强迫症与分裂型障碍共病的临床研究

目的调查强迫症患者的分裂型症状以及分裂型障碍共病发生比率并探讨伴有分裂型障碍的强迫症的临床特点。方法201例门诊强迫症患者,符合ICD-10与DSM-IV强迫症诊断标准,进行强迫症相关的一系列临床评定和ICD-10分裂型障碍症状评定,并分析分裂型症状与临床变量的关系,然后对伴有分裂型障碍的强迫症和单纯强迫症进行临床对照。结果31.3%(63/201)强迫症患者伴有3条或3条以上的分裂型障碍症状,28.4%(57/201)的强迫症患者同时存在ICD-10分裂型障碍。在9条ICD-10分裂型障碍症状中出现率比较高的依次是无内在阻力的强迫思维、古怪的信念或巫术性思想、不寻常的知觉体验、思维形式障碍(如赘述)等。有短暂的幻觉或妄想样信念者占9%。相关分析显示分裂型症状与强迫症状荒谬性(r=0.699,P<0.001)、抵抗力弱(r=0.5,P<0.001)、自知力不良(r=0.453,P<0.001)、残疾程度(r=0.328,P<0.001)等临床变量正相关。与单纯强迫症相比,伴有分裂型障碍者起病相对较急(P<0.05)、强迫症状比较荒谬、患者对症状顺从、自知力差、病情与社会功能障碍较重(P<0.001)。结论部分强迫症患者同时存在分裂型症状并符合分裂型障碍的诊断标准,分裂型症状与强迫症的某些临床特点相关,伴有分裂型障碍的强迫症倾向强迫症状荒谬、患者对症状抵抗较弱、自知力不良、病情较严重、社会功能损害较重。

A clinical study of the comorbidity of schizotypal disorder in obsessive-compulsive disorder

Objective To investigate the rate of the comorbidity of schizotypal symptoms and schizotypal disorder in obsessive compulsive disorder (OCD) and their possible clinical relationship to OCD.Methods A total of 201 patients met with ICD-10 and DSM-IV criteria for OCD were consecutively recruited. All patients were assessed with clinical measurements of OCD and schizotypal symptoms with the 9 items of schizotypal disorder in ICD-10. Spearman association analysis was conducted between clinical variables of OCD and the schizotypal symptoms. Then, the clinical variables were compared between the two groups of the OCD with and that without schizotypal disorder.Results 31.3% (63/201) had at least 3 schizotypal symptoms, 28.4% (57/201) met with the criteria of schizotypal disorder in ICD-10.The more frequent schizotypal symptoms in the sample were obsession without inner-resistance,odd beliefs or magical thinking, unusual perceptual experiences, and abnormal thought patterns (such as circumstantiality).There were 9% of sample had short episodes of hallucination or delusion-like beliefs with no obvious inducement from life events. Spearman correlation analysis showed that there were positive correlation between schizotypal symptoms and the some clinical variables of OCD, such as the absurdity of symptoms (r=0.699, P<0.001), lack of resistance (r=0.5, P<0.001), poor insight (r=0.473, P<0.001). Compared with the simple OCD, the patients with schizoptypal disorder had more likely acute or sub-acute onset (P<0.05), more unreasonable obsessive and compulsive symptoms, more likely obedient to symptoms, poorer insight (P<0.001), worse level of general severity, and poorer social function (P<0.001).Conclusion Schizotypal symptoms, which may meet with schizotypal disorder criteria of ICD-10, are relatively common among patients with OCD. There are some special clinical relationship between the schizotypal symptoms and OCD. The patients of OCD with schizotypal symptoms or schizotypal disorder may have special clinical features, such as more likely acute or sub-acute onset,unreasonable or absurd OCD symptoms, lack of resistance, poor insight and worse social function.