氯丙咪嗪、SSRIs及两者合并治疗强迫症的临床对照研究

目的观察氯丙咪嗪、5-羟色胺再摄取抑制剂(SSRIs)及SSRIs合并小剂量氯丙咪嗪治疗强迫症的远期疗效及其对社会功能的影响。方法分别使用氯丙咪嗪、SSRIs、SSRIs联合小剂量氯丙咪嗪治疗84例门诊强迫症患者,分别在治疗3月末和6月末应用Yale-Brown强迫量表、临床疗效总评(CGI)和Sheehan残疾量表进行疗效评定,并自编问卷了解患者的一般资料。结果与治疗前相比,氯丙咪嗪组(N=31)、SSRIs组(N=22)及SSRIs联合小剂量氯丙咪嗪组(N=31)在3月和6月的Yale-Brown强迫量表、CGI评分均有显著性差异(P<0.01)。治疗前和治疗6月末,三组在Sheehan残疾量表评分均有显著差异。结论氯丙咪嗪和SSRIs对强迫症均有效,长期治疗可改善社会功能,SSRIs联合使用小剂量氯丙咪嗪可能与病情较重的患者有潜在的临床应用价值。     

国产与进口氯丙咪嗪双盲交叉对照治疗强迫症

用国产与进口氯丙咪嗪及安慰剂给26例强迫症病人作双盲交叉自身对照治疗,按开放型双向序贯 t 检验方法逐个试验,至第10例时便获得结论,此二种产品在临床疗效及副反应方面基本相同。     

苯妥英治疗强迫症的双盲对照研究

符合DSMⅢ—R和CCMD—2诊断标准的62例强迫症患者,随机分为三组:氯丙咪嗪组(22例)、苯妥英组(20例)、安慰剂组(20例),采用双盲对照研究法,每组经4周治疗,在治疗前后,经Y-BOCS、MSCPOR、HAMD量表测定及临床疗效评定。资料提示氯丙咪嗪组、苯妥英组、安慰剂组的痊愈,显进者分别为68％、55％、0％,而Y-BOCS、MSCPOR减分率分别为54.6％、46.05％、3.2％。提示氯两咪嗪组、苯妥英组对治疗强迫症明显优于安慰剂组。     

米氮平治疗强迫症的疗效对照观察

目的 探讨米氮平治疗强迫症的疗效及不良反应.方法 将58例强迫症患者随机分为两组,分别以米氮平和氯丙咪嗪治疗8周.用Yale-Brown强迫症量表(Y-BOCS)、汉密尔顿抑郁量表(HAMD)、不良反应量表(TESS)评定疗效和不良反应.结果 米氮平与氯丙咪嗪治疗强迫症疗效相似,但前者起效更快,不良反应少.结论 米氯平是一种安全有效的抗强迫症药.     

氟西汀与氯丙咪嗪治疗强迫症对照研究

用盐酸氟西汀和氯丙咪嗪治疗强迫症３６例，通过对照观察，发现两药疗效相近，而副反应氟西汀明显比氯丙咪嗪少且轻微，并且有日服剂量小，给药方法简便等优点。     

利培酮治疗精神分裂症强迫症状的对照研究

目的探索利培酮合并安慰剂与利培酮合并氯丙咪嗪对精神分裂症强迫症状的疗效。方法将合并有强迫症状的住院精神分裂症病人75例随机分为利培酮合并安慰剂组38例与利培酮合并氯丙咪嗪组37例,进行8周的治疗对照研究,治疗前后用MMOCI、Y-BOCS、PANSS、及TESS进行评定。结果治疗前后比较,两组疗效都显著。利培酮合并安慰剂组对强迫症状的总有效率82.9%,显效率为68.6%,利培酮合并氯丙咪嗪组的总有效率为97.3%,显效率为89.2%,两组疗效比较有显著差异。结论利培酮合并安慰剂治疗精神分裂症的强迫症状有效,但合并氯丙咪嗪治疗疗效更好。     

帕罗西汀与氯丙咪嗪治疗强迫症对照研究

目的探讨帕罗西汀治疗强迫症的疗效和不良反应。方法应用帕罗西汀和氯丙咪嗪治疗强迫症各30例,应用Yale-Brown强迫量表(Y-BOCS)、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,用副反应量表(TESS)评定副反应。结果帕罗西汀与氯丙咪嗪疗效相似,两组显效率及有效率差异无显著性,帕罗西汀不良反应发生率明显少于氯丙咪嗪。结论帕罗西汀治疗强迫症疗效与氯丙咪嗪相当,不良反应较轻,值得推广。     

氟西汀治疗强迫症对照研究

目的比较氟西汀与氯丙咪嗪对强迫症的临床疗效及副反应。方法对36例强迫症患者分别以氟西汀与氯丙咪嗪治疗,采用耶鲁布朗强迫量表(Y-BOCS),副反应量表(TESS)评价疗效和副反应。结果两组临床疗效相当,无显著差异;但氟西汀组见效更快、副反应少、患者依从性好。结论氟西汀对强迫症有肯定的疗效,且安全性较高。     

强迫症的药物治疗

复习有关比较氯咪帕明与SSRIs治疗强迫症的献,结果认为两均是治疗强迫症的选用药物。     

舍曲林治疗强迫症临床对照研究

目的：探讨舍曲林治疗强迫症的疗效和副反应。方法：56例强迫症患者随机平分为2组，分别以舍曲林和氯丙咪嗪治疗8周，采用强迫症量表（Y-BOCS）及副反应量表（TESS）评定。结果：舍曲林比氯丙咪嗪见效明显较早，治疗结束时，两组Y-BOCS分无显著差异。结论：舍曲林治疗强迫症的疗效与氯丙咪嗪相仿，起效快，副反应少而轻。     

Quetiapine addition in obsessive-compulsive disorder: is treatment outcome affected by type and dose of serotonin reuptake inhibitors?

