Greist John H, Bandelow Borwin, Hollander Eric, Marazziti Donatella, Montgomery Stuart A, Nutt David J, Okasha Ahmed, Swinson Richard P, Zohar Joseph
Healthcare Technology Systems, Inc., Madison, Wisconsin 53717, USA.
CNS Spectr. 2003 Aug;8(8 Suppl 1):7-16. doi: 10.1017/s1092852900006908.
What are the latest psychotherapeutic and pharmacotherapeutic treatment recommendations for obsessive-compulsive disorder (OCD)? OCD is a relatively common disorder with a lifetime prevalence of approximately 2% in the general population. It often has an early onset, usually in childhood or adolescence, and frequently becomes chronic and disabling if left untreated. High associated healthcare utilization and costs, and reduced productivity resulting in loss of earning, pose a huge economic burden to OCD patients and their families, employers, and society. OCD is characterized by the presence of obsessions and compulsions that are time-consuming, cause marked distress, or significantly interfere with a person's functioning. Most patients with OCD experience symptoms throughout their lives and benefit from long-term treatment. Both psychotherapy and pharmacotherapy are recommended, either alone or in combination, for the treatment of OCD. Cognitive-behavioral therapy is the psychotherapy of choice. Pharmacologic treatment options include the tricyclic antidepressant clomipramine and the selective serotonin reuptake inhibitors (SSRIs) citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. These have all shown benefit in acute treatment trials; clomipramine, fluvoxamine, fluoxetine, and sertraline have also demonstrated benefit in long-term treatment trials (at least 24 weeks), and clomipramine, sertraline, and fluvoxamine have United States Food and Drug Administration approvals for use in children and adolescents. Available treatment guidelines recommend first-line use of an SSRI (ie, fluoxetine, fluvoxamine, paroxetine, sertraline, or citalopram) in preference to clomipramine, due to the latter's less favorable adverse-event profile. Further, pharmacotherapy for a minimum of 1-2 years is recommended before very gradual withdrawal may be considered.
强迫症（OCD）最新的心理治疗和药物治疗建议是什么？强迫症是一种相对常见的疾病，在普通人群中的终生患病率约为2%。它通常起病较早，多在儿童期或青少年期，若不治疗，常转为慢性且导致残疾。较高的相关医疗利用率和成本，以及因生产力下降导致的收入损失，给强迫症患者及其家庭、雇主和社会带来了巨大的经济负担。强迫症的特征是存在耗时、引起明显痛苦或严重干扰个人功能的强迫观念和强迫行为。大多数强迫症患者一生都会经历症状，并受益于长期治疗。治疗强迫症推荐单独或联合使用心理治疗和药物治疗。认知行为疗法是首选的心理治疗方法。药物治疗选择包括三环类抗抑郁药氯米帕明和选择性5-羟色胺再摄取抑制剂（SSRI）西酞普兰、氟西汀、氟伏沙明、帕罗西汀和舍曲林。这些药物在急性治疗试验中均显示出疗效；氯米帕明、氟伏沙明、氟西汀和舍曲林在长期治疗试验（至少24周）中也显示出疗效，氯米帕明、舍曲林和氟伏沙明已获得美国食品药品监督管理局批准用于儿童和青少年。现有的治疗指南推荐首选SSRI（即氟西汀、氟伏沙明、帕罗西汀、舍曲林或西酞普兰）而非氯米帕明，因为后者的不良事件情况较差。此外，建议至少进行1 - 2年的药物治疗后才考虑非常缓慢地减药。
