认知领悟疗法治疗强迫症的对照研究

将符合CCMD—2—R诊断标准的30例强迫症患者,随机对其中15例在抗强迫症药物治疗的基础上联合心理治疗,另15例以单纯的药物治疗为对照组。结果显示前者疗效明显优于后者。本文认为认知领悟疗法结合药物治疗对强迫症能更有效地控制症状,改善预后。     

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。     

强迫症病理性认知特征及其心理治疗的研究进展

强迫症是临床上常见的一种慢性精神障碍，其症状表现及背后的认知特征具有一定的复杂性，心理治疗方法主要以传统认知行为治疗、“第三代”认知行为治疗以及一些具有其他特色的心理治疗技术为主，这些治疗技术具有各自的侧重点。现就强迫症患者的神经认知、自知力、认知及元认知信念、社会认知的缺陷及其心理治疗技术进行阐述，旨在了解强迫症患者的病理性认知特征，并在此基础上为强迫症患者提供更具针对性的治疗方案。     

强迫症物理治疗进展

<正>强迫症是以侵入性、破坏性的强迫思维和强迫行为为主要临床症状的精神障碍。在世界范围内,其终身患病率为0.8%～3.0%~([1])。目前强迫症的治疗,一线药物为选择性5-羟色胺再摄取抑制剂(selective serotonin reuptake in hibitors,SSRIs),一线心理治疗为以暴露反应预防(exposure     

1例强迫症患者沙盘治疗效果

<正>国外流行病学调查显示强迫症在全世界人口中的患病率约为2%~3%[1]。作为临床常见的精神障碍,强迫症的治疗也令人棘手。临床上多采用药物治疗与心理治疗相结合的方法,甚至会使用电休克等疗法,但疗效有待商榷。沙盘治疗作为一种较好的治疗方式被应用于神经症的治疗,但是被应用于治疗强迫症的研究却比较少。有研究表明,沙盘治疗被应用于强迫症     

对一例强迫症病人的心理护理体会

强迫性神经症是以各种强迫症状为主要临床相的一种较常见的神经官能症。目前尚无有效的治疗药物。良好的心理治疗及护理对强迫症状的消除有十分重要的意义。我们曾护理过一例强迫症病人,现将粗浅的一些心得体会报告如下。     

正念认知疗法在强迫症治疗中的研究现状

强迫症是一组以强迫思维和强迫行为主要临床表现的心理障碍。正念认知疗法(MBCT)作为一种新兴的心理治疗方法,在强迫症的治疗中有着积极作用。本文通过对MBCT在强迫症治疗中的现状和效果进行综述,为强迫症的临床心理治疗提供参考。     

腹侧内囊前肢小毁损灶治疗难治性强迫症的随访观察

目的研究立体定向下双侧腹侧内囊前肢小毁损灶手术治疗难治性强迫症的临床疗效与安全性。方法 18例难治性强迫症病例,均行内囊前肢毁损术,毁损灶长度左侧内囊为10 mm,右侧内囊12 mm,术后1、3、6个月短期随访并以耶鲁-布朗强迫症状量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评估症状改善情况及安全性指标。结果术后随访治疗有效11例(61.1%),部分有效1例(5.6%),无明显改善或无效6例(33.3%)。病人术后Y-BOCS评分显著降低,不良反应轻微。结论立体定向下双侧腹侧内囊前肢小毁损术对难治性强迫症有明显疗效,副作用多为短期、可恢复,是药物与心理治疗无效后的一种增效治疗选择。     

强迫症认知行为团体治疗疗效的研究进展

认知行为团体治疗应用在强迫症人群已有了大量临床研究,结果证实其疗效与个体认知行为治疗效果相当,可以显著改善强迫症状,与药物结合可以进一步提高治愈率,值得临床推广。     

全国药物依赖性进展学术研讨会征文

中国医师协会拟于 2 0 0 2年 8月在西藏拉萨市召开全国药物依赖性进展学术研讨会。会议邀请著名药物依赖专家和精神科专家作专题报告。现开始征文。内容有 :(1)吸毒人员心理障碍的分析和治疗 ;(2 )成瘾药物对人体危害的临床研究 ;(3)有关戒毒政策与法规研究 ;(4)传统医学对防治和治疗药物依赖的作用与研究 ;(5 )药物滥用 (吸毒 )的预防、治疗及康复研究 ;(6 )精神障碍的药物及心理治疗 ;(7)精神病学的临床研究及进展 ;(8)心理脱瘾对策与预防复吸措施 ;(9)流行病学的临床研究及进展 ;(10 )自愿戒毒及强制戒毒的管理方法探讨 ;(11)当前我国戒…     

Tic disorders and obsessive compulsive disorder: where is the link?

