Université Clermont Auvergne, CNRS, Clermont Auvergne INP, CHU Clermont-Ferrand, Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre de Compétences Gilles de la Tourette, Institut Pascal, F-63000, Clermont-Ferrand, France.
Université Clermont Auvergne, CNRS, Clermont Auvergne INP, CHU Clermont-Ferrand, Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Institut Pascal, F-63000, Clermont-Ferrand, France.
J Psychiatr Res. 2024 Dec;180:24-32. doi: 10.1016/j.jpsychires.2024.09.048. Epub 2024 Sep 30.
Up to 30% of subjects with obsessive compulsive disorder (OCD) also have a lifetime tic disorder. Several meta-analyses of pharmaceutical or psychotherapeutic interventions for the management of OCD have been published, but none specifically on patients with OCD comorbid with tics. The literature regarding pharmacological treatments of patients with this condition is mainly focused on studies of OCD. After a search of the Cochrane, EMBASE, PubMed, PsychINFO and Science Direct databases, we performed a proportion meta-analysis of the percentage of patients whose condition improved and a paired meta-analysis of the change in the OCD score (Y-BOCS). Twelve case reports were retained for qualitative analysis and 14 articles for meta-analysis. Case reports showed better efficacy of combined antidepressant-antipsychotic treatment for OCD comorbid with tic disorder. The meta-analysis showed an improvement in 29% [18-42] of patients with antidepressants. Although there was no significant difference with placebo add-on, in antidepressant-resistant OCD patients, adding an antipsychotic to the antidepressant regimen led to an increase in the number of patients who improved (67% [45-86] vs 7% [0-35]) and seemed to show a decrease in the Y-BOCS score (-10.06 [-20.38; 0.26] vs (-3.61 [-9.08; 13.85]). Our study provides new evidence on the pharmacological treatment of OCD comorbid with tics. In some patients, the condition is improved by a first-line antidepressant. In case of non-response or insufficient efficacy of antidepressants, add-on treatment with certain antipsychotics can be implemented.
高达 30%的强迫症（OCD）患者也有终身抽动障碍。已经发表了几项关于药物或心理治疗干预 OCD 管理的荟萃分析，但没有专门针对 OCD 伴发抽动的患者。关于该病症药物治疗的文献主要集中在 OCD 的研究上。在对 Cochrane、EMBASE、PubMed、PsychINFO 和 Science Direct 数据库进行搜索后，我们对改善患者比例进行了比例荟萃分析，并对 OCD 评分（Y-BOCS）的变化进行了配对荟萃分析。保留了 12 份病例报告进行定性分析，14 份文章进行荟萃分析。病例报告显示，联合使用抗抑郁药和抗精神病药治疗 OCD 伴发抽动障碍的疗效更好。荟萃分析显示，抗抑郁药治疗 OCD 伴发抽动障碍的患者中有 29%[18-42]得到改善。尽管与安慰剂附加治疗相比没有显著差异，但在抗抑郁药抵抗的 OCD 患者中，在抗抑郁药方案中添加抗精神病药可增加改善的患者数量（67%[45-86]与 7%[0-35]），并且似乎可降低 Y-BOCS 评分（-10.06[-20.38;0.26]与-3.61[-9.08;13.85]）。我们的研究为 OCD 伴发抽动障碍的药物治疗提供了新的证据。在某些患者中，一线抗抑郁药可改善病情。在抗抑郁药反应不佳或疗效不足的情况下，可以采用某些抗精神病药附加治疗。
