电针及氯米帕明并用治疗强迫症

背景：电针及氯米帕明并用治疗强迫症是中西医结合的行为尝试。目的：探讨针药并用治疗强迫症的长期疗效及对社会功能恢复的影响。设计：以患者为研究对象的观察对比研究。地点：一昕市级精神卫生中心的病房。对象：本研究在淄博市第五人民医院完成。选择1997-01／2003-10本院的住院患者30例，年龄18—57岁，平均(33&;#177;12)岁。将30例患者随机分为两组，试验组15例，男8例，女7例。对照组15例，男7例，女8例。方法：试验组用电针内关、人中、承浆合并氯米帕明口服，对照组单用氯米帕明。于治疗前、治疗后4，6，8周末、6个月随访分别用强迫量表(Y-Bocs)、副反应量表(TESS)和临床评定标准评定疗效及副反应，治疗后8周用社会功能缺陷筛选量表(SDSS)评定。主要观察指标：Y-BOCS，TESS，SDSS量表评分结果比较。结果：治疗4，6，8周末Y-Bocs分减分率试验组高于对照组，但两组差异无显著性意义(P&;gt;0．05)。TESS分对照组明显高于试验组(P&;lt;0．01)，SDSS“职业和工作”因子分试验组低于对照组(P&;lt;0．05)。结论：应用电针内关、人中、承浆治疗强迫症状，减少了氯米帕明的副反应，能够改善强迫症患者的生活质量。     

氟伏沙明与氯米帕明治疗强迫症的对照研究

目的比较氟伏沙明与氯米帕明治疗强迫症的疗效和不良反应。方法强迫症患者共64例，根据入组序号随机分为2组，疗程8周。应用恐怖／强迫量表（MSCPOR）、汉密尔顿焦虑量表（HAMA）评定疗效，TESS评价不良反应。结果氟伏沙明组治疗总有效率90．6％。氯米帕明组治疗总有效率84．3％，与氟伏沙明组相比差异无统计学意义（P〉0．05）。氟伏沙明治疗过程中出现药物不良反应较氯米帕明轻。结论氟伏沙明是一种治疗强迫症安全有效的药物。     

氟伏沙明联合氯米帕明治疗强迫症对照研究

目的探讨氟伏沙明联合氯米帕明治疗强迫症的临床疗效及安全性。方法将45例强迫症患者随机分为两组,研究组25例,口服氟伏沙明联合氯米帕明治疗;对照组20例,单用氯米帕明治疗。观察8w。于治疗前及治疗8w末采用Yale-Brown强迫量表,汉密顿焦虑量表、汉密顿抑郁量表评定临床疗效,副反应量表评定不良反应。结果治疗8w末研究组显效率为80%,对照组为50%,研究组显效率显著高于对照组（χ^2=4.09,P〈0.05）。Yale-Brown强迫量表,汉密顿焦虑量表、汉密顿抑郁量表评分,治疗8w末两组均较治疗前有显著下降（P均〈0.01）,但研究组均较对照组下降显著（P均〈0.05）。研究组不良反应多在联用氯米帕明治疗的第1w出现,且程度及发生率显著低于对照组。结论氟伏沙明联合氯米帕明治疗强迫症疗效显著,且安全性高。     

氟伏沙明与氯米帕明治疗强迫症的对照研究

目的探讨氟伏沙明治疗强迫症的疗效和安全性。方法61例强迫症患者随机分为氟伏沙明组31例，氯米帕明组30例，共治疗8周，采用Yale—Brown强迫量表（Y—BOCS）、Hamilton抑郁量表（HAMD）和不良反应量表（TESS）评定。结果氟伏沙明组与氯米帕明组治疗前后Y—BOCS与HAMD分值比较差异均有显著性，而两组治疗后分值相比较，差异无显著性。氟伏沙明组不良反应明显比氯米帕明组小，差异有显著性。结论氟伏沙明治疗强迫症，疗效显著，不良反应少，依从性好，是治疗强迫症的理想药物。     