Over the last years evidence on the overlap between tic-disorders (TD) and obsessive compulsive behavior/disorder (OCB/OCD) has increased. The main focus of research have been the phenomenological and epidemiological similarities and differences in samples of different age, primary diagnosis (TD vs. OCD) including the co-occurrence of both. Unfortunately, only a minority of studies included all three groups (TD, TD + OCD, OCD). Nevertheless, new insight concerning possible subtypes for both TD and OCD has been gained. While some authors concentrated on OCD with/without tics we will summarize the field of TD and OCB/OCD from the viewpoint of tics, since OCB plays an important role in patients with TD. Thereby we will not only sharpen the clinicans' awareness of known differences in phenomenology, epidemiology, genetics and neurobiology, aimed to improve their diagnoses and treatment but also highlight the gaps of knowledge and discuss possibilities for further research in this field.     

Eating disorder and obsessive-compulsive disorder: neurochemical and phenomenological commonalities.

This paper explores a possible connection between neurochemistry and cognitions in eating disorders (ED). Cognitions play an important role in ED. However, a possible neurochemical origin of these cognitions has not been explored. Obsessive-compulsive disorder (OCD) is known as a disorder of thinking. Extensive neurochemical research conducted on this disorder indicates a connection between serotonin (5-HT) dysregulation and cognitions in OCD. This study used research done on OCD as a template to interpret the available research findings in ED and their possible meaning in terms of neurochemical origin of cognitions in ED. This paper suggests that the neurochemical and behavioral expression of both ED and OCD occur on a continuum. At one end of the continuum, ED and OCD are expressed through constrained behaviors of an avoidant quality. This pole is also characterized by high levels of serotonin markers. At the other end, both disorders are characterized by disinhibited approach behavior. This end of the continuum is characterized by low levels of 5-HT markers. It is suggested that these levels of 5-HT generate cognitions that may in turn promote specific behaviors.     

Obsessive-compulsive disorder (OCD) with schizotypy vs. schizophrenia with OCD: diagnostic dilemmas and therapeutic implications

Although schizophrenia and obsessive-compulsive disorder (OCD) are distinct diagnostic entities, there are substantial areas of overlap between the two disorders in clinical characteristics, affected brain areas and pharmacotherapy. Though OCD patients apparently do not have increased risk for developing schizophrenia, schizotypal personality disorder has consistently been found in OCD patients. Compelling evidence also points to an increased rate of OCD in schizophrenia patients. Accurate diagnosis of both disorders in their "pure" and overlapping forms is necessary in order to evaluate etiological mechanisms underlying schizophrenia and OCD, and to provide adequate treatment and prognosis. In this review, we address some aspects of the current status of research pertinent to the OCD-schizophrenia interface and suggest further steps towards the clinical and etiological identification of homogeneous subgroups on the putative OCD-schizophrenia axis.     

Overlapping and distinctive features of hypochondriasis and obsessive-compulsive disorder

The spectrum of obsessive-compulsive disorders has received a great deal of theoretical attention, but there has been relatively little associated empirical research. The purpose of this study was to compare three groups of patients; those diagnosed with hypochondriasis (HC, a proposed spectrum condition), obsessive-compulsive disorder (OCD) and those with both OCD and HC (OCD/HC). The results show that patients with HC scored highest on a measure of overvalued ideas, and that the HC and HC/OCD groups scored significantly higher on measures of panic and agoraphobic cognitions. The groups also differed significantly for symptoms associated with compulsions. The patient groups were not different for measures of obsessions, depression, and anxiety. The results provide partial support for inclusion of HC in the spectrum of obsessive-compulsive disorders, but also provide indirect support for the association between HC and panic disorder. These results are interpreted in light of distinguishing characteristics among obsessive-compulsive spectrum conditions.     

Electroconvulsive therapy in a patient with Tourette's syndrome and co-morbid Obsessive Compulsive Disorder.

Various strategies have been implemented to treat Tourette's syndrome (TS) and the frequently associated Obsessive Compulsive Disorder (OCD). While pharmacological interventions are widely used and have proven efficacy in the treatment of both disorders, ECT has not been considered a first-line treatment option. A few anecdotal reports of treatment with ECT for patients with co-morbid depression and tic disorder are available in the literature. ECT also has been used in the treatment of refractory OCD. We present the case of a 39-year-old female patient, who has chronically suffered from both TS and OCD. After a course of nine electroconvulsive treatments, her symptomatology resolved fairly rapidly. Monthly outpatient ECT sessions were arranged in order to sustain the positive treatment outcome. Since then, remission of both disorders has been maintained successfully for more than a year.     

