Stein Dan J, Carey Paul D, Lochner Christine, Seedat Soraya, Fineberg Naomi, Andersen Elisabeth W
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
CNS Spectr. 2008 Jun;13(6):492-8. doi: 10.1017/s1092852900016722.
There is a substantial body of evidence that obsessive-compulsive disorder (OCD) symptoms can be grouped into a series of discrete dimensions, and some evidence that not all OCD symptom dimensions respond equally well to pharmacologic or psychotherapeutic intervention. The response of OCD symptom dimensions to 12 weeks of treatment with escitalopram or placebo was investigated.
Data from a randomized, double-blind, placebo-controlled study of escitalopram in 466 adults with OCD were analyzed. Exploratory factor analysis of individual items of the Yale-Brown Obsessive-Compulsive Scale checklist was performed and subscale scores based on the extracted factors were determined. Analyses of covariance were undertaken to determine whether inclusion of each subscale score in these models impacted on the efficacy of escitalopram versus placebo.
Exploratory factor analysis of individual Yale-Brown Obsessive-Compulsive Scale items yielded 5 factors (contamination/cleaning, harm/checking, hoarding/symmetry, religious/sexual, and somatic/hypochondriacal). Analyses of covariance including all the subscales demonstrated that escitalopram was more effective than placebo. There was a significant interaction for the hoarding/symmetry factor, which was associated with a poor treatment response.
Escitalopram shows good efficacy across the range of OCD symptom dimensions. Nevertheless, hoarding/symmetry was associated with a poorer treatment response. Hoarding/symmetry may be particularly characteristic of an early-onset group of OCD patients, with the involvement of neurotransmitters other than serotonin. Further work is needed to delineate fully the subtypes of OCD, and their correlates with underlying psychobiology and treatment responsivity.
有大量证据表明，强迫症（OCD）症状可分为一系列离散维度，并且有证据表明并非所有强迫症症状维度对药物或心理治疗干预的反应都同样良好。本研究调查了强迫症症状维度对艾司西酞普兰或安慰剂治疗12周的反应。
对一项针对466名成年强迫症患者的艾司西酞普兰随机、双盲、安慰剂对照研究的数据进行分析。对耶鲁-布朗强迫症量表清单中的各个项目进行探索性因素分析，并根据提取的因素确定子量表分数。进行协方差分析以确定在这些模型中纳入每个子量表分数是否会影响艾司西酞普兰与安慰剂的疗效。
对耶鲁-布朗强迫症量表各个项目的探索性因素分析产生了5个因素（污染/清洁、伤害/检查、囤积/对称、宗教/性和躯体/疑病）。包括所有子量表的协方差分析表明，艾司西酞普兰比安慰剂更有效。囤积/对称因素存在显著交互作用，这与较差的治疗反应相关。
艾司西酞普兰在强迫症症状维度范围内显示出良好疗效。然而，囤积/对称与较差的治疗反应相关。囤积/对称可能是一组早发性强迫症患者的特别特征，涉及血清素以外的神经递质。需要进一步开展工作以全面界定强迫症的亚型及其与潜在心理生物学和治疗反应性的关联。
