帕罗西汀合并利培酮治疗强迫症对照研究

目的评价帕罗西汀合并利培酮治疗强迫症的临床效果。方法将53例强迫症患者随机分为治疗组与对照组,两组分别为27、26例,治疗组给予帕罗西汀合并利培酮治疗,对照组单用帕罗西汀治疗,应用临床疗效标准及耶鲁布朗强迫量表(Y-BOCS)定期评定,观察12周。结果12周末时,治疗组的显效率及有效率分别为62.9%、85.2%,均高于对照组;在治疗后2、4、8、12周末时,两组Y-BOCS评分均显著降低,尤以治疗组明显,在治疗各时段Y-BOCS的减分率,治疗组均高于对照组。结论帕罗西汀合并利培酮联合治疗强迫症疗效优于单用帕罗西汀治疗,对于强迫症的治疗,小剂量利培酮不失为一种有效的增效剂。     

利培酮合并帕罗西汀治疗强迫症疗效分析

目的：探讨利培酮合并帕罗西汀治疗强迫症的疗效。方法：40例强迫症患者随机分为利培酮合并帕罗西汀组和帕罗西汀组,治疗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,更以合用利培酮组明显。结论：利培酮合并帕罗西汀治疗强迫症可以增加疗效。     

Perospirone augmentation of paroxetine in treatment of refractory obsessive-compulsive disorder with depression

Obsessive-compulsive disorder (OCD) is often complicated by depression. We report on a patient with treatment-refractory OCD and treatment-refractory major depression who demonstrated a robust response to augmentation of paroxetine with perospirone. Perospirone is a second-generation antipsychotic agent with antagonist effects on both serotonin 5-HT(2A) and dopamine D(2) receptors, as well as a unique agonist effects on serotonin 5-HT(1A) receptors. Future studies would be valuable to elucidate the utility of augmentation therapy of selective serotonin reuptake inhibitors with perospirone in the treatment of refractory OCD with depression.     

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。     

万拉法新与帕罗西汀治疗强迫症的对照观察

目的　比较万拉法新与帕罗西汀治疗强迫症的疗效及副反应。方法　对符合CCMD 3强迫症诊断标准的 4 0例患者随机分为两组 ,分别给予万拉法新与帕罗西汀治疗 8周。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　万拉法新与帕罗西汀疗效相似 ,两组显效率与有效率差异无显著性。万拉法新组副反应多于帕罗西汀组。结论　万拉法新治疗强迫症有较好疗效 ,可作为治疗强迫症的一种药物。     

帕罗西汀与氯米帕明治疗难治性强迫症对照研究

目的：观察帕罗西汀和氯米帕明对难治性强迫症的疗效和不良反应。方法：对难治性强迫症患者60例,随机分为两组,分别用帕罗西汀和氯米帕明治疗8周。采用强迫症量表（Y-BOCS）和副反应量表（TESS）评价疗效及不良反应。结果：两药的总体疗效相仿。帕罗西汀对强迫行为疗效较好,不良反应小,尤其是心血管系统及抗胆碱能不良反应少。结论：帕罗西汀尤适用于以强迫行为为主的难治性强迫症患者。     

Acute and long-term treatment and prevention of relapse of obsessive-compulsive disorder with paroxetine

BACKGROUND: Limited information is available regarding optimal dosing or long-term pharmacotherapy with serotonin reuptake inhibitors in obsessive-compulsive disorder. This study evaluated the acute safety and efficacy and long-term efficacy, safety, and impact on relapse prevention of paroxetine in obsessive-compulsive disorder. METHOD: We enrolled 348 outpatients with DSM-III-R obsessive-compulsive disorder in phase 1, a 12-week randomized, double-blind, parallel study of fixed doses of paroxetine (20 mg/day, 40 mg/day, or 60 mg/day) and placebo. In phase 2, 263 phase 1 completers were enrolled in 6 months of flexibly dosed open-label paroxetine treatment. In phase 3, 105 responders to open-label paroxetine were randomized to 6-month double-blind, fixed-dose, parallel paroxetine/placebo treatment to evaluate long-term efficacy, safety, and impact on relapse prevention. The study was conducted from July 1991 to February 1994. RESULTS: Patients in phase 1 acute treatment receiving 40 mg/day or 60 mg/day of paroxetine improved significantly (p < .05) more than those receiving placebo; the mean reduction in Yale-Brown Obsessive-Compulsive Scale score was 25% on 40 mg/day of paroxetine and 29% on 60 mg/day compared with 13% on placebo. During phase 3, long-term treatment, a greater proportion of placebo- (59%) than paroxetine-treated (38%) patients relapsed. Paroxetine was well tolerated at all doses, with no significant increase in frequency of adverse events during long-term compared with short-term therapy. Greater adverse events in the placebo than in the paroxetine group in phase 3 probably represent a discontinuation effect. CONCLUSION: Paroxetine doses of 40 mg/day and 60 mg/day (but not 20 mg/day) are effective in treating acute obsessive-compulsive disorder. Long-term treatment with paroxetine is effective and safe, decreases the rate of relapse, and lengthens the time to relapse.     

