Fenske Jill N, Petersen Ketti
University of Michigan Medical School, Ann Arbor, MI, USA.
Am Fam Physician. 2015 Nov 15;92(10):896-903.
Obsessive-compulsive disorder (OCD) is a chronic illness that can cause marked distress and disability. It is a complex disorder with a variety of manifestations and symptom dimensions, some of which are underrecognized. Early recognition and treatment with OCD-specific therapies may improve outcomes, but there is often a delay in diagnosis. Patients can experience significant improvement with treatment, and some may achieve remission. Recommended first-line therapies are cognitive behavior therapy, specifically exposure and response prevention, and/or a selective serotonin reuptake inhibitor (SSRI). Patients with OCD require higher SSRI dosages than for other indications, and the treatment response time is typically longer. When effective, long-term treatment with an SSRI is a reasonable option to prevent relapse. Patients with severe symptoms or lack of response to first-line therapies should be referred to a psychiatrist. There are a variety of options for treatment-resistant OCD, including clomipramine or augmenting an SSRI with an atypical antipsychotic. Patients with OCD should be closely monitored for psychiatric comorbidities and suicidal ideation.
强迫症（OCD）是一种慢性疾病，可导致明显的痛苦和功能障碍。它是一种复杂的疾病，有多种表现形式和症状维度，其中一些尚未得到充分认识。早期识别并用针对强迫症的疗法进行治疗可能会改善预后，但诊断往往会延迟。患者通过治疗可取得显著改善，一些患者可能实现缓解。推荐的一线疗法是认知行为疗法，特别是暴露与反应阻止疗法，和/或选择性5-羟色胺再摄取抑制剂（SSRI）。与其他适应症相比，强迫症患者需要更高剂量的SSRI，且治疗反应时间通常更长。有效时，用SSRI进行长期治疗是预防复发的合理选择。症状严重或对一线疗法无反应的患者应转诊至精神科医生处。对于难治性强迫症有多种治疗选择，包括氯米帕明或用非典型抗精神病药增强SSRI的疗效。应对强迫症患者密切监测精神共病情况和自杀意念。
