Greist J H
Department of Psychiatry, University of Wisconsin, Madison 53792.
J Clin Psychiatry. 1992 Apr;53 Suppl:38-41.
Except for rarely performed psychosurgery, obsessive compulsive disorder seldom improved with reversible treatments before 1966. In that year, Victor Meyer reported successful treatment of OCD with behavior therapy, and clomipramine was first released. For the past 25 years, controlled research has demonstrated specific efficacy of exposure for obsessional anxiety and ritual or response prevention for reducing ritual time, interference, and associated distress. Over the same time span, clomipramine has been conclusively shown to be an effective treatment for obsessive compulsive disorder in double-blind controlled trials against placebo and other nonpotent serotonin uptake inhibitor antidepressants. Fluvoxamine, fluoxetine, and sertraline, all potent serotonin uptake inhibitors, have also demonstrated efficacy in obsessive compulsive disorder; fluvoxamine is the best studied of these three compounds. The combination of behavior therapy and a potent serotonin uptake inhibitor is currently the best treatment for most patients. Psychosurgery still has a part to play in the treatment of a small proportion of severely disabled and distressed obsessive compulsive patients unresponsive to other effective treatments.
除了极少进行的精神外科手术外，在1966年之前，强迫症很少能通过可逆性治疗得到改善。同年，维克多·迈耶报告了行为疗法成功治疗强迫症的案例，并且氯米帕明首次上市。在过去25年里，对照研究已证明暴露疗法对强迫性焦虑有效，而仪式行为或反应预防对减少仪式行为时间、干扰及相关痛苦有效。在同一时期，在针对安慰剂和其他非强效5-羟色胺摄取抑制剂类抗抑郁药的双盲对照试验中，氯米帕明已被确凿证明是治疗强迫症的有效药物。氟伏沙明、氟西汀和舍曲林，均为强效5-羟色胺摄取抑制剂，也已证明对强迫症有效；氟伏沙明是这三种化合物中研究得最充分的。行为疗法与强效5-羟色胺摄取抑制剂相结合目前是大多数患者的最佳治疗方法。精神外科手术在一小部分对其他有效治疗无反应的严重残疾且痛苦的强迫症患者的治疗中仍有一定作用。
