一例多维整合治疗成人重度强迫症的案例（英文）

概述:强迫症(OCD)是一种慢性、痛苦和进行性损害的神经精神疾病,其特点是存在强迫意念或强迫动作。本文报道的一名44岁成年女性强迫症的病例。之前3年治疗中,患者对数个选择性5-羟色胺再摄取抑制剂(SSRIs)疗效不佳,生活质量受到严重影响。经过6个月的多维整合治疗,包括认知行为治疗(CBT)、舍曲林和低剂量抗精神病药物(阿立哌唑),以及家庭支持和网络支持。每两个月Yale-Brown Obsessive-Compulsive Scale(Y-BOCS)标准化量表评估显示,强迫意念或强迫动作明显减少,其社会功能和生活质量得到明显改善。本病例初步显示OCD多维整合治疗有助于达到最佳治疗疗效较好治疗效果,期待今后更严格的临床试验验证。     

强迫症患者生活质量调查及影响因素分析

强迫症 (Obsessive CompulsiveDisorder,OCD)是一种以无法控制的强迫思维和 (或 )强迫动作为特征的精神疾病 ,病程迁延 ,给病人带来极大的痛苦和心理伤害 ,造成巨大的生活负担 ,严重影响患者的生活质量[1 ,2 ] 。国外关于强迫症患者生活质量的研究起步较早[3] ,而国内有关这方面的研究较少 ,起步也较晚 ,我们对近 1年来在我院住院或门诊治疗的强迫症患者进行了调查 ,现将结果报告如下。1　资料1 1　对象 :患者组 (OCD组 ) :为 2 0 0 3年 1月 1日至 2 0 0 3年 12月 31日在本院住院 (33例 )或门诊 (19例 )治疗的患者 ,符合中国精神障碍分…     

药物及心理干预对强迫症心率变异的影响

<正>强迫症(obsessive compulsive disorder,OCD)是以反复出现的侵入性的强迫思维和(或)强迫行为,同时存在反强迫思维为临床特征的常见精神障碍,终生患病率为2‰~3‰[1]。本研究就强迫症治疗前后心率变异的变化,分析氟伏沙明合并认知行为治疗对强迫症患者心率变异性变化的影响,探讨其成为强迫症病情程度和疗效判断的一种检测手     

难治性强迫症的外科治疗

强迫症(Obsessive-Compulsive Disorder,OCD)是一种慢性精神障碍性疾病,其主要症状为反复出现的强迫观念和和强迫动作,患者明知道没意义却无法摆脱;强迫症的终生患病率为2%～3%[1],有超过10%的强迫症患者对系统规范的药物治疗和行为治疗无效或效果不佳[2-3]。国外有学者[4]将难     

强迫障碍认知行为治疗的研究进展

强迫障碍(obsessive-compulsive disorder,OCD)是以强迫思维和(或)强迫动作为特征的一种焦虑障碍,其症状明显影响患者的日常生活能力,且病程迁徙,常导致严重的功能损害.过去的10余年中,OCD药物治疗[主要是氯米帕明和选择性5-羟色胺(5-HT)再摄取抑制剂]和认知行为治疗(cognitive-behavioral therapy,CBT)都取得了重要进展.     

药物治疗与合并认知行为治疗对强迫症疗效的比较

目的探讨认知行为心理治疗(CBT)在强迫症(OCD)患者各亚型治疗中的有效性和规律性。方法本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6、12个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表和自评量表得分在6个月和12个月两组有显著差异(P<0.05)。其中强迫症亚型(怕脏型、反复检查型和反复担心型)的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异(P<0.05);反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异(P<0.05);反复检查型两组间无统计学差异。结论认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为:反复担心型>怕脏型>反复检查型。     

强迫障碍认知行为治疗的研究进展

强迫障碍(obsessive-compulsive disorder,OCD)是以强迫思维和(或)强迫动作为特征的一种焦虑障碍,其症状明显影响患者的日常生活能力,且病程迁徙,常导致严重的功能损害.过去的10余年中,OCD药物治疗[主要是氯米帕明和选择性5-羟色胺(5-HT)再摄取抑制剂]和认知行为治疗(cognitive-behavioral therapy,CBT)都取得了重要进展.     

强迫障碍认知行为治疗的研究进展

强迫障碍(obsessive-compulsive disorder,OCD)是以强迫思维和(或)强迫动作为特征的一种焦虑障碍,其症状明显影响患者的日常生活能力,且病程迁徙,常导致严重的功能损害.过去的10余年中,OCD药物治疗[主要是氯米帕明和选择性5-羟色胺(5-HT)再摄取抑制剂]和认知行为治疗(cognitive-behavioral therapy,CBT)都取得了重要进展.     

