Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, CA, United States.
Curr Med Chem. 2018;25(41):5712-5721. doi: 10.2174/0929867324666170505113631.
Obsessive-Compulsive Disorder (OCD) is a highly disabling condition with early onset and chronic course in most of the affected patients. In addition, OCD may show high comorbidity and suicide attempt rates, which worsen the overall burden of the disease for patients and their caregivers. First-line treatments for OCD consist of pro-serotonergic compounds and cognitive-behavioral therapy. Nonetheless, many patients show only limited benefit from such interventions and require additional "next-step" interventions, including augmentative antipsychotics and glutamate-modulating agents. Based on the knowledge about altered neurocircuitry in OCD, brain stimulation techniques, including transcranial magnetic and electrical stimulations (TMS and tDCS) and deep brain stimulation (DBS), have been increasingly investigated over the last decade, revealing positive results for otherwise intractable and treatment-refractory patients. Available evidence in the field is in continuous evolution and professionals actively involved in the management of OCD patients, psychiatrists in particular, need to be updated about latest developments. Through the analysis of controlled studies, meta-analyses, and International treatment guidelines, the present article is aimed at providing the state of the art on the use of brain stimulation techniques for the treatment of OCD.
强迫症（OCD）是一种高度致残的疾病，大多数患者在早期发病且病程慢性。此外，OCD 可能表现出高共病率和自杀企图率，这会加重患者及其照顾者的疾病总体负担。OCD 的一线治疗包括促血清素化合物和认知行为疗法。尽管如此，许多患者仅从这些干预措施中获得有限的益处，需要额外的“下一步”干预措施，包括增效抗精神病药和谷氨酸调节剂。基于 OCD 中神经回路改变的知识，过去十年中，脑刺激技术（包括经颅磁刺激和经颅直流电刺激（TMS 和 tDCS）以及深部脑刺激（DBS））越来越受到研究，为其他难治性和治疗抵抗性患者带来了积极的结果。该领域的现有证据在不断发展，积极参与 OCD 患者管理的专业人员，尤其是精神科医生，需要了解最新的发展。通过对对照研究、荟萃分析和国际治疗指南的分析，本文旨在介绍脑刺激技术在 OCD 治疗中的应用现状。
