Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, Hertfordshire AL8 6HG, UK; Center for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; Department of Psychiatry, ASST Fatebenefratelli-Sacco, Via GB Grassi 74, 20157, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Fondazione IRCCS Ca' Granda, CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy.
Eur Neuropsychopharmacol. 2019 Apr;29(4):549-565. doi: 10.1016/j.euroneuro.2019.02.002. Epub 2019 Feb 14.
Obsessive-compulsive disorder (OCD) is common, emerges early in life and tends to run a chronic, impairing course. Despite the availability of effective treatments, the duration of untreated illness (DUI) is high (up to around 10 years in adults) and is associated with considerable suffering for the individual and their families. This consensus statement represents the views of an international group of expert clinicians, including child and adult psychiatrists, psychologists and neuroscientists, working both in high and low and middle income countries, as well as those with the experience of living with OCD. The statement draws together evidence from epidemiological, clinical, health economic and brain imaging studies documenting the negative impact associated with treatment delay on clinical outcomes, and supporting the importance of early clinical intervention. It draws parallels between OCD and other disorders for which early intervention is recognized as beneficial, such as psychotic disorders and impulsive-compulsive disorders associated with problematic usage of the Internet, for which early intervention may prevent the development of later addictive disorders. It also generates new heuristics for exploring the brain-based mechanisms moderating the 'toxic' effect of an extended DUI in OCD. The statement concludes that there is a global unmet need for early intervention services for OC related disorders to reduce the unnecessary suffering and costly disability associated with under-treatment. New clinical staging models for OCD that may be used to facilitate primary, secondary and tertiary prevention within this context are proposed.
强迫症（OCD）较为常见，在生命早期出现，并往往呈现慢性、致残的病程。尽管有有效的治疗方法，但未治疗的疾病持续时间较长（在成年人中高达 10 年左右），这给患者及其家庭带来了相当大的痛苦。本共识声明代表了包括儿童和成人精神病学家、心理学家和神经科学家在内的国际专家组的观点，他们来自高、中、低收入国家，具有强迫症患者的生活经验。该声明汇集了来自流行病学、临床、健康经济学和脑成像研究的证据，这些研究记录了治疗延迟对临床结果的负面影响，并支持早期临床干预的重要性。它还将强迫症与其他已被认识到早期干预有益的疾病（如精神病和与互联网问题使用相关的冲动强迫障碍）进行了类比，因为早期干预可能预防后期成瘾障碍的发生。它还为探索调节 OCD 中延长 DUI 的“毒性”作用的基于大脑的机制提供了新的启发式方法。该声明得出结论，全球需要针对 OCD 相关障碍提供早期干预服务，以减少治疗不足相关的不必要痛苦和昂贵的残疾。为此，提出了用于促进 OCD 一级、二级和三级预防的新的临床分期模型。
