深部脑刺激治疗强迫症:荟萃分析结果。

Deep brain stimulation in obsessive-compulsive disorder: Results from meta-analysis.

机构信息

Child and Adolescent Mental Health Service, Jaén University Hospital Complex, Jaén, Spain.

Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain; Department of Psychiatry, University of Granada, Granada, Spain; Psychiatry Service, Hospital San Cecilio, Granada, Spain.

出版信息

Psychiatry Res. 2022 Nov;317:114869. doi: 10.1016/j.psychres.2022.114869. Epub 2022 Sep 28.

Abstract

The aim of this work is to investigate the effectiveness of Deep Brain Stimulation (DBS) in patients with severe Obsessive Compulsive Disorder (OCD) who are resistant to pharmacological treatments, focusing on obsessive compulsive, depressive and anxiety symptoms as well as global function. A systematic review and meta-analysis including 25 studies (without language restrictions) from between 2003 and 2020 was performed. A total of 303 patients were evaluated twice (before and after DBS). After DBS treatment OCD patients with resistance to pharmacological treatments showed a significant improvement of obsessive-compulsive symptoms (25 studies; SMD=2.39; 95% CI, 1.91 to 2.87; P<0.0001), depression (9 studies; SMD= 1.19; 95%CI, 0.84 to 1.54; P<0.0001), anxiety (5 studies; SMD=1.00; 95%CI, 0.32 to 1.69; P=0.004) and functionality (7 studies; SMD=-3.51; 95%CI, -5.00 to -2.02; P=0.005) measured by the standardized scales: Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Global Assessment of Function (GAF). Publication bias were discarded by using funnel plot. The main conclusions of this meta-analysis highlight the statistically significant effectiveness of DBS in patients with severe OCD who are resistant to conventional pharmacological treatments, underlying its role in global functioning apart from obsessive-compulsive symptoms.

摘要

本研究旨在探讨深部脑刺激(DBS)对药物治疗抵抗的重度强迫症(OCD)患者的疗效,重点关注强迫、抑郁和焦虑症状以及整体功能。我们进行了一项系统综述和荟萃分析,纳入了 2003 年至 2020 年间的 25 项研究(无语言限制)。共有 303 名患者接受了两次评估(DBS 治疗前后)。经过 DBS 治疗后,药物治疗抵抗的 OCD 患者的强迫症状(25 项研究;SMD=2.39;95%置信区间,1.91 至 2.87;P<0.0001)、抑郁(9 项研究;SMD=1.19;95%置信区间,0.84 至 1.54;P<0.0001)、焦虑(5 项研究;SMD=1.00;95%置信区间,0.32 至 1.69;P=0.004)和功能(7 项研究;SMD=-3.51;95%置信区间,-5.00 至 -2.02;P=0.005)均显著改善,这些功能通过耶鲁-布朗强迫症量表(YBOCS)、汉密尔顿抑郁评定量表(HAM-D)、汉密尔顿焦虑评定量表(HAM-A)和总体功能评估量表(GAF)进行测量。采用漏斗图排除发表偏倚。这项荟萃分析的主要结论强调了 DBS 对药物治疗抵抗的重度 OCD 患者的显著疗效,除了强迫症状外,它还对整体功能具有治疗作用。

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