口吃共病强迫症的访谈与治疗

本文目的是通过报道病例诊疗过程,呈现口吃共病强迫症的临床诊疗思路及治疗方案的制定。咨客是一位23岁的未婚男性,自幼口吃,在应激和焦虑状态下加重,影响工作和社交。咨客自高中二年级开始时出现反复数钱、反复计算的行为,被诊断为强迫症,予以SSRIs类药物联合第二代抗精神病药物治疗,强迫思维和强迫行为得到改善,但出现嗜睡、情绪烦躁等,减少思瑞康剂量后,出现失眠,焦虑加重影响口吃,伴有心慌、紧张、进食后腹泻等。咨客被诊断为口吃共病强迫症,建议采用生物-心理-社会综合干预方法,通过积极运动缓解压力,继续服用百忧解,降低思瑞康剂量,减轻嗜睡,予以β-受体阻断剂普萘洛尔弥补思瑞康减量带来的焦虑。心理治疗推荐认知行为治疗和正念减压;社会学方面,继续从事会计等人际交往较少的工作。

Interview and treatment of stuttering comorbid obsessive-compulsive disorder

The purpose of this article is to present the clinical diagnosis and treatment process of one case of stuttering comorbid obsessive-compulsive disorder. The client was a 23-year-old unmarried male who started stuttering since childhood. Symptoms worsened when he was exposed to stress and anxiety, which influenced his work and social life. Due to repetitive counting and calculation behaviors in the second year of high school, he was diagnosed as obsessive-compulsive disorder, and began to receive drug treatment of selective serotonin reuptake inhibitors (SSRIs) and second generation antipsychotics. During the treatment process, there was an improvement in the obsessive thinking and compulsive behaviors, while symptoms including drowsiness and emotional irritability developed. After reducing the dosage of seroquel, patients had insomnia and anxiety, and accompanied by palpitation, nervousness, and diarrhea after eating, which aggravated stuttering. After this consultation, the client was diagnosed with stuttering comorbid obsessive-compulsive disorder, which required bio-psycho-social intervention. Active exercise was applied to relieve stress, fluoxetine and low-dose seroquel were used to alleviate drowsiness, and beta-blocker propranolol was given to relieve anxiety. In the aspects of psychology and sociology, mindfulness and cognitive behavioral therapies, and less interpersonal jobs such as accounting are recommended.