Koran Lorrin M, Bullock Kim D, Hartston Heidi J, Elliott Michael A, D'Andrea Vincent
Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif., USA.
J Clin Psychiatry. 2002 Aug;63(8):704-8. doi: 10.4088/jcp.v63n0808.
Compulsive shopping, a DSM-IV impulse-control disorder not otherwise specified, is characterized by preoccupation with shopping and inability to resist buying unneeded items, with resulting marked distress, social or occupational impairment, and financial and/or familial problems. Because an open-label trial suggested that fluovaxamine, a selective serotonin reuptake inhibitor (SSRI), is effective for this disorder, we tested the effectiveness of the SSRI citalopram.
We enrolled adults meeting formal diagnostic criteria (as defined by McElroy and colleagues) in a 12-week open-label trial. We excluded subjects with obsessive-compulsive disorder, bipolar disorder, substance abuse or dependence, or psychotic disorders. Citalopram treatment was begun at 20 mg/day and increased every 2 weeks by 20 mg/day, absent marked response and limiting side effects, to 60 mg/day. At endpoint, all subjects were asked to give written informed consent for follow-up telephone interviews at 3-month intervals for 12 months.
We enrolled 24 subjects, 22 women and 2 men, whose mean +/- SD age was 43.7 +/- 8.1 years; most had been shopping compulsively for 2 decades or more. Citalopram (mean +/- SD endpoint dose = 35.4 +/- 21.4 mg/day) produced rapid, marked, sustained improvements on both the Yale-Brown Obsessive Compulsive Scale-Shopping Version and the Clinical Global Impressions-Improvement (CGI-I) scale in subjects with and without comorbid conditions. Seventeen subjects (71%) were responders, achieving ratings of much or very much improved on the CGI-I, including 2 of the 3 subjects who discontinued for adverse events (sedation or agitation). During a 6-month follow-up period, those continuing citalopram therapy were less likely to relapse than those discontinuing the medication.
Citalopram appears to be a safe and effective treatment for compulsive shopping. Acute and long-term, double-blind, placebo-controlled trials of citalopram and other SSRIs for the treatment of this disorder are indicated.
强迫性购物是一种未在《精神疾病诊断与统计手册》第四版中另行规定的冲动控制障碍，其特征为过度关注购物且无法抗拒购买不需要的物品，从而导致明显的痛苦、社交或职业功能受损以及财务和/或家庭问题。由于一项开放标签试验表明，选择性5-羟色胺再摄取抑制剂（SSRI）氟伏沙明对该疾病有效，我们对SSRI西酞普兰的有效性进行了测试。
我们让符合正式诊断标准（由麦克尔罗伊及其同事定义）的成年人参加了一项为期12周的开放标签试验。我们排除了患有强迫症、双相情感障碍、物质滥用或依赖或精神障碍的受试者。西酞普兰治疗从20毫克/天开始，每2周增加20毫克/天，若无明显反应且无限制副作用，则增至60毫克/天。在试验终点，所有受试者均被要求书面知情同意接受为期12个月、每3个月一次的随访电话访谈。
我们招募了24名受试者，其中22名女性和2名男性，其平均年龄±标准差为43.7±8.1岁；大多数人已经强迫性购物20年或更长时间。西酞普兰（平均±标准差终点剂量=35.4±21.4毫克/天）在耶鲁-布朗强迫量表-购物版和临床总体印象-改善（CGI-I）量表上，使有或无合并症的受试者都迅速、显著且持续地得到改善。17名受试者（71%）有反应，在CGI-I量表上达到了明显改善或非常明显改善的评级，其中包括3名因不良事件（镇静或激动）而停药的受试者中的2名。在为期6个月的随访期内，继续接受西酞普兰治疗的受试者比停药者复发的可能性更小。
西酞普兰似乎是一种治疗强迫性购物的安全有效的方法。需要进行西酞普兰和其他SSRI治疗该疾病的急性和长期双盲、安慰剂对照试验。
