Mataix-Cols David, Marks Isaac M
Institute of Psychiatry, King's College London, PO BOX 69, De Crespigny Park, London SE5 8AF, UK.
Eur Psychiatry. 2006 Mar;21(2):75-80. doi: 10.1016/j.eurpsy.2005.07.003. Epub 2005 Dec 19.
Though there are effective psychological and drug treatments for obsessive-compulsive disorder (OCD), many patients remain inadequately treated or untreated. Making effective self-treatment guidance available may increase the number of patients being helped. In this review, database and manual literature searches were performed of case studies, open and randomised controlled trials (RCTs) of bibliotherapy, self-help groups, telecare and computer-aided self-help for OCD. We found no RCTs of bibliotherapy or self-help groups for OCD. Three open studies showed the efficacy of brief exposure and ritual prevention (ERP) instructions delivered by a live therapist by phone. A vicarious ERP computer program was effective in a small open study. Fully interactive computer-aided self-help by ERP for OCD was efficacious in two open studies and a large multicentre RCT, and in a small RCT compliance and outcome with that program was enhanced by brief scheduled support from a clinician. Although more research is needed, self-help approaches have the potential to help many more patients who would otherwise remain inadequately treated or untreated. Their dissemination could save resources used by health care providers. We propose a stepped care model for the treatment of OCD.
尽管针对强迫症（OCD）有有效的心理和药物治疗方法，但许多患者仍未得到充分治疗或根本未接受治疗。提供有效的自我治疗指导可能会增加得到帮助的患者数量。在本综述中，我们对案例研究、关于针对强迫症的阅读疗法、自助小组、远程护理和计算机辅助自助的开放性及随机对照试验（RCT）进行了数据库检索和手动文献检索。我们未发现针对强迫症的阅读疗法或自助小组的随机对照试验。三项开放性研究表明，由现场治疗师通过电话提供的简短暴露与仪式预防（ERP）指导具有疗效。在一项小型开放性研究中，一个替代性ERP计算机程序有效。在两项开放性研究和一项大型多中心随机对照试验中，针对强迫症的完全交互式计算机辅助ERP自助疗法是有效的，并且在一项小型随机对照试验中，临床医生的简短定期支持提高了该程序的依从性和治疗效果。尽管还需要更多研究，但自助方法有可能帮助更多原本未得到充分治疗或未接受治疗的患者。它们的推广可以节省医疗服务提供者所使用的资源。我们提出了一种用于治疗强迫症的分级护理模式。
