强迫症患者的生活质量结局：与治疗反应和症状复发的关系。

Quality of life outcomes in patients with obsessive-compulsive disorder: relationship to treatment response and symptom relapse.

机构信息

Montefiore Medical Center University Hospital for Albert Einstein College of Medicine Child Psychiatry Annex, 111 E. 210th St, Bronx, NY 10467-2490, USA.

出版信息

J Clin Psychiatry. 2010 Jun;71(6):784-92. doi: 10.4088/JCP.09m05911blu. Epub 2010 May 4.

DOI:10.4088/JCP.09m05911blu

PMID:20492845

Abstract

OBJECTIVE

Data were analyzed from 2 prospective, double-blind, placebo-controlled trials of escitalopram in obsessive-compulsive disorder (OCD) to characterize the baseline levels of functional disability and impairment in health-related quality of life (HRQoL) and to assess the relationship between treatment outcomes (response or relapse) and disability or HRQoL.

METHOD

Data from a 24-week, placebo-controlled, fixed-dose trial (N = 466) of escitalopram (10-20 mg/d) or paroxetine (40 mg/d) and from a 40-week, flexible-dose (escitalopram 10-20 mg/d), placebo-controlled relapse-prevention trial (N = 468) were analyzed. Obsessive-compulsive disorder symptoms (DSM-IV criteria) were assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS), functioning was assessed using the Sheehan Disability Scale (SDS), and HRQoL was assessed using the Medical Outcomes Study Short Form (SF-36). Baseline data were pooled for patients across both studies. For patients in the fixed-dose study, SDS and SF-36 scores were compared across treatment groups and for responders versus nonresponders. In the relapse-prevention trial, SDS and SF-36 scores were compared for relapsed versus nonrelapsed patients.

RESULTS

Patients with more severe baseline symptoms (YBOCS > or = 27) reported significantly greater impairment on the SDS (P < .001) and SF-36 (except for bodily pain). Patients receiving escitalopram or paroxetine reported significant improvements on most SF-36 dimensions and on the SDS compared to placebo; however, improvements in work-related functioning were seen earlier for patients receiving escitalopram (20 mg/d). At the study endpoints, SDS and SF-36 scores were significantly better for patients who were responders (versus nonresponders) and for patients who did not relapse (versus relapsers).

CONCLUSIONS

Obsessive-compulsive disorder is associated with significant impairment in functioning and HRQoL. Significant differences in disability and HRQoL between responders and nonresponders or relapsers and nonrelapsers suggest a relationship between symptomatic and functional outcomes.

TRIAL REGISTRATION

lundbecktrials.com Identifiers: 10205 and 10193.

摘要

目的

对来自两项前瞻性、双盲、安慰剂对照的依地普仑治疗强迫症（OCD）的研究数据进行分析，以描述基线时的功能残疾和健康相关生活质量（HRQoL）损害程度，并评估治疗结果（应答或复发）与残疾或 HRQoL 之间的关系。

方法

分析了一项为期 24 周、安慰剂对照、固定剂量的依地普仑（10-20mg/d）或帕罗西汀（40mg/d）试验（N=466）和一项为期 40 周、灵活剂量（依地普仑 10-20mg/d）、安慰剂对照的复发预防试验（N=468）的数据。采用耶鲁-布朗强迫量表（YBOCS）评估强迫症症状（DSM-IV 标准），采用 Sheehan 残疾量表（SDS）评估功能，采用医疗结局研究简表（SF-36）评估 HRQoL。对来自两项研究的患者进行了 pooled 分析。对于固定剂量研究中的患者，比较了治疗组之间以及应答者与无应答者之间的 SDS 和 SF-36 评分。在复发预防试验中，比较了复发患者与未复发患者的 SDS 和 SF-36 评分。

结果

基线症状更严重（YBOCS≥27）的患者报告 SDS（P<.001）和 SF-36（除身体疼痛外）评分的损害程度显著更高。与安慰剂相比，接受依地普仑或帕罗西汀治疗的患者在大多数 SF-36 维度和 SDS 上均有显著改善；然而，接受依地普仑（20mg/d）治疗的患者更早出现与工作相关的功能改善。在研究终点，应答者（与无应答者相比）和未复发者（与复发者相比）的 SDS 和 SF-36 评分显著更好。