Piacentino Daria, Maraone Annalisa, Roselli Valentina, Berardelli Isabella, Biondi Massimo, Kotzalidis Georgios D, Pasquini Massimo
NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), School of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
Department of Human Neurosciences, Sapienza University, Policlinico Umberto I, Rome, Italy.
Ann Gen Psychiatry. 2020 Sep 30;19:57. doi: 10.1186/s12991-020-00309-z. eCollection 2020.
Preliminary studies have tested nicotine as a novel treatment for OCD patients who respond partially/incompletely or not at all to first and second-line treatment strategies, with the former represented by SSRIs or clomipramine, and the latter by switching to another SSRI, or augmentation with atypical antipsychotics, and/or combination with/switching to cognitive-behavioural therapy. Some studies found nicotine-induced reduction of obsessive thoughts and/or compulsive behaviour in OCD patients. We aimed to evaluate the efficacy of nicotine administration in OCD patients.
We searched the PubMed, ScienceDirect Scopus, CINHAL, Cochrane, PsycINFO/PsycARTICLES, and EMBASE databases from inception to the present for relevant papers. The 'Preferred Reporting Items for Systematic Review and Meta-Analyses' (PRISMA) standards were used. We included all studies focusing on the effects of nicotine administration on OCD patients' obsessions or compulsions. Studies could be open-label, cross-sectional, randomized controlled trials, case series or case reports.
A total of five studies could be included. Nicotine administration may ameliorate behavioural features and recurrent thoughts of severe, treatment-resistant OCD patients; however, in one study it was not associated with OC symptom improvement or cognitive enhancement across various executive function subdomains.
Although encouraging, the initial positive response from the use of nicotine in OCD needs testing in large controlled studies. This, however, raises ethical issues related to nicotine administration, due to its addiction potential, which were not addressed in the limited literature we examined. As an alternative, novel treatments with drugs able to mimic only the positive effects of nicotine could be implemented.
初步研究已将尼古丁作为一种新型治疗方法，用于那些对一线和二线治疗策略部分有效/不完全有效或完全无效的强迫症患者，一线治疗策略以选择性5-羟色胺再摄取抑制剂（SSRIs）或氯米帕明为代表，二线治疗策略则是换用另一种SSRIs、联用非典型抗精神病药物，和/或联合/换用认知行为疗法。一些研究发现尼古丁可减少强迫症患者的强迫观念和/或强迫行为。我们旨在评估尼古丁给药对强迫症患者的疗效。
我们检索了PubMed、ScienceDirect Scopus、CINAHL、Cochrane、PsycINFO/PsycARTICLES和EMBASE数据库，从建库至当前，查找相关论文。采用“系统评价和Meta分析的首选报告项目”（PRISMA）标准。我们纳入了所有关注尼古丁给药对强迫症患者强迫观念或强迫行为影响的研究。研究可以是开放标签、横断面、随机对照试验、病例系列或病例报告。
总共可纳入五项研究。尼古丁给药可能改善重度、难治性强迫症患者的行为特征和反复出现的想法；然而，在一项研究中，它与强迫症状改善或各执行功能子领域的认知增强无关。
尽管令人鼓舞，但尼古丁用于强迫症的初步阳性反应需要在大型对照研究中进行验证。然而，由于尼古丁具有成瘾潜力，这引发了与尼古丁给药相关的伦理问题，我们查阅的有限文献中并未涉及这些问题。作为一种替代方案，可以采用仅能模拟尼古丁积极作用的新型药物治疗。
