Schruers K, Koning K, Luermans J, Haack M J, Griez E
Academic Anxiety Center, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands.
Acta Psychiatr Scand. 2005 Apr;111(4):261-71. doi: 10.1111/j.1600-0447.2004.00502.x.
Obsessive-compulsive disorder (OCD) is a chronic disabling disease with profound implications for social functioning. Thirty per cent of all patients with OCD show insufficient improvement with state-of-the-art treatment. Conventional treatment and alternative treatment options for this population were investigated.
A selective review of the relevant scientific literature on OCD treatment and treatment resistance was conducted.
In addition to serotonin reuptake inhibitors (SRIs) and cognitive-behavioural therapy, alternative monotherapies, SRI augmentation strategies with a variety of drugs and electroconvulsive therapy have shown results in individual cases, but no conclusive evidence has been found in placebo-controlled trials. While studies investigating neurosurgery for refractory OCD show positive results, most of these studies have methodological shortcomings.
Novel approaches currently under investigation that have shown promising effects for treatment-resistant OCD include SRI augmentation with atypical antipsychotics and chronic deep brain stimulation, a new surgical technique. Placebo-controlled trials for both treatment options will be needed to confirm preliminary findings.
强迫症（OCD）是一种慢性致残性疾病，对社会功能有深远影响。所有强迫症患者中有30%对现有最佳治疗反应欠佳。本研究对该人群的传统治疗和替代治疗方案进行了调查。
对强迫症治疗及治疗抵抗的相关科学文献进行了选择性综述。
除5-羟色胺再摄取抑制剂（SRIs）和认知行为疗法外，替代单一疗法、多种药物联用的SRI增强策略以及电休克疗法在个别病例中显示出疗效，但在安慰剂对照试验中未发现确凿证据。虽然针对难治性强迫症的神经外科手术研究显示出积极结果，但这些研究大多存在方法学缺陷。
目前正在研究的、对难治性强迫症显示出有前景疗效的新方法包括联用非典型抗精神病药物增强SRI疗效以及慢性深部脑刺激，后者是一种新的外科技术。两种治疗方案均需进行安慰剂对照试验以证实初步研究结果。
