Prasko Jan, Raszka Michal, Adamcova Katarina, Grambal Ales, Koprivova Jana, Kudrnovská Hana, Latalova Klara, Vyskocilová Jana
Department of Psychiatry, Unveristy Hosptial Olomouc, Olomouc, Czech Republic.
Neuro Endocrinol Lett. 2009;30(5):615-23.
The aim of our study was to establish the efficacy of CBT on the sample of non-selected medication-resistant patients with OCD and to search for predictors of therapeutic response in such a group.
The treatment was carried out under usual conditions at the department for anxiety disorders. Systematic CBT steps were tailored to the needs of each patient. Pharmacology treatment remained grossly unchanged during the trial period. We used the following outcome measures in the study: Yale-Brown Obsessive Compulsive Scale, subjective version (S-Y-BOCS), the Clinical Global Impression - Severity of Illness scale (CGI-S), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatoform Dissociation Questionnaire (SDQ-20) and Dissociative Experience Scale (DES). The primary outcome measure was a decrease by 35% in Y-BOCS rating. Remission was defined as a 12 point score or lower in Y-BOCS and 1 or 2 points in CGI-S.
47 patients completed the study (19 male and 28 female). One female patient refused to participate. All patients completed at least 5 weeks of intensive CBT programme and showed significant improvement on Y-BOCS, CGI-S, and BDI scales. At the end of the treatment 40.4% of the patients achieved clinical remission according to the CGI-S scale. The main characteristics present at the beginning of the trial increasing probability of achieving improvement or remission during the treatment were a Y-BOCS score lower than 22, good insight, higher resistance to symptoms, low level of dissociation, and aggressive obsessions.
As negative predictors we identified higher scores in Y-BOCS, poorer insight, low resistance to symptoms, high level of dissociation, obsessions focused on control/symmetry and obsessive slowness/ambivalence as associated with poor improvement.
我们研究的目的是确定认知行为疗法（CBT）对未选择的强迫症药物抵抗患者样本的疗效，并在此类患者群体中寻找治疗反应的预测因素。
治疗在焦虑症科室的常规条件下进行。系统性的CBT步骤根据每位患者的需求进行调整。在试验期间，药物治疗基本保持不变。我们在研究中使用了以下结果指标：耶鲁-布朗强迫症量表主观版（S-Y-BOCS）、临床总体印象-疾病严重程度量表（CGI-S）、贝克抑郁量表（BDI）、贝克焦虑量表（BAI）、躯体形式解离问卷（SDQ-20）和解离体验量表（DES）。主要结果指标是Y-BOCS评分降低35%。缓解定义为Y-BOCS评分为12分或更低，CGI-S评分为1分或2分。
47名患者完成了研究（19名男性和28名女性）。一名女性患者拒绝参与研究。所有患者均完成了至少5周的强化CBT项目，并在Y-BOCS、CGI-S和BDI量表上显示出显著改善。治疗结束时，根据CGI-S量表，40.4%的患者实现了临床缓解。在试验开始时存在的主要特征，这些特征增加了治疗期间改善或缓解的可能性，包括Y-BOCS评分低于22、洞察力良好、对症状的抵抗力较高、解离水平较低以及攻击性强迫观念。
作为负面预测因素，我们确定Y-BOCS得分较高、洞察力较差、对症状的抵抗力较低、解离水平较高、专注于控制/对称的强迫观念以及强迫性迟缓/矛盾心理与改善不佳相关。
