Foa Edna B, Simpson Helen Blair, Rosenfield David, Liebowitz Michael R, Cahill Shawn P, Huppert Jonathan D, Bender James, McLean Carmen P, Maher Michael J, Campeas Raphael, Hahn Chang-Gyu, Imms Patricia, Pinto Anthony, Powers Mark B, Rodriguez Carolyn I, Van Meter Page E, Vermes Donna, Williams Monnica T
University of Pennsylvania, School of Medicine, Department of Psychiatry, 3535 Market St, 6th Floor, Philadelphia, PA 19104
J Clin Psychiatry. 2015 Apr;76(4):440-6. doi: 10.4088/JCP.14m09044.
To compare outcomes after 6-month maintenance treatment of adults diagnosed with obsessive-compulsive disorder (OCD) based on DSM-IV criteria who responded to acute treatment with serotonin reuptake inhibitors (SRIs) augmented by exposure and response prevention (EX/RP) or risperidone.
A randomized trial was conducted at 2 academic sites from January 2007 through December 2012. In the acute phase, 100 patients on therapeutic SRI dose with at least moderate OCD severity were randomized to 8 weeks of EX/RP, risperidone, or pill placebo. Responders entered the 6-month maintenance phase, continuing the augmentation strategy they received acutely (n = 30 EX/RP, n = 8 risperidone). Independent evaluations were conducted every month. The main outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
Intent-to-treat analyses indicated that, after 6-month maintenance treatment, EX/RP yielded OCD outcomes that were superior to risperidone (Y-BOCS = 10.95 vs 18.70; t40 = 2.76, P = .009); more patients randomized to EX/RP met response criteria (Y-BOCS decrease ≥ 25%: 70% vs 20%; P < .001) and achieved minimal symptoms (Y-BOCS ≤ 12: 50% vs 5%; P < .001). During maintenance, OCD severity decreased slightly in both conditions (Y-BOCS decrease = 2.2 points, P = .020). Lower Y-BOCS at entry to maintenance was associated with more improvement in both conditions (r38 = 0.57, P < .001).
OCD patients taking SRIs who responded to acute EX/RP or risperidone maintained their gains over 6-month maintenance. Because EX/RP patients improved more during acute treatment than risperidone-treated patients, and both maintained their gains during maintenance, EX/RP yielded superior outcomes 6 months later. The findings that 50% of patients randomized to EX/RP had minimal symptoms at 6-month maintenance, a rate double that of prior studies, suggests that EX/RP maintenance helps maximize long-term outcome.
ClinicalTrials.gov identifier: NCT00389493.
比较根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准诊断为强迫症（OCD）的成年人，在接受5-羟色胺再摄取抑制剂（SRIs）联合暴露与反应阻止疗法（EX/RP）或利培酮进行急性治疗后，进行6个月维持治疗的效果。
2007年1月至2012年12月在2个学术机构进行了一项随机试验。在急性期，100名服用治疗剂量SRIs且强迫症严重程度至少为中度的患者被随机分为接受8周的EX/RP、利培酮或口服安慰剂治疗。有反应的患者进入6个月的维持期，继续采用他们在急性期接受的强化策略（n = 30接受EX/RP，n = 8接受利培酮）。每月进行独立评估。主要结局指标是耶鲁-布朗强迫症量表（Y-BOCS）。
意向性分析表明，在6个月的维持治疗后，EX/RP组的强迫症治疗效果优于利培酮组（Y-BOCS分别为10.95和18.70；t40 = 2.76，P = 0.009）；更多随机分配到EX/RP组的患者达到反应标准（Y-BOCS降低≥25%：70%对20%；P < 0.001）并实现症状轻微（Y-BOCS≤12：50%对5%；P < 0.001）。在维持期，两种治疗情况下强迫症严重程度均略有下降（Y-BOCS降低 = 2.2分，P = 0.020）。维持期开始时较低的Y-BOCS与两种治疗情况下更大的改善相关（r38 = 0.57，P < 0.001）。
服用SRIs且对急性EX/RP或利培酮有反应的强迫症患者在6个月维持期内保持了治疗效果。由于EX/RP组患者在急性治疗期间比利培酮治疗组患者改善更多，且两者在维持期均保持了治疗效果，因此6个月后EX/RP组的结局更好。随机分配到EX/RP组的患者中有50%在6个月维持期时症状轻微，这一比例是先前研究的两倍，这一结果表明EX/RP维持治疗有助于使长期结局最大化。
ClinicalTrials.gov标识符：NCT00389493。
