Pallanti Stefano, Quercioli Leonardo
Mount Sinai School of Medicine, New York, New York, USA.
Prog Neuropsychopharmacol Biol Psychiatry. 2006 May;30(3):400-12. doi: 10.1016/j.pnpbp.2005.11.028. Epub 2006 Feb 28.
While controlled trials with SRIs have demonstrated a selective efficacy in obsessive-compulsive disorder (OCD), up to 40-60% of patients do not have a satisfactory outcome. Non-response to treatment in OCD is associated with serious social disability. There are a large number of non-responsive patients, and they are difficult to cluster due to ambiguities in diagnostic criteria, possibility of subtypes and a high rate of comorbidity. Moreover, the findings of current studies of "so-called" non-responsive cases are currently non-generalizable because of the lack of an operational definition of non-response. The result has been that a cumulative body of data on a reasonably homogeneous sample of non-responders has not been developed. The aims of the research in this area are to clarify some of the obstacles in defining stages of response and levels of non-response and, through a comprehensive analysis, to propose a systematic nosology for this rather common condition. Better characterization of which patients respond and do not respond to various treatments will enable more accurate clustering of patients, and help facilitate multisite data collection for future research trials. The authors reviewed also the more recent therapeutic pharmacological and psychological lines for the treatment of refractoriness in OCD.
虽然选择性5-羟色胺再摄取抑制剂（SRI）的对照试验已证明其在强迫症（OCD）治疗中具有选择性疗效，但高达40%-60%的患者治疗效果并不理想。强迫症患者对治疗无反应与严重的社会功能障碍相关。存在大量无反应患者，由于诊断标准不明确、可能存在亚型以及高共病率，这些患者难以聚类。此外，由于缺乏无反应的操作性定义，目前对“所谓”无反应病例的研究结果无法推广。结果是，尚未形成关于一个相当同质的无反应者样本的累积数据。该领域研究的目的是阐明定义反应阶段和无反应水平的一些障碍，并通过全面分析，为这种相当常见的疾病提出一个系统的疾病分类学。更好地描述哪些患者对各种治疗有反应和无反应，将使患者聚类更准确，并有助于促进未来研究试验的多中心数据收集。作者还回顾了近期治疗强迫症难治性的药理学和心理学治疗方法。
