Choi Yun-Jung
Red Cross College of Nursing, 98 Saemoonan-Gil,Jongno-Gu, Seoul 110-102, Korea.
J Am Acad Nurse Pract. 2009 Apr;21(4):207-13. doi: 10.1111/j.1745-7599.2009.00408.x.
This systematic review examines the efficacy of pharmacological therapy for obsessive-compulsive disorder (OCD), addressing two major issues: which treatment is most effective in treating the patient's symptoms and which is beneficial for maintaining remission.
Seven databases were used to acquire articles. The key words used to search for the relative topics published from 1996 to 2007 were "obsessive-compulsive disorder" and "Yale-Brown obsession-compulsion scale." Based on the inclusion and exclusion criteria, 25 studies were selected from 57 potentially relevant studies.
The effects of treatment with clomipramine and selective serotonin reuptake inhibitors (SSRIs: fluvoxamine, sertraline, fluoxetine, citalopram, and escitalopram) proved to be similar, except for the lower adherence rate in case of clomipramine because of its side effects. An adequate drug trial involves administering an effective daily dose for a minimum of 8 weeks. An augmentation strategy proven effective for individuals refractory to monotherapy with SSRI treatment alone is the use of atypical antipsychotics (risperidone, olanzapine, and quetiapine).
Administration of fluvoxamine or sertraline to patients for an adequate duration is recommended as the first-line prescription for OCD, and augmentation therapy with risperidone, olanzapine, or quetiapine is recommended for refractory OCD.
本系统评价考察了强迫症（OCD）药物治疗的疗效，探讨两个主要问题：哪种治疗对缓解患者症状最有效，哪种治疗对维持缓解有益。
使用七个数据库获取文章。用于检索1996年至2007年发表的相关主题的关键词为“强迫症”和“耶鲁-布朗强迫量表”。根据纳入和排除标准，从57项可能相关的研究中选取了25项研究。
氯米帕明与选择性5-羟色胺再摄取抑制剂（SSRIs：氟伏沙明、舍曲林、氟西汀、西酞普兰和艾司西酞普兰）的治疗效果相似，但氯米帕明因其副作用导致依从率较低。充分的药物试验包括给予有效日剂量至少8周。对于单用SSRI治疗无效的个体，一种已被证明有效的增效策略是使用非典型抗精神病药物（利培酮、奥氮平和喹硫平）。
建议对强迫症患者给予足够疗程的氟伏沙明或舍曲林作为一线处方，对于难治性强迫症，建议使用利培酮、奥氮平或喹硫平进行增效治疗。
