Veale David, Naismith Iona, Miles Sarah, Childs Grace, Ball Jack, Muccio Francesca, Darnley Simon
Institute of Psychiatry,Psychology and Neuroscience,King's College London,and the Bethlem Royal Hospital,Beckenham,UK.
Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK.
Behav Cogn Psychother. 2016 May;44(3):331-46. doi: 10.1017/S1352465815000259. Epub 2015 Jun 30.
There is little data to inform the treatment of severe obsessive compulsive disorder (OCD) in an inpatient or residential setting.
This paper aimed to: a) describe treatment outcomes at a residential unit over 11 years; b) investigate whether treatment was successful for a subset of severe treatment refractory residents; c) compare an intensive treatment programme to a "standard" treatment programme; and d) find predictors of self or early discharge from the unit.
We compared treatment outcomes for (i) a minimum 12-week treatment (hereafter "standard") programme versus a 2-week intensive programme and (ii) for severe treatment refractory cases on the standard programme. We identified 472 residents with OCD admitted to the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital between 2001 and 2012. Outcomes were measured with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Obsessive Compulsive Inventory (OCI), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) obtained throughout treatment and up to one year after discharge.
Although residents had very severe OCD on admission, sequential assessment with the Y-BOCS, OCI, BAI and BDI demonstrated that scores on all outcome measures significantly decreased from pre to posttreatment and were generally maintained at follow-up. There was no significant difference between those on the standard or the 2-week intensive programme. Sixty-nine per cent of residents with OCD made significant improvements, with at least a 25% reduction on the Y-BOCS. There were predictors of self or early discharge but none for outcome on the Y-BOCS.
The data support the principle of stepped care for severe OCD.
关于住院或寄宿环境下重度强迫症（OCD）的治疗，可供参考的数据很少。
本文旨在：a）描述一个寄宿治疗单元11年来的治疗效果；b）调查对于一部分重度难治性患者，治疗是否成功；c）比较强化治疗方案与“标准”治疗方案；d）找出患者自行出院或提前出院的预测因素。
我们比较了（i）至少为期12周的治疗（以下简称“标准”）方案与为期2周的强化治疗方案的治疗效果，以及（ii）标准方案中重度难治性病例的治疗效果。我们确定了2001年至2012年间入住贝斯勒姆皇家医院焦虑症寄宿治疗单元的472例强迫症患者。通过在整个治疗过程中及出院后长达一年的时间里使用耶鲁-布朗强迫症量表（Y-BOCS）、强迫观念与强迫行为量表（OCI）、贝克焦虑量表（BAI）和贝克抑郁量表（BDI）来衡量治疗效果。
尽管患者入院时强迫症病情非常严重，但通过Y-BOCS、OCI、BAI和BDI的连续评估表明，所有疗效指标的得分从治疗前到治疗后均显著下降，且在随访时总体保持稳定。标准治疗方案组和为期2周的强化治疗方案组之间没有显著差异。69%的强迫症患者有显著改善，Y-BOCS得分至少降低了25%。存在患者自行出院或提前出院的预测因素，但没有Y-BOCS治疗效果的预测因素。
数据支持对重度强迫症采用分级护理原则。
