Smith Louise, Tracy Derek K, Giaroli Giovanni
From the *Institute of Psychiatry, Psychology and Neuroscience, King's College London; †Oxleas NHS Foundation Trust, London; and ‡Division of Psychiatry, University College London, United Kingdom.
J Clin Psychopharmacol. 2016 Feb;36(1):57-62. doi: 10.1097/JCP.0000000000000431.
Licensed pharmacological treatments for obsessive-compulsive disorders include selective serotonin reuptake inhibitors and tricyclic antidepressants. However, a large proportion of patients show minimal or no therapeutic response to these treatments. The glutamatergic system has been implicated in the etiology of obsessive-compulsive spectrum disorders, and it has been postulated that n-acetyl-cysteine (NAC) could have a therapeutic effect on these conditions through its actions on the glutamatergic system and the reduction of oxidative stress. A systematic review was conducted on the existing methodologically robust literature regarding the efficacy of NAC on obsessive-compulsive spectrum disorders in adults and children. Four randomized, double-blind placebo-controlled studies were identified, investigating the effects of NAC on obsessive-compulsive disorder, trichotillomania, and onychophagia. Results remain inconclusive, but NAC may still be useful as a treatment for obsessive-compulsive spectrum disorders on an individual level, particularly as the compound has a relatively benign side-effect profile. The dearth of methodologically robust work is clinically important: larger randomized controlled trials are required to inform of any meaningful clinical effectiveness, and to better determine which, if any, clinical populations might most benefit.
强迫症的许可药物治疗包括选择性5-羟色胺再摄取抑制剂和三环类抗抑郁药。然而，很大一部分患者对这些治疗的反应甚微或没有治疗反应。谷氨酸能系统与强迫谱系障碍的病因有关，据推测，N-乙酰半胱氨酸（NAC）可能通过其对谷氨酸能系统的作用和减少氧化应激对这些疾病产生治疗效果。对现有的关于NAC对成人和儿童强迫谱系障碍疗效的方法学严谨的文献进行了系统评价。确定了四项随机、双盲、安慰剂对照研究，研究NAC对强迫症、拔毛癖和咬甲癖的影响。结果尚无定论，但NAC在个体层面上仍可能作为强迫谱系障碍的一种治疗方法有用，特别是因为该化合物的副作用相对较小。方法学严谨的研究匮乏具有临床重要性：需要更大规模的随机对照试验来告知任何有意义的临床疗效，并更好地确定哪些临床人群（如果有的话）可能最受益。
