National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic.
Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10, Czech Republic.
Pharmacopsychiatry. 2018 Nov;51(6):229-242. doi: 10.1055/s-0043-118665. Epub 2017 Sep 26.
Obsessive-compulsive disorder (OCD) is a chronic psychiatric illness and 1 of the most common anxiety disorders with the prevalence of 3%. Although its pathogenesis remains unclear, the traditional model focused on alternations in the serotonin system. Selective serotonin reuptake inhibitors provide the most effective treatment; however, as much as 40-60% of patients do not respond to antidepressants therapy. Thus, attention has shifted towards other neurotransmitter systems and related neuroanatomical structures. Recently, there is extensive evidence showing a key role of glutamate pathways abnormalities within the cortico-striatal-thalamo-cortical circuitry and temporal lobes in OCD pathogenesis. In this review, we link together the existent neuroanatomical, neurophysiological, and neuropsychological evidence to argue for potential benefits of adjuvant treatment with glutamatergic agents, especially memantine. By a targeted de-excitation effect on the glutamatergic system in the temporal lobes and connected brain regions, memantine might further alleviate OCD symptoms. This effect should be even more pronounced in certain subtypes of patients with specific cognitive deficits and maladaptive compensatory memory processes (e.g., checkers).
强迫症（OCD）是一种慢性精神疾病，也是最常见的焦虑症之一，其患病率为 3%。尽管其发病机制仍不清楚，但传统模式侧重于 5-羟色胺系统的改变。选择性 5-羟色胺再摄取抑制剂提供了最有效的治疗方法；然而，多达 40-60%的患者对抗抑郁药治疗没有反应。因此，人们的注意力已经转向其他神经递质系统和相关的神经解剖结构。最近，有大量证据表明，谷氨酸能通路异常在皮质-纹状体-丘脑-皮质回路和颞叶中的作用在 OCD 的发病机制中起着关键作用。在这篇综述中，我们将现有的神经解剖学、神经生理学和神经心理学证据联系起来，以证明辅助使用谷氨酸能药物（特别是美金刚）治疗的潜在益处。通过对颞叶和相关脑区的谷氨酸能系统进行靶向去兴奋作用，美金刚可能会进一步减轻 OCD 症状。对于具有特定认知缺陷和适应不良补偿性记忆过程（例如，检查者）的某些特定亚型患者，这种效果应该更为明显。