舍曲林和氯米帕明治疗强迫症临床疗效对照观察

目的比较舍曲林和氯米帕明治疗强迫症的疗效。方法采用耶鲁布朗强迫症量表和副作用量表，对应用舍曲林和氯米帕明治疗的两组病人治疗前后分别进行评定。结果舍曲林和氯米帕明疗效相当。舍曲林的不良反应明显少于氯米帕明，差异有统计学意义。结论舍曲林治疗强迫症有效，依从性好。     

阿立哌唑与氯米帕明治疗强迫症的临床疗效分析

目前，强迫症的药物治疗，其效果均欠理想。虽然氯米帕明的有效率为50％～70％，但不良反应较多，临床应用受限。有报道使用奎硫平、维思通等非典型抗精神病药物治疗强迫症能获得一定的效果，然而，使用此类药物中的阿立哌唑治疗强迫症的效果如何呢？本文对此进行了临床疗效观察，并与氯米帕明治疗对照分析，并报道于后。     

帕罗西汀与氯米帕明治疗强迫症对照研究

目的 探讨帕罗西汀与氯米帕明治疗强迫症的临床疗效和安全性.方法 将80例强迫症患者按照随机数字表法分为两组,每组40例,观察组口服帕罗西汀治疗,对照组口服氯米帕明治疗,观察8周.治疗前后采用耶鲁-布朗强迫症状评定量表、汉密顿抑郁量表评定临床疗效,副反应量表评定不良反应.结果 治疗8周末两组耶鲁-布朗强迫症状评定量表、汉密顿抑郁量表评分均较治疗前显著降低(P＜0.01),总有效率均为65.o％,两组总有效率比较差异无显著性(P＞0.05).观察组不良反应发生率为7.5％、对照组为25.0％,观察组不良反应发生率显著低于对照组(x2 =4.50,P＜0.05).结论 帕罗西汀与氯米帕明治疗强迫症起效快,疗效显著,但帕罗西汀较氯米帕明安全性高,依从性好,优于氯米帕明治疗.     

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。     

舍曲林与氯米帕明治疗强迫症对照观察

目的：探讨舍曲林与氯米帕明治疗强迫症的临床疗效和安全性。方法将62例强迫症患者随机分为两组,分别给予舍曲林、氯米帕明治疗,观察8周。采用耶鲁‐布朗强迫量表、副反应量表评定临床疗效及不良反应。结果治疗2周末起两组耶鲁‐布朗强迫量表评分均较治疗前显著降低（P＜0．01）,同期两组比较差异无显著性（P＞0．05）。两组总有效率比较差异无显著性（P＞0．05）,舍曲林组不良反应发生率显著低于氯米帕明组（P＜0．01）。结论舍曲林治疗强迫症疗效显著,与氯米帕明相当,但舍曲林安全性高。     

Treatment of obsessive-compulsive disorder using clomipramine in a very old patient.

OBJECTIVE: To describe the effect of the tricyclic drug clomipramine in a very old patient with obsessive-compulsive disorder and Alzheimer dementia. CASE SUMMARY: A 93-year-old woman had a history of obsessive-compulsive disorder since early adulthood. The obsession consisted of remembering names of famous people and the compulsion consisted of excessive list making. With the onset of memory loss secondary to Alzheimer disease, she became increasingly anxious and compulsive as a result of a failure to remember. After nine weeks on fluoxetine she became jittery and more confused. After a two-week wash-out period, she was given a nine-week course of clomipramine that was carefully titrated up to a therapeutic concentration. RESULTS: At the completion of clomipramine treatment, the patient no longer felt driven to recall the names of famous people. Her score from the Yale-Brown Obsessive-Compulsive Scale dropped from 29 to 3. Her Folstein Mini-Mental State Examination score increased from 21 to 23. CONCLUSIONS: Clomipramine appeared much more effective and better tolerated than fluoxetine in this very old patient despite its potential anticholinergic effect and the coexistence of Alzheimer disease.     

