Kaplan Alicia, Hollander Eric
Department of Psychiatry, Mount Sinai Scjhool of Medicine, New York, New York 10029, USA.
Psychiatr Serv. 2003 Aug;54(8):1111-8. doi: 10.1176/appi.ps.54.8.1111.
Obsessive-compulsive disorder is a chronic and often disabling disorder that affects 2 to 3 percent of the U.S. population. Optimal treatment involves a combination of pharmacologic and cognitive-behavioral therapies. Advances in psychopharmacology have led to safe and effective treatments for obsessive-compulsive disorder that provide clinically significant improvement in symptoms. In this article the authors review studies of pharmacologic treatments.
A MEDLINE search was conducted to identify relevant articles from 1991 to 2002. Double-blind, placebo-controlled studies as well as open-label studies and case reports were included.
The serotonin reuptake inhibitors (SRIs), including clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine, have been approved by the U.S. Food and Drug Administration for the treatment of adults with obsessive-compulsive disorder; three of these (clomipramine, fluvoxamine, and sertraline) have been approved for treatment of children and adolescents. Clomipramine and the selective serotonin reuptake inhibitors (SSRIs) are first-line agents. However, 40 to 60 percent of patients with obsessive-compulsive disorder do not respond to adequate treatment trials with SRIs, and agents that alter serotonin receptors and other neurotransmitter systems, such as dopamine, norepinephrine, and second-messenger systems, may play a role in treatment. Treatment options for patients who do not respond to SRIs include switching, augmentation, or novel-agent strategies. Up to two-thirds of patients with obsessive-compulsive disorder have comorbid psychiatric disorders, which may present a challenge in pharmacologic treatment. Major depressive disorder is the most common comorbid condition. Nonpharmacologic invasive techniques may play a role in refractory cases of obsessive-compulsive disorder, but further research is warranted.
强迫症是一种慢性且往往导致功能障碍的疾病，影响着2%至3%的美国人口。最佳治疗方法包括药物治疗和认知行为疗法的结合。精神药理学的进展已带来了针对强迫症的安全有效的治疗方法，这些方法能在临床上显著改善症状。在本文中，作者回顾了药物治疗的研究。
进行了一项医学文献数据库（MEDLINE）检索，以识别1991年至2002年的相关文章。纳入了双盲、安慰剂对照研究以及开放标签研究和病例报告。
5-羟色胺再摄取抑制剂（SRIs），包括氯米帕明、氟伏沙明、氟西汀、舍曲林和帕罗西汀，已获美国食品药品监督管理局批准用于治疗患有强迫症的成年人；其中三种（氯米帕明、氟伏沙明和舍曲林）已获批准用于治疗儿童和青少年。氯米帕明和选择性5-羟色胺再摄取抑制剂（SSRIs）是一线药物。然而，40%至60%的强迫症患者对充分的SRIs治疗试验无反应，而改变5-羟色胺受体及其他神经递质系统（如多巴胺、去甲肾上腺素和第二信使系统）的药物可能在治疗中发挥作用。对SRIs无反应的患者的治疗选择包括换药、增效或采用新药策略。多达三分之二的强迫症患者患有共病性精神障碍，这可能在药物治疗中带来挑战。重度抑郁症是最常见的共病情况。非药物侵入性技术可能在难治性强迫症病例中发挥作用，但仍需进一步研究。
