暴露与反应预防联合药物治疗对强迫症的有效性：一项系统评价与荟萃分析。
The effectiveness of exposure and response prevention combined with pharmacotherapy for obsessive-compulsive disorder: A systematic review and meta-analysis.
作者信息
Mao Lingyun, Hu Maorong, Luo Lan, Wu Yunhong, Lu Zihang, Zou Jingzhi
机构信息
Key Laboratory of Psychology of TCM and Brain Science, Jiangxi Administration of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.
出版信息
Front Psychiatry. 2022 Sep 15;13:973838. doi: 10.3389/fpsyt.2022.973838. eCollection 2022.
OBJECTIVE
To systematically evaluate the effectiveness of exposure and response prevention (ERP) combined with medication on obsessive-compulsive disorder (OCD).
METHODS
PubMed, Web of Science, EBSCO, Cochrane, Embase, and Science Direct databases were searched to include randomized controlled trials of ERP combined with medication for OCD that met the criteria. The Yale Brown Obsessive Compulsive Scale was used as the primary outcome indicator, and Depression scales were used as secondary outcome indicators. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Review Manager 5.3 and Stata 16.0 software was used to perform meta-analysis of the extracted data.
RESULTS
A total of 21 studies with 1113 patients were included. Meta-analysis showed that ERP combined with medication therapy was significantly better than medication therapy alone including selective serotonin reuptake inhibitors, clomipramine and risperidone (MD = -6.60, 95% CI: -8.35 to -4.84, < 0.00001), but D-cycloserine (DCS) drugs do not enhance the effect of ERP intervention in patients with OCD (MD = 0.15, 95% CI: -0.87 to 1.17, = 0.77). There is more significant maintenance by combined treatment method of medication plus ERP than medication treatment alone during the follow-up period (MD = -7.14, 95% CI: -9.17 to -5.10, < 0.00001). DCS drugs did not enhance the effect of ERP intervention on depression in patients with OCD (SMD = -0.08, 95% CI: -0.31 to 0.15, = 0.50). ERP combined with drug improved patients' depression levels significantly better than providing drug alone (SMD = -0.40, 95% CI: -0.68 to -0.11, = 0.006).
CONCLUSION
Patients with OCD have significant improvement in symptoms of obsessive-compulsive disorder and depression when ERP is combined with medication, however, not enough to prove that DCS can enhance ERP effectiveness.
目的
系统评价暴露与反应阻止疗法（ERP）联合药物治疗对强迫症（OCD）的有效性。
方法
检索PubMed、Web of Science、EBSCO、Cochrane、Embase和Science Direct数据库，纳入符合标准的ERP联合药物治疗OCD的随机对照试验。以耶鲁布朗强迫量表作为主要结局指标，抑郁量表作为次要结局指标。基于方法学和临床因素进行偏倚风险评估，以识别可能的偏倚来源。使用Review Manager 5.3和Stata 16.0软件对提取的数据进行荟萃分析。
结果
共纳入21项研究，涉及1113例患者。荟萃分析表明，ERP联合药物治疗显著优于单独药物治疗，单独药物治疗包括选择性5-羟色胺再摄取抑制剂、氯米帕明和利培酮（MD = -6.60，95%CI：-8.35至-4.84，P<0.00001），但D-环丝氨酸（DCS）药物并不能增强ERP对OCD患者的干预效果（MD = 0.15，95%CI：-0.87至1.17，P = 0.77）。在随访期间，药物联合ERP的治疗方法比单独药物治疗有更显著的维持效果（MD = -7.14，95%CI：-9.17至-5.10，P<0.00001）。DCS药物并未增强ERP对OCD患者抑郁的干预效果（SMD = -0.08，95%CI：-0.31至0.15，P = 0.50）。ERP联合药物治疗比单独药物治疗能显著更好地改善患者的抑郁水平（SMD = -0.40，95%CI：-0.68至-0.11，P = 0.006）。
结论
OCD患者在ERP联合药物治疗时，强迫症和抑郁症状有显著改善，然而，不足以证明DCS能增强ERP的有效性。
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