有分裂型障碍的强迫症的临床特点。方法201例门诊强迫症患者,符合ICD-10与DSM-IV强迫症诊断标准,进行强迫症相关的一系列临床评定和ICD-10分裂型障碍症状评定,并分析分裂型症状与临床变量的关系,然后对伴有分裂型障碍的强迫症和单纯强迫症进行临床对照。结果31.3%(63/201)强迫症患者伴有3条或3条以上的分裂型障碍症状,28.4%(57/201)的强迫症患者同时存在ICD-10分裂型障碍。在9条ICD-10分裂型障碍症状中出现率比较高的依次是无内在阻力的强迫思维、古怪的信念或巫术性思想、不寻常的知觉体验、思维形式障碍(如赘述)等。有短暂的幻觉或妄想样信念者占9%。相关分析显示分裂型症状与强迫症状荒谬性(r=0.699,P<0.001)、抵抗力弱(r=0.5,P<0.001)、自知力不良(r=0.453,P<0.001)、残疾程度(r=0.328,P<0.001)等临床变量正相关。与单纯强迫症相比,伴有分裂型障碍者起病相对较急(P<0.05)、强迫症状比较荒谬、患者对症状顺从、自知力差、病情与社会功能障碍较重(P<0.001)。结论部分强迫症患者同时存在分裂型症状并符合分裂型障碍的诊断标准,分裂型症状与强迫症的某些临床特点相关,伴有分裂型障碍的强迫症倾向强迫症状荒谬、患者对症状抵抗较弱、自知力不良、病情较严重、社会功能损害较重。     

强迫症、抑郁症及焦虑症患者血小板5-羟色胺浓度的对照研究

目的　研究 5 羟色胺 ( 5 HT)在强迫症发病中的作用及强迫思维与强迫动作亚组、抑郁症及焦虑症患者间血小板 5 HT含量的差异。方法　采用高效液相色谱法 ,分别测定 2 9例强迫症患者 [(强迫症组 ,根据Y BOCS强迫量表因子得分将其分为强迫思维 ( 16例 )、强迫动作 ( 7例 )和混合性( 6例 ) 3组 ]、2 0例抑郁障碍患者 (抑郁症组 )、17例焦虑障碍患者 (焦虑症组 )和 2 8名正常人 (正常人组 )的血小板 5 HT含量。结果　强迫症组血小板 5 HT水平 [( 139± 172 ) μg/L]低于正常人组 [( 2 4 8±2 15 ) μg/L]及焦虑症组 [( 397± 4 0 1) μg/L],差异具有显著性 (P =0 0 39;P =0 0 2 0 ) ;与抑郁症组 [( 2 0 2± 16 2 ) μg/L]的差异无显著性 ( P >0 0 5 ) ;强迫思维 [( 85± 6 6 ) μg/L]与强迫动作组 [( 16 9± 10 0 ) μg/L]间血小板 5 HT含量的差异有显著性 (P =0 0 2 5 )。结论　强迫症患者 5 HT浓度变化与抑郁障碍患者趋同 ,与焦虑障碍患者的差异有显著性 ;单纯强迫思维者的 5 HT浓度与单纯强迫动作患者的差异有显著性     

A meta-analytic review of the relationship between family accommodation and OCD symptom severity

Accommodation of obsessive compulsive disorder (OCD) symptoms by family members is common. This paper presents a systematic meta-analytic review on family accommodation and OCD symptom severity. Fourteen studies investigating the relationship between family accommodation and OCD symptoms were selected. The medium effect size of the relationship between family accommodation and OCD symptom severity was significant (r = .35; 95% CI: .23 to .47), based on a Hunter–Schmidt random effects model with a total of 849 participants. Although there was some evidence of publication bias, Rosenthal's fail-safe N suggested that 596 studies with zero effect would be needed to reduce the mean effect size to non-significant. Findings are discussed in the context of the limitations of the studies, and in particular the reliance on cross-sectional designs which impede causal conclusions. Future research to evaluate a family accommodation intervention in a randomized controlled design and using mediation analysis to explore change mechanisms is called for.     