Differential cerebral metabolic changes with paroxetine treatment of obsessive-compulsive disorder vs major depression

BACKGROUND: Serotonin reuptake inhibitors (SRIs) effectively treat both major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). We compared and contrasted the functional neuroanatomical effects of SRIs in OCD and MDD as these 2 disorders occurred separately and concurrently by measuring pretreatment to posttreatment cerebral glucose metabolic changes in OCD vs MDD vs concurrent OCD + MDD. METHODS: We obtained [(18)F]fluorodeoxyglucose positron emission tomography (PET) brain scans on 25 subjects with OCD, 25 with MDD, and 16 with concurrent OCD + MDD before and after 8 to 12 weeks of treatment with paroxetine hydrochloride. Controls (n = 16) were scanned 10 to 12 weeks apart without treatment. Treatment response was defined as a more than 25% decline in OCD symptom severity, a more than 50% decline in MDD severity, and "much improved" clinical global impression. RESULTS: Although all patient groups received the same paroxetine dose for the same duration, regional metabolic changes differed significantly among diagnostic groups. Subjects with OCD alone showed significant metabolic decreases in the right caudate nucleus, right ventrolateral prefrontal cortex (VLPFC), bilateral orbitofrontal cortex, and thalamus that were not seen in any other group. Both the MDD and concurrent OCD + MDD groups showed metabolic decreases in the left VLPFC and increases in the right striatum. Treatment response was associated with a decrease in striatal metabolism in nondepressed OCD patients but with an increase in striatal activity in patients with OCD + MDD. CONCLUSIONS: Brain metabolic responses to SRIs are both disorder-specific and response-specific. They vary according to the underlying pathophysiology of the patient and the degree of symptomatic improvement.     

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。     

Obsessive-compulsive spectrum disorders: effective treatment with paroxetine.

OBJECTIVE: To examine whether, like pure obsessive-compulsive disorder, obsessive-compulsive spectrum disorders are treatable with a selective serotonin reuptake inhibitor (SSRI). METHOD: Case histories of patients prescribed paroxetine for compulsive collecting, skin-picking, and trichotillomania were reviewed. RESULTS: All patients were successfully treated with paroxetine. CONCLUSIONS: Obsessive-compulsive spectrum disorders may share a serotonin-related dysfunction, and SSRIs may prove effective in their treatment.     

DSM-III personality disorders in obsessive-compulsive disorder: changes with treatment

Twenty-seven patients meeting DSM-III diagnostic criteria for obsessive-compulsive disorder (OCD) completed the Personality Diagnostic Questionnaire (PDQ; a self-rating scale designed to assess the axis II personality disorders [PDs] from the DSM-III) before and after 12 weeks of treatment with clomipramine. Treatment was accompanied with reduction on several personality variables, including the number of personality diagnoses assigned, the distribution of traits in the sample, and the number of items endorsed in each personality category. The data also showed that improvement in personality functioning was significantly greater in responders compared with nonresponders or partial responders. Further investigation of the relationship between personality and treatment outcome did not provide strong support for the notion that personality factors may have prognostic significance in the treatment of OCD. These findings suggest similarities and differences with panic/agoraphobia which are briefly discussed.     

