Solyom L, DiNicola V F, Phil M, Sookman D, Luchins D
Can J Psychiatry. 1985 Aug;30(5):372-80. doi: 10.1177/070674378503000515.
The study explores whether an atypical form of obsessional illness can be delineated and separated from the conventional form of obsessive-compulsive neurosis (OCN). From a group of 45 obsessive patients, 8 were selected on the basis of 3 criteria: presence of a severely debilitating main obsessive symptom; bordering on the delusional; no schizophrenic symptoms. Assessment and outcome measures included the Psychiatric Questionnaire, the Leyton Obsessional Inventory, Fear Survey Schedule, and IPAT Self-Analysis Form. Self-assessment forms allowed patients to make social adjustment and neurotic symptom ratings. In a multimodal approach, patients were assigned to behavioural and pharmacological treatments on the basis of severity. Reassessment took place after 50 sessions of therapy. Results of analysis of variance statistics indicated that the atypical group had a more malignant form of illness, with more varied and severe obsessions. A poorer prognosis for the atypical group was indicated by: greater social maladjustment, poor employment records, illness of longer duration showing no remissions despite more courses of treatment, and poor response to treatment throughout. The atypical group manifested fewer characteristic features of OCN (example: fewer precipitating events). On the other hand, schizophrenia was not imputed, although delusion-like experiences in the atypical group suggest a psychotic form of illness. The term "obsessive psychosis" suggested by Strauss and recently investigated by Weiss et al and Robinson et al is proposed for our atypical group. Results are compared with those of other investigators. It is concluded that the delineation of a subgroup of obsessional illness is desirable for research and therapy since a form of atypical obsessional illness or obsessive psychosis can be differentiated on aetiological, phenomenological and prognostic factors.
该研究探讨了是否能够界定一种非典型形式的强迫性疾病，并将其与传统形式的强迫性神经症（OCN）区分开来。从45名强迫性患者组成的群体中，根据3条标准挑选出了8名患者：存在严重致残的主要强迫症状；近乎妄想；无精神分裂症症状。评估和结果测量包括《精神科问卷》《莱顿强迫观念量表》《恐惧调查量表》以及IPAT自我分析表。自我评估表让患者能够对社交适应情况和神经症症状进行评分。采用多模式方法，根据严重程度为患者分配行为治疗和药物治疗。在50次治疗疗程后进行重新评估。方差分析统计结果表明，非典型组的疾病形式更为严重，强迫观念更多样、更严重。非典型组预后较差体现在以下方面：社交适应能力更差、就业记录不佳、病程更长，尽管接受了更多疗程的治疗仍无缓解，且总体对治疗反应不佳。非典型组表现出的OCN特征较少（例如：诱发事件较少）。另一方面，虽然非典型组存在类似妄想的体验，提示可能是一种精神病性疾病形式，但并未将其归为精神分裂症。Strauss提出的“强迫性精神病”一词，近期经Weiss等人以及Robinson等人研究，现建议用于我们的非典型组。研究结果与其他研究者的结果进行了比较。得出的结论是，由于可以根据病因、现象学和预后因素区分出一种非典型形式的强迫性疾病或强迫性精神病，因此为了研究和治疗的目的，界定强迫性疾病的一个亚组是很有必要的。