脑深部电刺激术在强迫症外科治疗中的应用

强迫症(obsessive-compulsive disorder,OCD)是临床常见的精神类疾病,以强迫观念或强迫行为为主要表现,症状较轻时可以采用认知行为治疗,较重时需要药物治疗,但部分患者药物治疗无效,称为药物难治性强迫症,需要外科手术治疗。以往常采用脑深部核团毁损术治疗,但副作用较大,疗效不够满意,而脑深部电刺激(deep brain stimulation,DBS)治疗OCD较毁损术具有微创、不破坏脑结构、可程控的优势,开辟了OCD外科治疗神经调控领域。本文对DBS治疗OCD的作用机制、外科治疗效果及其进展等进行综述。     

强迫症患者生活质量及其影响因素的最新研究进展

强迫症(Obsessive-compulsive disorder,OCD)是一种慢性致残性焦虑障碍,主要临床表现是强迫思维(反复持续思考,体验到思维闯入)和/或强迫动作(反复的行为,如反复洗手、检查、确认等),有对也可表现为强迫冲动(如反复数数字、反复想用好的想法抵消坏的想法等)[1].     

Drug treatment of obsessive-compulsive disorder

Knowledge of pharmacotherapeutic treatment options in obsessive-compulsive disorder (OCD) has grown considerably over the past 40 years. Serotonergic antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and clomipramine, are the established pharmacologic first-line treatment of OCD. Medium to large dosages and acute treatment for at least 3 months are recommended until efficacy is assessed. In case of significant improvement, maintenance treatment is necessary. Unfortunately, about half of the patients do not respond sufficiently to oral serotonergic antidepressants; augmentation with atypical antipsychotics is an established second-line drug treatment strategy. Alternatives include intravenous serotonergic antidepressants and combination with or switch to cognitive behavioral psychotherapy. Remarkably, a considerable proportion of OCD patients still do not receive rational drug treatment. Novel research approaches, such as preliminary treatment studies with glutamatergic substances, and trials with further drugs, as well as needed aspects of future research, are reviewed.     

Quality of life with OCD. A self-reported survey among members of the Danish OCD Association

Obsessive-compulsive disorder (OCD) is today the fourth most frequent diagnosis issued within psychiatry. OCD can be quite incapacitating for the affected person and often becomes chronic. The purpose of the present study has been to help illuminate the character of the quality of life among the members of the Danish OCD Association. The data was compiled from 406 questionnaires sent out to all those members of the Danish OCD Association who had reported to suffer from OCD. The level of response was 54.4%. Persons with OCD signalled striking influences on their academic, occupational and social functions and thereby a corresponding influence on their quality of life in general. Emerging were significant levels of comorbidity and suicidal tendency. The time interval between symptom onset and the establishment of a correct diagnosis was found to be 13 years in average in this study. There appeared to be a marked tardiness in treatment as a consequence of the latency period between onset of symptoms and the establishment of a diagnosis. This has proven to be of importance in relation to the provision of proper treatment, the developmental course of the OCD condition, and not least in the quality of life for the person with OCD as well as his/her family members.     

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: a controlled trial

OBJECTIVE: To evaluate the relative efficacy of (1) individual cognitive-behavioral family-based therapy (CBFT); (2) group CBFT; and (3) a waitlist control group in the treatment of childhood obsessive-compulsive disorder (OCD). METHOD: This study, conducted at a university clinic in Brisbane, Australia, involved 77 children and adolescents with OCD who were randomized to individual CBFT, group CBFT, or a 4- to 6-week waitlist control condition. Children were assessed before and after treatment and at 3 months and 6 months following the completion of treatment using diagnostic interviews, symptom severity interviews, and self-report measures. Parental distress, family functioning, sibling distress, and levels of accommodation to OCD demands were also assessed. Active treatment involved a manualized 14-week cognitive-behavioral protocol, with parental and sibling components. RESULTS: By an evaluable patient analysis, statistically and clinically significant pretreatment-to-posttreatment change occurred in OCD diagnostic status and severity across both individual and group CBFT, with no significant differences in improvement ratings between these conditions. There were no significant changes across measures for the waitlist condition. Treatment gains were maintained up to 6 months of follow-up. CONCLUSIONS: Contrary to previous findings and expectations, group CBFT is as effective in reducing OCD symptoms for children and adolescents as individual treatment. Findings support the efficacy and durability of CBFT in treating childhood OCD.     