青少年强迫症患者父母心理状况调查及护理干预

目的:分析青少年强迫症患者父母存在的心理问题,了解其心理健康状况,实施及时有效的护理干预.方法:采用症状自评量表(SCL-90)、焦虑自评量表(SAS)和抑郁自评量表(SDS),对60名住院青少年强迫症患者的父母进行测评,对心理问题突出者给予相应的护理干预;干预后再次进行评定,将干预前的测评结果分别同全国常模、护理干预后的测评结果进行比较.结果:青少年强迫症患者父母干预前SCL-90、SAS、SDS得分均高于全国常模,差异具有显著性(P＜0.01);干预前后得分比较差异具有显著性(P＜0.01).结论:青少年强迫症患者父母普遍存在心理问题,及时有效的护理干预能改善其心理状况.     

Death obsession in Kuwaiti and American college students

Two samples of Kuwaiti ( n =460) and American ( n =273) male and female undergraduates responded to the Death Obsession Scale (DOS) in Arabic and English, respectively. Cronbach's alpha reliability statistics were .96 and .91, respectively, denoting high internal consistency. In the same vein, all the item-remainder correlations in both samples were significant denoting item validity and content validity. A general factor of death obsession was disclosed in the Kuwaiti sample, whereas two salient factors (death rumination, and death dominance and repetition) were extracted in the American sample. Gender-related differences were significant in the Kuwaiti sample, that is, females attained higher mean score than their male counterparts, whereas there were no significant gender differences in the American sample. Kuwaiti students attained significantly higher mean DOS score than their American counterparts in the total and all the individual items of the DOS.     

强迫思想不伴强迫行为的强迫症二重辨证施治

目的探讨二重辨证施治对强迫思想不伴强迫行为强迫症患者的疗效,及其在开放式心理病房的适应情况。方法将47例强迫思想不伴强迫行为强迫症患者按随机的原则在开放式心理病房分为研究组(24例)和对照组(23例)。研究组用二重辨证施治,对照组用认知疗法结合氯丙咪嗪、氟西汀等。研究时间共5个月,前2个月为积极治疗期,后3个月为自由治疗期。采用耶鲁布朗强迫症量表(YBOCS)进行评定。结果两组在积极治疗期末和自由治疗期末痊愈率均有非常显著性差异(P<0005)。YBOCS总分两组治疗前无显著性差异(t=0375,P>05);在积极治疗期末和自由治疗期末,两组有显著性差异(均P<0001)。结论二重辨证施治对强迫思想不伴强迫行为的强迫症者有良好疗效,且疗效持续。开放式心理病房可作为强迫症含强迫思想不伴强迫行为者二重辨证施治的医疗平台。     

Possible serotonin syndrome associated with clomipramine after withdrawal of clozapine

OBJECTIVE: To report on the possible development of serotonin syndrome in a patient receiving clomipramine after clozapine was withdrawn from the treatment regimen. CASE REPORT: A 44-year-old white man with a 23-year history of undifferentiated schizophrenia and obsessive-compulsive behavior had been treated with clozapine and clomipramine for several years. He tolerated both agents together well, with the exception of experiencing chronic constipation. Clomipramine was tapered and reduced to 50 mg over a period of 10 days. A worsening of ritualistic behavior was noted, and the clomipramine dosage was increased to 150 mg/d over 14 days. Simultaneously with the clomipramine dosage increase, clozapine was tapered and stopped ever a period of 19 days. The day after clozapine was stopped, while he was still receiving clomipramine 150 mg/d, he began behaving oddly, started sweating profusely, shivering, and became tremulous, agitated, and confused. He was diagnosed with possible serotonin syndrome; his symptoms resolved after clomipramine was stopped but before clozapine was restarted eight days later. DISCUSSION: There are similarities in symptoms between serotonin syndrome and clozapine withdrawal. This article discusses the reasons why this case may represent serotonin syndrome rather than clozapine withdrawal and the possible pharmacologic mechanisms involved. CONCLUSIONS: Clinicians should be aware that removing a serotonin-2a (S-HT2a) antagonist 1mm a treatment regimen including an agent that increases serotonin in the synaptic cleft may worsen clozapine withdrawal or potentially result in serious adverse drug reactions, such as serotonin syndrome.     

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