Mental Health Service, Franklin Delano Roosevelt Hospital, Veterans Affairs Hudson Valley Healthcare System, PO Box 100, Montrose, NY 10548, USA.
Psychiatr Clin North Am. 2009 Dec;32(4):835-51. doi: 10.1016/j.psc.2009.08.002.
Although obsessive-compulsive symptoms (OCS) in schizophrenia have been conceptually controversial and clinically challenging, recent evidence suggests that schizophrenia with OCS may constitute a distinct schizophrenic subgroup. Recent epidemiological and clinical findings have shown that the subgroup obsessive-compulsive (OC) schizophrenia is associated with poor outcome and is more frequent than previously realized. Emerging biological evidence suggests that OCS in schizophrenia has more than one pathogenesis, with distinct mechanisms that may require different treatment interventions. Therefore, the management of OCS in patients with schizophrenia requires an individualized treatment approach based on the pathogenesis and clinical status of the patient. For example, the atypical antipsychotics that are potent serotonin antagonists sometimes induce de novo or exacerbate preexisting OCS, which resolves if the patient is switched to an antipsychotic with a different profile or if adjunctive treatment with serotonin reuptake inhibitors (SSRIs) is undergone. Regarding OC schizophrenia, SSRIs are often a necessary part of treatment, with knowledge of potential pharmacokinetic interactions with antipsychotic drugs essential. In this article, recent progress and current knowledge of OC schizophrenia is reviewed and treatment guidelines are offered for this complex and challenging subgroup of schizophrenic patients.
尽管精神分裂症中的强迫症状（OCS）在概念上存在争议，临床上也具有挑战性，但最近的证据表明，伴有强迫症状的精神分裂症可能构成一个独特的精神分裂症亚组。最近的流行病学和临床研究结果表明，亚组强迫性（OC）精神分裂症与不良结局相关，其频率高于之前的认识。新兴的生物学证据表明，精神分裂症中的 OCS 有不止一种发病机制，具有不同的机制，可能需要不同的治疗干预措施。因此，精神分裂症患者 OCS 的管理需要根据患者的发病机制和临床状况采用个体化的治疗方法。例如，具有强大血清素拮抗作用的非典型抗精神病药物有时会引起新的或加重以前存在的 OCS，如果患者改用具有不同特征的抗精神病药物或接受血清素再摄取抑制剂（SSRIs）的辅助治疗，OCS 就会得到缓解。对于 OC 精神分裂症，SSRIs 通常是治疗的必要组成部分，了解与抗精神病药物的潜在药代动力学相互作用至关重要。本文综述了 OC 精神分裂症的最新进展和现有知识，并为这一复杂且具有挑战性的精神分裂症亚组患者提供了治疗指南。