New approach to obsessive-compulsive disorder: dopaminergic theories

In patients with obsessive-compulsive disorder (OCD), structural and volumetric abnormalities have been identified by up-to-date neuroimaging techniques both in the prefrontal region and in the basal ganglia (striatum, thalamus, amygdala). The dysfunction of these regions also has been proved by neuroimaging techniques. These alterations can be described as dopaminergic hyperfunction in the prefrontal cortex and serotonergic hypofunction in the basal ganglia. The dysfunction of the so-called 'cortico-striato-thalamic' loops is strongly linked to the symptoms of OCD, where the dopamine is the most dominant neurotransmitter. The ascending serotonergic projections from the raphe nuclei restrain and control the function of these loops. Thus, when serotonergic hypofunction is present, the predominantly dopaminergic loops became overactive, which has been confirmed by neuroimaging techniques and by neurocognitive tests as well. The linkage of the two predominant neurotransmitter systems affected in OCD can be the reason for the fact that SSRIs have limited success in the treatment of OCD symptoms. In recent international, multicentric studies, the treatment of SSRI non-responder subgroup of OCD patients were supplemented by antipsychotics with dopaminergic activity. Many studies have confirmed the beneficial effect of these antidopaminergic substances on the hyperactive cortico-striato-thalamic loops in OCD. The investigation of these dysfunctional loops is also connected to the genetic background of OCD, because some of the candidate gene regions of OCD are coding proteins of the dopamine synthesis (for example: COMT). In this paper, we present a detailed overview of these relationships based on recent findings of OCD research.     

Normal CSF oxytocin and NPY levels in OCD.

BACKGROUND: Attention has recently been focused on central nervous system neuropeptides as potential mediators of the symptom profile of obsessive-compulsive disorder (OCD). Increased CSF levels of the anxiolytic neuropeptide oxytocin have been reported in OCD. CSF levels of NPY, another anxiolytic neuropeptide, have not been studied. METHODS: We measured CSF oxytocin and NPY in 14 OCD patients and 26 healthy normal volunteers. RESULTS: There were no significant differences between the OCD patients and control subjects in CSF oxytocin or NPY levels. In both the OCD and control groups, women had significantly higher CSF oxytocin levels than men. CONCLUSIONS: These results do not support a prior finding of elevated CSF oxytocin in OCD patients and do not provide any evidence for an abnormality of NPY regulation in OCD.     

Effects of cognitive self-consciousness on visual memory in obsessive-compulsive disorder

Previous research has documented high trait cognitive self-consciousness (CSC) in obsessive-compulsive disorder (OCD). It remains unclear whether elevated CSC levels can also explain cognitive performance deficits that have frequently been found in OCD. This study examined whether experimentally heightened CSC affects visual memory performance in OCD. OCD participants and healthy controls completed a complex figure test under three experimental conditions: simultaneously focusing on their thoughts (= CSC condition), simultaneously focusing on acoustic stimuli (= dual-task condition), and without a parallel task (= standard condition). In the OCD sample both the CSC condition and the dual-task condition reduced memory performance compared to the standard condition, whereas in controls only the dual-task condition led to reduced performance. Results indicate that raising CSC in OCD has a deteriorating effect on memory encoding that parallels the effect of a secondary task. High CSC and its effects on cognitive performance might be amenable to meta-cognitive treatment approaches.     

Overview of genetics and obsessive–compulsive disorder

This paper reviews the current state of research into the genetics of obsessive–compulsive disorder (OCD). Heredity has a major role in OCD etiology. This evidence comes from several methodological approaches such as family, twin, and segregation analysis studies. A major single gene effect as well as a polygenic hypothesis has been suggested based on segregation studies. In addition, candidate gene association and linkage analyses have shown not only one gene, but a few interesting genes and areas of the genome that may be relevant in OCD. In this search for genes, new definitions of the OCD phenotype have emerged, and some of them may be considered intermediate phenotypes between the gene effect and OCD–DSM-IV diagnosis. The phenotypic and genetic heterogeneity of OCD magnifies the challenge of locating susceptibility genes; at the same time, the identification of vulnerability genes will elucidate the identification of subtypes or dimensions of the disorder. Therefore research strategies that take advantage of clinical subtyping and that redefine the OCD phenotype in the context of genetic studies may potentially contribute to the nosology of OCD and ultimately pathophysiology. There is a lack of understanding about how genes and environment interact in OCD. However, there are some reports that will be discussed, which have attempted to evaluate how the environment contributes to OCD.     

Overlapping and Distinctive Features of Hypochondriasis and Obsessive–Compulsive Disorder

The spectrum of obsessive–compulsive disorders has received a great deal of theoretical attention, but there has been relatively little associated empirical research. The purpose of this study was to compare three groups of patients; those diagnosed with hypochondriasis (HC, a proposed spectrum condition), obsessive–compulsive disorder (OCD) and those with both OCD and HC (OCD/HC). The results show that patients with HC scored highest on a measure of overvalued ideas, and that the HC and HC/OCD groups scored significantly higher on measures of panic and agoraphobic cognitions. The groups also differed significantly for symptoms associated with compulsions. The patient groups were not different for measures of obsessions, depression, and anxiety. The results provide partial support for inclusion of HC in the spectrum of obsessive–compulsive disorders, but also provide indirect support for the association between HC and panic disorder. These results are interpreted in light of distinguishing characteristics among obsessive–compulsive spectrum conditions.