Fontenelle Leonardo F, Nascimento Antonio L, Mendlowicz Mauro V, Shavitt Roseli G, Versiani Marcio
Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal of Rio de Janeiro (IPUB/UFRJ), Icaraí, Niterói, RJ, Brazil.
Expert Opin Pharmacother. 2007 Apr;8(5):563-83. doi: 10.1517/14656566.8.5.563.
The purpose of this article is to introduce the reader to an updated evidence-based drug treatment algorithm to be employed in patients with obsessive-compulsive disorder (OCD). Relevant studies were identified through a comprehensive review and classified according to the type of patients enrolled, the quality of the study design and the invasiveness, availability and complexity of the therapeutic approach. When ineffective, therapeutic trials with first-line strategies (such as the selective serotonin re-uptake inhibitors [SSRIs] and venlafaxine) should be followed by treatment approaches such as clomipramine, augmentation with antipsychotics or pindolol, SSRI megadoses or cognitive behavioral therapy. These therapeutic strategies are expected to help most patients with OCD. Additional approaches include intravenous clomipramine, oral morphine, 'heroic drug strategies', deep brain stimulation and functional neurosurgery. Independent studies are urgently needed to help identify the most promising drug treatment sequences for OCD.
本文旨在向读者介绍一种用于强迫症（OCD）患者的最新循证药物治疗算法。通过全面综述确定相关研究，并根据纳入患者的类型、研究设计质量以及治疗方法的侵入性、可及性和复杂性进行分类。当一线策略（如选择性5-羟色胺再摄取抑制剂[SSRIs]和文拉法辛）治疗无效时，应采用氯米帕明、联合抗精神病药物或吲哚洛尔、SSRIs超大剂量治疗或认知行为疗法等治疗方法。这些治疗策略有望帮助大多数强迫症患者。其他方法包括静脉注射氯米帕明、口服吗啡、“激进药物策略”、深部脑刺激和功能性神经外科手术。迫切需要独立研究来帮助确定最有前景的强迫症药物治疗顺序。
