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Defining and Addressing Gaps in Care for Obsessive-Compulsive Disorder in the United States.定义并解决美国强迫症护理中的差距。
Psychiatr Serv. 2021 Jul 1;72(7):784-793. doi: 10.1176/appi.ps.202000296. Epub 2021 May 7.
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Course and outcome of obsessive-compulsive disorder.强迫症的病程及转归
Indian J Psychiatry. 2019 Jan;61(Suppl 1):S43-S50. doi: 10.4103/psychiatry.IndianJPsychiatry_521_18.
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Influence of Culture in Obsessive-compulsive Disorder and Its Treatment.文化在强迫症及其治疗中的影响
Curr Psychiatry Rev. 2017 Dec;13(4):285-292. doi: 10.2174/2211556007666180115105935.
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A cross-cultural clinical comparison between subjects with obsessive-compulsive disorder from the United States and Brazil.美国和巴西强迫症患者的跨文化临床比较。
Psychiatry Res. 2017 Aug;254:104-111. doi: 10.1016/j.psychres.2017.04.024. Epub 2017 Apr 12.
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Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis.儿童强迫症的认知行为和药物治疗:系统评价和荟萃分析。
J Anxiety Disord. 2016 Oct;43:58-69. doi: 10.1016/j.janxdis.2016.08.003. Epub 2016 Aug 13.
6
Half of obsessive-compulsive disorder cases misdiagnosed: vignette-based survey of primary care physicians.半数强迫症病例被误诊:基于病例的初级保健医生调查。
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7
Factors associated with non-treatment or delayed treatment seeking in OCD sufferers: a review of the literature.与强迫症患者不治疗或延迟治疗寻求相关的因素:文献综述。
Psychiatry Res. 2014 Dec 15;220(1-2):1-10. doi: 10.1016/j.psychres.2014.07.009. Epub 2014 Jul 11.
8
High rates of OCD symptom misidentification by mental health professionals.心理健康专业人员对强迫症症状的误判率很高。
Ann Clin Psychiatry. 2013 Aug;25(3):201-9.
9
Misdiagnosis and exacerbation of unusual obsessive-compulsive disorder presentation with risperidone and clozapine in an adolescent girl - A case report.青少年女性使用利培酮和氯氮平导致罕见强迫症表现的误诊及病情加重——一例病例报告
Coll Antropol. 2011 Jan;35 Suppl 1:293-6.
10
Mental health care reforms in Latin America: An overview of mental health care reforms in Latin America and the Caribbean.拉丁美洲的精神卫生保健改革:拉丁美洲和加勒比精神卫生保健改革概述。
Psychiatr Serv. 2010 Mar;61(3):218-21. doi: 10.1176/ps.2010.61.3.218.

拉丁美洲精神卫生保健提供者对强迫症的误诊

Obsessive-Compulsive Disorder Misdiagnosis among Mental Healthcare Providers in Latin America.

作者信息

Perez Mayra I, Limon Danica L, Candelari Abigail E, Cepeda Sandra L, Ramirez Ana C, Guzick Andrew G, Kook Minjee, La Buissonniere Ariza Valerie, Schneider Sophie C, Goodman Wayne K, Storch Eric A

机构信息

Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine.

Department of Psychology, Brigham Young University.

出版信息

J Obsessive Compuls Relat Disord. 2022 Jan;32. doi: 10.1016/j.jocrd.2021.100693. Epub 2021 Nov 1.

DOI:10.1016/j.jocrd.2021.100693
PMID:34840937
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8612600/
Abstract

Mental healthcare professionals often have limited awareness of different obsessive-compulsive disorder (OCD) symptom presentations, which may contribute to years between OCD symptom onset and treatment initiation. While research has identified high rates of OCD misdiagnosis among clinicians from the United States and Canada, research on OCD symptom awareness among healthcare providers in Latin American (LATAM) regions is limited. In this study, LATAM mental healthcare providers ( = 83) provided diagnostic impressions based on five OCD vignettes: three with symptoms centered on taboo thoughts (sexual, harming others, and religion/scrupulosity) and two about contamination or symmetry obsessions. Rates of incorrect (non-OCD) diagnoses were significantly higher for the taboo thoughts vignettes (sexual, 52.7%; harm/aggression, 42.0%; and religious, 34.7%) vs. contamination obsessions (11.0%) and symmetry obsessions (6.9%). The OCD vignette depicting sexual obsessions was often attributed to a paraphilic disorder (36.5%). Bachelor's level clinicians had significantly lower odds of accurately identifying all three vignettes related to taboo thoughts compared to respondents with a graduate degree. Accurate identification of the three taboo vignettes was also associated with first-line psychological treatment recommendations (i.e., cognitive-behavioral therapy) even when controlling for respondents' theoretical orientation. Exposure was rarely mentioned when clinicians were prompted to provide treatment recommendations for each vignette (8-9% of the time for symmetry and contamination vignettes, 5-7% for taboo though vignettes). Like clinicians in the United States and Canada, mental health professionals in LATAM may misidentify OCD symptom presentations, particularly sexual obsessions, highlighting a need for education and training.

摘要

精神卫生保健专业人员对不同的强迫症(OCD)症状表现往往认识有限,这可能导致从强迫症症状出现到开始治疗之间间隔数年。虽然研究发现美国和加拿大的临床医生对强迫症的误诊率很高,但关于拉丁美洲(LATAM)地区医疗服务提供者对强迫症症状的认识的研究却很有限。在这项研究中,拉丁美洲的精神卫生保健专业人员(n = 83)根据五个强迫症案例提供诊断意见:三个案例的症状集中在禁忌思想(性、伤害他人和宗教/谨小慎微)上,另外两个案例是关于污染或对称强迫观念。与污染强迫观念(11.0%)和对称强迫观念(6.9%)相比,禁忌思想案例的错误(非强迫症)诊断率显著更高(性方面为52.7%;伤害/攻击方面为42.0%;宗教方面为34.7%)。描述性强迫观念的强迫症案例常常被归因于性偏好障碍(36.5%)。与拥有研究生学位的受访者相比,本科水平的临床医生准确识别所有三个与禁忌思想相关案例的几率显著更低。即使在控制受访者的理论取向的情况下,准确识别这三个禁忌案例也与一线心理治疗建议(即认知行为疗法)相关。当临床医生被要求为每个案例提供治疗建议时,暴露疗法很少被提及(对称和污染案例为8 - 9%的时间,禁忌思想案例为5 - 7%的时间)。与美国和加拿大的临床医生一样,拉丁美洲的心理健康专业人员可能会错误识别强迫症症状表现,尤其是性强迫观念,这凸显了教育和培训的必要性。