Goodman W K
Department of Psychiatry, University of Florida College of Medicine, Gainesville 32610-0256, USA.
J Clin Psychiatry. 1999;60 Suppl 18:27-32.
Obsessive-compulsive disorder (OCD) is a chronic, disabling anxiety disorder that is characterized by recurrent obsessions and uncontrolled compulsions such as repetitive behavioral or mental acts that are performed in response to an obsession. OCD often occurs comorbidly with a number of depressive and anxiety disorders. In addition, patients with OCD suffer significant personal and social morbidity and may have difficulty maintaining a job, finishing school, and developing relationships. The backbone of pharmacologic treatment for OCD is a 10- to 12-week trial with a selective serotonin reuptake inhibitor (SSRI) in adequate doses. In most cases, treatment should be initiated with an SSRI because of the superior safety, tolerability, and equivalent efficacy of this class of drugs compared with clomipramine. When dealing with patients who do not respond to one SSRI, effective alternatives include switching to a different SSRI, combining another medication or behavioral therapy with SSRI therapy, considering novel or experimental drug treatments, or employing nonpharmacologic biological approaches, such as electroconvulsive therapy, neurosurgery, or repetitive transcranial magnetic stimulation. This article provides an update on the diagnosis and medical management of OCD and will discuss guidelines for the use of SSRIs and novel approaches for managing treatment-refractory patients.
强迫症（OCD）是一种慢性致残性焦虑症，其特征是反复出现强迫观念和无法控制的强迫行为，如为应对强迫观念而进行的重复性行为或心理活动。强迫症常与多种抑郁和焦虑症合并发生。此外，强迫症患者会遭受严重的个人和社会损害，可能难以维持工作、完成学业以及发展人际关系。强迫症药物治疗的主要方法是使用足量的选择性5-羟色胺再摄取抑制剂（SSRI）进行10至12周的试验。在大多数情况下，应首选SSRI开始治疗，因为与氯米帕明相比，这类药物具有更高的安全性、耐受性和同等疗效。对于对一种SSRI无反应的患者，有效的替代方法包括换用另一种SSRI、将另一种药物或行为疗法与SSRI疗法联合使用、考虑新型或实验性药物治疗，或采用非药物生物方法，如电休克疗法、神经外科手术或重复经颅磁刺激。本文提供了强迫症诊断和药物治疗的最新信息，并将讨论SSRI的使用指南以及治疗难治性患者的新方法。
