Soomro G Mustafa
St. James Hospital, Portsmouth, UK.
BMJ Clin Evid. 2012 Jan 18;2012:1004.
Obsessions or compulsions that cause personal distress or social dysfunction affect about 1% of adult men and 1.5% of adult women. About half of adults with obsessive compulsive disorder (OCD) have an episodic course, whereas the other half have continuous problems. Prevalence in children and adolescents is 2.7%. The disorder persists in about 40% of children and adolescents at mean follow-up of 5.7 years.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of initial treatments for obsessive compulsive disorder in adults? What are the effects of initial treatments for obsessive compulsive disorder in children and adolescents? What are the effects of maintenance treatment for obsessive compulsive disorder in adults? What are the effects of maintenance treatment for obsessive compulsive disorder in children and adolescents? What are the effects of treatments for obsessive compulsive disorder in adults who have not responded to initial treatment with serotonin reuptake inhibitors (SRIs)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 43 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: addition of antipsychotics to serotonin reuptake inhibitors, behavioural therapy alone or with serotonin reuptake inhibitors, cognitive therapy or cognitive behavioural therapy (CBT) (alone or with serotonin reuptake inhibitors), electroconvulsive therapy, optimum duration of maintenance treatment, psychosurgery, serotonin reuptake inhibitors (citalopram, clomipramine, fluoxetine, fluvoxamine, paroxetine, or sertraline), and transcranial magnetic stimulation.
导致个人痛苦或社会功能障碍的强迫观念或强迫行为影响约1%的成年男性和1.5%的成年女性。约一半的强迫症（OCD）成年患者病程呈发作性，而另一半则存在持续性问题。儿童和青少年中的患病率为2.7%。在平均5.7年的随访中，约40%的儿童和青少年的该疾病仍持续存在。
我们进行了一项系统评价，旨在回答以下临床问题：成人强迫症初始治疗的效果如何？儿童和青少年强迫症初始治疗的效果如何？成人强迫症维持治疗的效果如何？儿童和青少年强迫症维持治疗的效果如何？对5-羟色胺再摄取抑制剂（SRIs）初始治疗无反应的成年强迫症患者的治疗效果如何？我们检索了：截至2011年4月的Medline、Embase、Cochrane图书馆及其他重要数据库（临床证据综述会定期更新；请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品及保健品监管局（MHRA）等相关组织的危害警示。
我们发现43项系统评价、随机对照试验或观察性研究符合我们的纳入标准。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们呈现了以下干预措施的有效性和安全性相关信息：5-羟色胺再摄取抑制剂联合抗精神病药物、单独使用行为疗法或与5-羟色胺再摄取抑制剂联合使用、认知疗法或认知行为疗法（CBT）（单独或与5-羟色胺再摄取抑制剂联合使用）、电休克治疗、维持治疗的最佳持续时间、精神外科手术、5-羟色胺再摄取抑制剂（西酞普兰、氯米帕明、氟西汀、氟伏沙明、帕罗西汀或舍曲林）以及经颅磁刺激。
