Bloch M H, Bartley C A, Zipperer L, Jakubovski E, Landeros-Weisenberger A, Pittenger C, Leckman J F
Child Study Center, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
Mol Psychiatry. 2014 Sep;19(9):1025-30. doi: 10.1038/mp.2014.50. Epub 2014 Jun 10.
DSM-5 recognizes hoarding disorder as distinct from obsessive-compulsive disorder (OCD), codifying a new consensus. Hoarding disorder was previously classified as a symptom of OCD and patients received treatments designed for OCD. We conducted a meta-analysis to determine whether OCD patients with hoarding symptoms responded differently to traditional OCD treatments compared with OCD patients without hoarding symptoms. An electronic search was conducted for eligible studies in PubMed. A trial was eligible for inclusion if it (1) was a randomized controlled trial, cohort or case-control study; (2) compared treatment response between OCD patients with and those without hoarding symptoms, or examined response to treatment between OCD symptom dimensions (which typically include hoarding) and (3) examined treatment response to pharmacotherapy, behavioral therapy or their combination. Our primary outcome was differential treatment response between OCD patients with and those without hoarding symptoms, expressed as an odds ratio (OR). Twenty-one studies involving 3039 total participants including 304 with hoarding symptoms were included. Patients with OCD and hoarding symptoms were significantly less likely to respond to traditional OCD treatments than OCD patients without hoarding symptoms (OR=0.50 (95% confidence interval 0.42-0.60), z=-7.5, P<0.0001). This finding was consistent across treatment modalities. OCD patients with hoarding symptoms represent a population in need of further treatment research. OCD patients with hoarding symptoms may benefit more from interventions specifically targeting their hoarding symptoms.
《精神疾病诊断与统计手册》第五版（DSM - 5）将囤积障碍认定为有别于强迫症（OCD）的一种疾病，从而形成了一项新的共识。囤积障碍此前被归类为强迫症的一种症状，患者接受针对强迫症的治疗。我们进行了一项荟萃分析，以确定有囤积症状的强迫症患者与无囤积症状的强迫症患者相比，对传统强迫症治疗的反应是否不同。我们在PubMed上对符合条件的研究进行了电子检索。如果一项试验满足以下条件则符合纳入标准：（1）为随机对照试验、队列研究或病例对照研究；（2）比较了有囤积症状和无囤积症状的强迫症患者的治疗反应，或研究了强迫症症状维度（通常包括囤积）之间的治疗反应；（3）研究了药物治疗、行为治疗或二者联合治疗的反应。我们的主要结局是有囤积症状和无囤积症状的强迫症患者之间的治疗反应差异，以优势比（OR）表示。共纳入21项研究，总计3039名参与者，其中304名有囤积症状。有囤积症状的强迫症患者对传统强迫症治疗的反应明显低于无囤积症状的强迫症患者（OR = 0.50（95%置信区间0.42 - 0.60），z = -7.5，P < 0.0001）。这一发现适用于所有治疗方式。有囤积症状的强迫症患者是需要进一步治疗研究的群体。有囤积症状的强迫症患者可能会从专门针对其囤积症状的干预措施中获益更多。
