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     

The clinical features of Tourette's disorder with obsessive-compulsive symptoms

Twenty-three patients with Tourette's disorder (13 with obsessive-compulsive symptoms [OCS] and 10 without) were comparatively investigated. In contrast to OCS-free Tourette's disorder patients, those with OCS were found to be characterized by (i) a higher incidence of volatile temper, (ii) a higher incidence of compulsive tics, (iii) a higher incidence of perinatal disorders and brain wave abnormalities, (iv) a higher severity as rated using the Seventy Scale, and (v) a higher prevalence of complications, especially of developmental disorders. Of the subjects with OCS-accompanied Tourette's disorder, approximately half had developed OCS by the onset of tics. These findings suggest the likelihood that OCS-accompanied Tourette's disorder is more strongly associated with organic cerebral disorders, independently of sites of tic disorders, than is OCS-free Tourette's disorder.     

强迫症与焦虑的关系及临床类型的研究

目的调查强迫症状与焦虑的关系及其临床类型。方法将１００例强迫症患者按症状自评量表的焦虑因子分分为高、低、无焦虑３组,以Ｆｏａ的强迫症８种类型对其临床诸方面进行分类和比较。结果１００例患者中伴焦虑者为６５％,伴抑郁者为６７％。高焦虑组的病程长于低焦虑组（Ｐ＜０．０５）。在Ｆｏａ的分型中,高焦虑组以Ⅰ、Ⅱ、Ⅵ型较多。结论强迫症与焦虑的关系可有８种临床类型。强迫症患者伴焦虑的程度并不完全取决于病程,而是致焦虑性强迫想法的性质和强度与减焦虑性强迫反应相互作用的结果。     

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。     

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.     

强迫障碍的临床表现和同病研究

目的：研究强迫障碍的现象学和病程。方法：对同时符合ＣＣＭＤ－２Ｒ及ＤＳＭ－Ⅲ强迫障碍诊断标准的患者进行动态ＡＤＩＳ－Ｐ,简明精神病评定量表（ＢＰＲＳ）,汉密尔顿焦虑量表（ＨＡＭＡ）,同的阳性精神障碍家族史,起病早,就诊迟,Ｂｅａｒ分别中Ⅱ型（污染／检查型）最多,同经高。治疗上均用氯丙咪嗪或ＳＳＲＩｓ联用或不联用其它精神药物。似以药物加心理治疗效果较好。结论：强迫障碍的现象学表现较为复杂,应引起重视     

强迫症共病皮肤搔抓障碍的临床访谈

本文对一例强迫及相关障碍的咨客进行了案例访谈报告,目的是提高精神科医疗工作者的临床访谈技巧和诊疗水平。一位17岁的男性咨客因难以自控地在街上抢女士的高跟鞋、引起群众恐慌而来访。他的行为极具违法的风险,警察已经多次上门问询。咨客被诊断为强迫症共病皮肤搔抓障碍,采取生物-心理-社会的整合式治疗进行干预。咨客既往使用氟西汀时造成肝功能损害,需要调整用药。运用认知行为疗法(CBT)治疗强迫症状。本案例中涉及了司法精神医学的相关知识,为临床访谈提供一定的借鉴。     

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     

Perceived parental characteristics of patients with obsessive compulsive disorder,depression, and panic disorder

It has been hypothesized that parents of patients with obsessive compulsive disorder exhibit specific traits. 320 consecutive inpatient admissions who met criteria for OCD, depression, and panic disorder checked a list of adjectives to describe their parents. Patients with OCD were 1) less likely to perceive their mothers as disorganized than depressives, 2) more likely to perceive their mothers as overprotective than depressives and 3) less likely to perceive their fathers as demanding than patients with panic.     

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     

Vitamin D levels in children and adolescents with obsessive compulsive disorder

Background: Recent studies showed that vitamin D deficiency may lead to dysfunctional changes in the brain and may be associated with neuropsychiatric diseases.

Aims: The present study aims to investigate vitamin D, calcium, phosphorus and alkaline phosphatase levels in children and adolescents diagnosed with obsessive-compulsive disorder (OCD) and compared them to healthy controls. Additionally, the correlation of OCD symptom severity with serum vitamin D level will be analyzed.

Methods: A semi-structured interview form (K-SADS-PL) was used to diagnose OCD and other comorbidities in accordance with DSM-IV criteria. In addition, all participants were assessed with clinical interviews based on DSM-5 OCD diagnostic criteria. Children's Yale Brown Obsession Compulsion Scale (CY-BOCS) and Children’s Depression Inventory were used in the clinical evaluation.

Results: Vitamin D levels were lower in patients diagnosed with OCD (15.88?±?6.96?ng/mL) when compared to healthy controls (18.21?±?13.24?ng/mL), but the difference was not statistically significant (p?=?.234). Serum calcium, serum phosphate and serum alkaline phosphatase levels were not different between the groups. A negative correlation was found between serum 25OH-D3 levels and obsession scale scores in CY-BOCS.