Episodic course in obsessive-compulsive disorder

The course of obsessive–compulsive disorder (OCD) is variable, ranging from episodic to chronic. We hypothesised that the former course is more likely to be related to bipolar mood disorders. With the use of a specially constructed OCD questionnaire, we studied 135 patients fulfilling DSM-III-R criteria for OCD with an illness duration of at least 10 years and divided by course: 27.4% were episodic and 72.6% chronic. We compared clinical and familial characteristics and comorbidity. Univariate analyses showed that episodic OCD had a significantly lower rate of checking rituals and a significantly higher rate of a positive family history for mood disorder. Multivariate stepwise discriminant analysis revealed a positive and significant relationship between episodic course, family history for mood disorders, lifetime comorbidity for panic and bipolar-II disorders, late age at onset and negative correlation with generalized anxiety disorder. These data suggest that the episodic course of OCD has important clinical correlates which are related to cyclic mood disorders. This correlation has implications for treatment and research strategies on the aetiology within a subpopulation of OCD. Received: 30 October 1997 / Accepted: 13 July 1998     

Objective sleep patterns and severity of symptoms in pediatric obsessive compulsive disorder: a pilot investigation

Sleep disturbances are common among youth with anxiety disorders, yet objective assessments of sleep in children with obsessive compulsive disorder (OCD) have been the focus of scant research. We therefore compared a small group of non-medicated, non-depressed children with primary OCD (ages 7-11 years) to matched healthy controls using home-based actigraphy during a 7-day prospective assessment. Validated parent and child sleep measures also were collected, and associations among objective sleep variables and severity of obsessions and compulsions were examined. We found significantly fragmented sleep patterns in the OCD group compared to controls including reduced total sleep time (TST) and longer wake periods after sleep onset. Severity of compulsions showed a significant negative correlation with TST. These preliminary findings indicate the presence of sleep abnormalities in pre-pubescent OCD patients with potential implications for future examinations of early developmental processes and features of the disorder.     

SSRIs治疗强迫症对照分析

目的：比较５羟色胺回收抑制剂（ＳＳＲＩｓ）与氯丙咪嗪对强迫症的临床疗效及副反应。方法：对３５例强迫症患者应用ＳＳＲＩｓ（１８例）与氯丙咪嗪（１７例）进行对照分析。采用Ｙａｌｅ－Ｂｒｏｗｎ强迫量表（Ｙ－ＢＯＣＳ）、汉密尔顿抑郁量表（ＨＡＭＤ）、副反应量表（ＴＥＳＳ）和临床疗效评定标准评定疗效及副反应。结果：ＳＳＲＩｓ与氯丙咪嗪疗效相似,两组显效率和有效率无显著差异。ＳＳＲＩｓ组副反应较氯丙咪嗪组少且     

利培酮合并氟西汀治疗强迫症疗效分析

目的:探讨利培酮合并氟西汀治疗强迫症的疗效.方法:将符合条件的39例强迫症患者随机分为利培酮合并氟西汀组和氟西汀组,治疗8周.采用强迫症量表(Y-BOCS)、汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)评定疗效.结果:治疗结束时两组Y-BOCS、HAMD、HAMA的评分均显著降低,更以合用组明显.结论:利培酮合并氟西汀治疗强迫症可以增加疗效.     

The profile of executive function in OCD hoarders and hoarding disorder

Hoarding disorder is a new mental disorder in DSM-5. It is classified alongside OCD and other presumably related disorders in the Obsessive-Compulsive and Related Disorders chapter. We examined cognitive performance in two distinct groups comprising individuals with both OCD and severe hoarding, and individuals with hoarding disorder without comorbid OCD. Participants completed executive function tasks assessing inhibitory control, cognitive flexibility, spatial planning, probabilistic learning and reversal and decision making. Compared to a matched healthy control group, OCD hoarders showed significantly worse performance on measures of response inhibition, set shifting, spatial planning, probabilistic learning and reversal, with intact decision making. Despite having a strikingly different clinical presentation, individuals with only hoarding disorder did not differ significantly from OCD hoarders on any cognitive measure suggesting the two hoarding groups have a similar pattern of cognitive difficulties. Tests of cognitive flexibility were least similar across the groups, but differences were small and potentially reflected subtle variation in underlying brain pathology together with psychometric limitations. These results highlight both commonalities and potential differences between OCD and hoarding disorder, and together with other lines of evidence, support the inclusion of the new disorder within the new Obsessive-Compulsive and Related Disorders chapter in DSM-5.