Quality of life with OCD. A self-reported survey among members of the Danish OCD association

Obsessive–compulsive disorder (OCD) is today the fourth most frequent diagnosis issued within psychiatry. OCD can be quite incapacitating for the affected person and often becomes chronic. The purpose of the present study has been to help illuminate the character of the quality of life among the members of the Danish OCD Association. The data was compiled from 406 questionnaires sent out to all those members of the Danish OCD Association who had reported to suffer from OCD. The level of response was 54.4%. Persons with OCD signalled striking influences on their academic, occupational and social functions and thereby a corresponding influence on their quality of life in general. Emerging were significant levels of comorbidity and suicidal tendency. The time interval between symptom onset and the establishment of a correct diagnosis was found to be 13?years in average in this study. There appeared to be a marked tardiness in treatment as a consequence of the latency period between onset of symptoms and the establishment of a diagnosis. This has proven to be of importance in relation to the provision of proper treatment, the developmental course of the OCD condition, and not least in the quality of life for the person with OCD as well as his/her family members.     

Aripiprazole augmentation of incomplete treatment response in an adolescent male with obsessive-compulsive disorder

We report the case of adolescent male with obsessive-compulsive disorder (OCD) who had an incomplete response to combined cognitive-behavioral therapy (CBT) and sertraline before successful augmentation of CBT with aripiprazole. Standardized assessments indicated significant reductions in OCD symptomatology associated with both initial treatment and aripiprazole augmentation. This case suggests that aripiprazole may have utility as an augmenting agent of CBT in adolescents with OCD and underscores the need for conducting controlled studies to test this hypothesis.     

Late-onset obsessive-compulsive disorder: the role of stressful life events

The onset of obsessive-compulsive disorder (OCD) for the first time in old age is uncommon and has been mostly related to cerebral abnormalities. We report a case of late-onset OCD in a 77-year-old woman following stressful life events but with a normal cerebral structure. The contribution of life events and vulnerability factors on the genesis and the presentation of her illness are discussed in relation to the literature on OCD.     

Metacognitive therapy for obsessive-compulsive disorder: a case series

Cognitive-behavior therapy and exposure and response prevention are the most effective psychological treatments for obsessive–compulsive disorder (OCD). However, these approaches often produce variable results with the majority of treated individuals remaining symptomatic. This study evaluated a new form of cognitive therapy based on Wells’ metacognitive model of OCD. Treatment efficacy was assessed using single case methodology in 4 consecutively referred individuals. At post-treatment, all participants made clinically significant change on a range of standardized outcome measures and these gains were largely maintained through to 6-month follow-up. Metacognitive therapy could be an effective and time efficient treatment for OCD.     

Case study: caudate glutamatergic changes with paroxetine persist after medication discontinuation in pediatric OCD

Proton magnetic resonance spectroscopy (1H-MRS) was used to examine glutamatergic (Glx) abnormalities in the caudate nucleus in pediatric obsessive-compulsive disorder (OCD), associated with severity of illness and response to acute (12 weeks) treatment with paroxetine. In this report, OCD symptoms improved markedly in an 8-year-old girl treated for 14 months with the selective serotonin reuptake inhibitor paroxetine (titrated from 10 to 40 mg/day). Paroxetine dose was then decreased in 10-mg decrements and discontinued without symptom recurrence. Serial 1H-MRS examinations were acquired before and after 12 weeks of paroxetine treatment (40 mg/day) and 3 months after medication discontinuation. A striking decrease in caudate Glx was observed after 12 weeks of treatment which persisted after medication discontinuation. These data provide further support for a reversible glutamatergically mediated dysfunction of the caudate nucleus in OCD that may serve as a pathophysiological and treatment response marker.     

Bilateral orbitomedial leucotomy for obsessive-compulsive disorder: a single-case study using positron emission tomography

OBJECTIVE: The objective of this report is to correlate the clinical outcome of neurosurgery for obsessive-compulsive disorder (OCD) with regional cerebral glucose metabolic changes. CLINICAL PICTURE: The patient was a 37-year-old female patient with severe and intractable OCD. TREATMENT: The patient was treated with bilateral stereotactic lesions in the frontal white matter superior to the orbito-medial cortex. OUTCOME: She had a remarkable improvement in her obsessive-compulsive symptoms, which was sustained up to 3 years of follow up. A positron emission tomography (PET) scan performed 18 days after surgery demonstrated an obvious reduction of metabolism in the caudate head, anterior cingulate and orbital, medial and lateral prefrontal cortices and the thalamus. At 1 year postsurgery, metabolic rate was still reduced in the anterior cingulate gyrus, caudate and thalamus compared with preoperative baseline. The patient demonstrated no long-term cognitive effects of the surgery. CONCLUSIONS: This case supports some of the cortical-subcortical circuit dysfunction models of OCD and argues for the further evaluation of neurosurgery for the treatment of a severe and intractable disorder.