Univeristy of Florence, Department of NEUROFARBA , 50134, via delle Gore 2H, Florence , Italy
Expert Opin Pharmacother. 2014 Dec;15(17):2543-52. doi: 10.1517/14656566.2014.964208. Epub 2014 Sep 25.
Obsessive-compulsive disorder (OCD) is clearly a heterogeneous syndrome in which comorbidity is the rule rather than the exception and is often 'phase-specific'. Comorbid conditions have a negative impact on OCD outcome and may clearly impact the disease trajectory. Nevertheless, in the current literature there is an impressive neglect of comorbidities in clinical trials and treatment approaches for these conditions are still not evidence-based.
In this paper we summarized the available data on the treatment of the main OCD comorbidities (mood and anxiety disorders, 'bipolar neurosis', tics and OCD-related disorders, addictions and impulsive disorders, eating disorders, attention deficit hyperactivity disorder, psychoses, and post-infective syndromes).
To achieve the goals of 'precision medicine' there is a critical need for deconstructing current diagnostic groups with biomarkers to predict and improve response to treatment. Despite the continuous efforts of several researchers in subtyping homogeneous samples of OCD patients (for example the comorbidity-based subclassification), current available treatments are still syndrome-based rather than network dysfunctions-based. Identifying the homogenous subgroup, subtyping patients according to comorbidity patterns, symptom dimensions, clinical course, neurocognitive and neurophysiological dysfunctions, could represent an essential first step in the direction of a 'precision medicine' approach.
强迫症（OCD）显然是一种异质综合征，共病是常态而非例外，且通常具有“阶段性特异性”。共病情况对 OCD 的预后有负面影响，可能明显影响疾病进程。然而，在当前的文献中，临床试验对共病的忽视令人震惊，针对这些疾病的治疗方法仍然缺乏循证依据。
本文总结了 OCD 主要共病（心境和焦虑障碍、“双相情感障碍”、抽动障碍和与 OCD 相关的障碍、成瘾和冲动障碍、饮食障碍、注意缺陷多动障碍、精神病和感染后综合征）的治疗相关现有数据。
为了实现“精准医学”的目标，迫切需要使用生物标志物解构当前的诊断组，以预测和改善治疗反应。尽管有几位研究人员在 OCD 同质患者样本中进行了亚分类（例如基于共病的亚分类）的持续努力，但目前可用的治疗方法仍然基于综合征，而非基于网络功能障碍。根据共病模式、症状维度、临床病程、神经认知和神经生理功能障碍对患者进行同质亚组分类，可以作为精准医学方法的重要第一步。