Conclusions: To our knowledge this is the first study that evaluated vitamin D levels in OCD patients without comorbidity. The vitamin D levels of newly diagnosed OCD cases were lower but not statistically different than healthy controls. Furthermore, the study does also not support the presence of a significant association between serum vitamin D levels and OCD.     

Neurological soft signs in obsessive compulsive disorder with good and poor insight

Objective

Obsessive compulsive disorder (OCD) is a clinically heterogeneous disorder; OCD with poor insight has been suggested to be a specific clinical subtype. Neurological soft signs (NSSs) may be helpful to identify the specific subtypes of OCD patients.

Methods

In the present study, we aimed to compare OCD patients with poor insight with OCD patients having good insight, and healthy individuals. Sixty-four OCD patients (38 with good insight and 26 with poor insight), and 32 healthy subjects were enrolled in the present study. The Overvalued Ideas Scale (OVIS) was used to determine OCD patients with poor insight. NSSs were assessed by using the Neurological Evaluation Scale (NES).

Results

Two OCD groups had significantly higher total NES scores compared to controls (p = .000). Compared to healthy controls, OCD patients with poor insight performed significantly worse on all NES subscales, and they had significantly more NSSs on motor coordination, and sensory integration subscales compared to the OCD with good insight group.

Conclusion

Our results suggested that OCD patients with poor insight exhibit more extensive neurodevelopmental impairments compared to OCD patients with good insight.     

Obsessive compulsive disorder arising in a 75-year-old woman

Presented is the case of a 75-year-old woman with obsessive compulsive disorder with an unusual age of onset at age 72 years. The patient was resistant to various treatments, but responded to lithium augmentation of fluoxetine.     

The role of obsessive beliefs in patients with major depressive disorder

Aim. The aim of this study is to evaluate the differences in obsessional beliefs between patients with major depressive disorder (MDD) and matched healthy controls using the obsessive-beliefs questionnaire (OBQ). Methods. The study sample included 74 outpatients with MDD and 74 healthy subjects. The two groups were matched for age, gender, and education level. The diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV). The severity of depression was measured with the Hamilton Depression Rating Scale (HAM-D). All participants filled out the 44-item OBQ. Results. The total and subscale OBQ scores [Responsibility/Threat Estimation (RT), Perfectionism/Certainly (PC), and Importance/Control of Thoughts (ICT)], were significantly higher in patients with MDD than those of the control group. There was a positive correlation between HAM-D scores and the OBQ subscale scores (RT, PC, and ICT) in the patients. Conclusion. Obsessional beliefs appear to be related to MDD.     

Clinical features associated with increased severity of illness in tertiary clinic referred patients with obsessive compulsive disorder

Objective: Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition. Specific patterns of psychiatric comorbidity, early age at onset, long duration of illness (DI) and untreated illness (DUI) have been associated with poor outcome in OCD. The present study was aimed to explore sociodemographic and clinical characteristics associated with increased severity of illness in a sample of OCD patients.

Methods: A total of 124 OCD outpatients were recruited and divided into two groups on the basis of their severity of illness, as assessed through the Yale-Brown Obsessive Compulsive Scale (>24). Chi-squared test and t-test for independent samples were performed to compare sociodemographic and clinical variables between the two groups.

Results: The group with increased severity of illness had a younger age, an earlier age at onset and age at first pharmacological treatment (p?p?p?Conclusions: Earlier age, age at onset and age at first pharmacological treatment, longer DI, shorter DUI and higher rate of psychiatric comorbidities were associated with increased severity of OCD. Further studies on larger samples are warranted to confirm the reported results.     

强迫症预后的有关因素分析

目的:探讨影响强迫症疗效的相关因素.方法:对出院时不同疗效的强迫症病人的临床资料进行对照研究.结果:文化程度较高,脑力劳动者,病前强迫人格,有心理社会诱因,伴消极观念的强迫症病人疗效较好,结论:知识分子,社会心理因素促发和病中有抑郁症状者预后好.     

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     

强迫症共病疾病焦虑障碍的临床访谈

为了提高广大精神心理科医务工作者的临床访谈及诊断技能,本文对一例较特殊的合并了两种强迫谱系障碍的患者进行了案例访谈报告。这是一位27岁的男性患者,执着于练习弹钢琴十几年,仪式化的行为与执着让患者不能正常工作,成为大家眼中的怪人。离职后逐渐开始关注排便问题,纠结于便秘、腹胀等感受问题,总认为自己患有肛肠疾病,开始反复检查就诊。在检查无明显异常的情况下,反复要求行手术治疗四次以解决肛肠问题,结果越治越难受。本案例患者被诊断为强迫症共病疾病焦虑障碍,需要采取生物-心理-社会的综合治疗。调整以往用药,加强运动,调整饮食结构。施行强迫症一线治疗方案,焦虑缓解后进行认知行为疗法(CBT)来改善自我认知,减轻心理压力。今后工作中放弃不切实际的想法,学习应对策略,合理安排工作和生活。