BACKGROUND: The purpose of this study was to assess the effect of type and dose of serotonin reuptake inhibitors (SRIs) on treatment outcome in quetiapine addition trials for obsessive-compulsive disorder. METHODS: Results from all available, double blind, placebo-controlled quetiapine addition trials were pooled. Treatment outcome was assessed in a sample of 102 patients by change from baseline to end point on the Yale-Brown obsessive-compulsive scale (Y-BOCS). RESULTS: Quetiapine addition was superior with a mean Y-BOCS decrease of 6.8 +/- 6.7 compared with placebo with a decrease of 3.9 +/- 6.5 points. Patients with the lowest SRI dose showed the largest decrease on the Y-BOCS (11.6 +/- 7.7) compared with patients with the median dose (6.1 +/- 6.1) and highest dose (5.9 +/- 6.4). CONCLUSIONS: We found a superior response in the quetiapine addition group compared with the placebo group. The best response was achieved with the combination of clomipramine, fluoxetine, and fluvoxamine and with the lowest SRI doses.     

Clinical predictors of response to pharmacotherapy with selective serotonin reuptake inhibitors in obsessive-compulsive disorder

The objective of this study was to investigate the clinical predictors of response to treatment with selective serotonin reuptake inhibitors (SSRI) in a sample of patients with obsessive-compulsive disorder (OCD). A total of 55 patients diagnosed as OCD according to revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders criteria underwent a 12-week standardized SSRI treatment. According to 'treatment response', defined as at least a 35% drop in the Yale-Brown Obsessive-Compulsive Scale total score, OCD patients were divided into two groups. A total of 32 (58.2%) patients who responded to treatment and 23 (41.8%) who did not, were compared in terms of sociodemographic and clinical characteristics. The authors' findings demonstrated that the severity of obsession-compulsions and disability in work, social and family lives at the beginning of treatment were significantly higher in OCD patients who did not respond to treatment in comparison to those who did. Linear regression analysis, however, revealed that Sheehan Disability Scale-work score at baseline was a predictor of response to SSRI treatment. The higher levels of disability at the beginning of treatment in patients with OCD are associated with a poorer response to SSRI.     

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、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     

帕罗西汀与氯米帕明治疗强迫症的多中心、随机、双盲、平行对照研究

目的 比较帕罗西汀和氯米帕明治疗强迫症的疗效和安全性。方法 141例符合美国精神障碍诊断与统计手册第4版强迫症诊断标准的患者完成了研究，其中帕罗西汀治疗72例(帕罗西汀组)，氯米帕明治疗69例(氯米帕明组)，疗程均为10周。所有患者在入组前均服用安慰剂1周。帕罗西汀组第1周20mg／d；第2周30mg／d；第3周40mg／d；第4～10周低剂量组40mg／d，高剂量组50mg／d。氯米帕明组第1周50mg／d；第2周100mg／d；第3周150mg/d，第4～10周低剂量组150mg／d，高剂量组200mg／d。结果 帕罗西汀组痊愈率为21％，显效率为60％，总有效率为93％。氯米帕明组痊愈率为28％，显效率为57％，总有效率为90％。两组患者疗效的差异无显著性。帕罗西汀组不良反应发生率为18％，氯米帕明组不良反应发生率为43％，两组的差异有显著性(χ^2=10．54，P=0.00)。结论 帕罗西汀治疗强迫症的疗效与氯米帕明相当，但不良反应比帕罗西汀少而轻。     

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.     

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     

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     

帕罗西汀与氯米帕明对强迫症的有效性及可行性综合评价

目的探讨CH和PH方案治疗OCD的临床疗效对比。方法将我院2011-10—2013-10收治的89例OCD患者分成CH组(45例)和PH组(44例),治疗方案按CH和PH方案执行,治疗后按标准进行疗效评定,并对数据进行统计学分析。结果 CH组患者中痊愈11例(24.44%),8周时Y-BOCS评分7.75±5.39,减分率为69.38%。而PH组中痊愈12例(27.27%)(χ2=3.645,P=0.084),8周时Y-BOCS评分7.68±5.26,减分率为70.42%(t=3.426,P=0.761),经检验,2组差异无统计学意义(P0.05)。2组在口干(χ2=8.624,P=0.015)、便秘(χ2=9.634,P=0.008)、头昏(χ2=8.145,P=0.017)、嗜睡(χ2=8.046,P=0.021)和视力模糊(χ2=9.715,P=0.009)等不良反应方面差异均有统计学意义(P0.05)。结论 PH组患者治愈率与CH相比差异无统计学意义,而不良反应上显著优于CH方案,故临床治疗OCD应优先选择PH方案。     

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。