Effectiveness of low doses of paroxetine controlled release in the treatment of major depressive disorder

CONTEXT: Paroxetine controlled release (CR) is approved for the treatment of major depressive disorder (MDD) in the dosage range of 25 to 62.5 mg daily. However, lower daily doses (12.5 mg and 25 mg) of this formulation have not been investigated in the treatment of MDD. If the 12.5-mg and 25-mg doses are found to be efficacious, these lower doses may well convey a superior tolerability profile for paroxetine CR in the treatment of MDD. OBJECTIVE: To evaluate the antidepressant efficacy and tolerability profile of daily doses of paroxetine CR 12.5 mg and 25 mg versus placebo in the treatment of MDD. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled clinical trial conducted in 40 clinical investigation centers in the United States. PARTICIPANTS: 447 adult (> or = 18 years of age) outpatients who met DSM-IV criteria for MDD and with a baseline 17-item Hamilton Rating Scale for Depression (HAM-D) score of at least 20 comprised the intent-to-treat study population (mean age = 38.8 years; 58.4% female; 75.6% white). INTERVENTION: Eligible patients completing a 1-week single-blind placebo run-in period were randomly assigned to receive once-a-day study medication (paroxetine CR 12.5 mg [N = 156], paroxetine CR 25 mg [N = 154], or placebo [N = 149]) in an 8-week, double-blind, parallel cell comparison. MAIN OUTCOME MEASURES: The primary efficacy measure was the change from baseline to study endpoint (week 8) as measured by the HAM-D. Secondary efficacy measures included change from baseline to study endpoint as assessed by both the depressed mood item on the HAM-D and the Clinical Global Impressions (CGI) Severity of Illness scale (CGI-S). The proportion of patients considered at study endpoint to be in response (CGI-Improvement score of 1 or 2) or in remission (HAM-D < or = 7) in the 3 treatment groups was also compared. Quality of life was assessed by the change from baseline in total score of the short form of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Safety observations were made by assessing the proportion of patients who had adverse experiences, including laboratory and electrocardiographic abnormalities, during the treatment period. RESULTS: The primary efficacy analysis revealed that both the 12.5-mg and the 25-mg paroxetine CR treatment groups were associated with significant therapeutic effects (change in HAM-D score) from baseline to study endpoint (LOCF: p = .038, 95% CI = -3.38 to -0.09 and p = .005, 95% CI = -4.06 to -0.74, respectively). Results from the Wilcoxon rank sum test of the depressed mood item of the HAM-D (p = .011, 95% CI = -0.57 to -0.07) demonstrated significant efficacy in the 25-mg treatment group but not in the 12.5-mg group. However, LOCF analysis of the CGI-S revealed significant therapeutic effects for both the 12.5-mg (p = .018, 95% CI = -0.61 to -0.06) and 25-mg (p < .001, 95% CI = -0.78 to -0.22) treatment groups. Significantly more patients in the 25-mg paroxetine CR-treated group than in the placebo-treated group met criteria for response (CGI-Improvement score of 1 or 2, p = .035, OR = 1.68, 95% CI = 1.04 to 2.73) as well as for remission (HAM-D score 相似文献   

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。     

A double-blind switch study of paroxetine and venlafaxine in obsessive-compulsive disorder

BACKGROUND: The treatment guidelines for obsessive-compulsive disorder (OCD) propose to switch serotonin reuptake inhibitors (SRIs) in case of refractoriness. However, no controlled research has been published yet that prospectively examined the effects of changing SRIs. This article describes the first double-blind switch study of 2 SRIs in patients with OCD. METHOD: 150 patients with primary OCD, according to DSM-IV criteria, were randomly assigned in a 12-week, double-blind trial to receive dosages titrated upward to 300 mg/day of venlafaxine (N = 75) or 60 mg/day of paroxetine (N = 75). Primary efficacy was assessed by the change from baseline on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and nonresponse was defined as less than 25% reduction on the Y-BOCS. After a 4-week tapering phase, 43 nonresponders were switched to 12 additional weeks of the alternate antidepressant, of which 16 patients received venlafaxine and 27 received paroxetine. RESULTS: Eighteen of 43 patients benefited from a switch to the alternate SRI with a mean +/- SD decrease of at least 25% on the Y-BOCS. At the end of 12 weeks, responder rates were 56% for paroxetine (15/27) and 19% for venlafaxine (3/16). An intent-to-treat, last-observation-carried-forward analysis demonstrated a mean decrease on the Y-BOCS of 1.8 +/- 3.5 in the venlafaxine group and 6.5 +/- 7.1 in the paroxetine group. After 2 consecutive SRI trials, 109 of 150 patients (73%) achieved a Y-BOCS decrease of at least 25%. CONCLUSION: The results of the current study show that 42% of the nonresponders benefited from a crossover to the other SRI, and that paroxetine was more efficacious than venlafaxine in the treatment of nonresponders to a previous SRI trial. Switching SRIs in case of refractoriness may be considered a useful strategy for patients with OCD.