Baer L, Rauch S L, Ballantine H T, Martuza R, Cosgrove R, Cassem E, Giriunas I, Manzo P A, Dimino C, Jenike M A
Department of Psychiatry, Massachusetts General Hospital, Charlestown, USA.
Arch Gen Psychiatry. 1995 May;52(5):384-92. doi: 10.1001/archpsyc.1995.03950170058008.
The purpose of this study was to assess prospectively long-term change in obsessive-compulsive disorder (OCD) symptoms in patients with an OCD diagnosis that was confirmed by structured interview and with documented unsuccessful trials of multiple medications and attempts at behavior therapy.
We conducted an unblinded preoperative and follow-up assessment of comorbid diagnosis; OCD, depressive, and anxiety symptoms; and functional status in 18 patients who underwent cingulotomy.
At a mean follow-up of 26.8 months, five patients (28%) met conservative criteria for treatment responders, and three others (17%) were partial responders. The group improved significantly in mean functional status, and few serious adverse events were found. Improvement in OCD symptoms was strongly correlated with improvement in depressive and anxiety symptoms.
The rate of clinical improvement was consistent with a previous retrospective study in the same setting, indicating that 25% to 30% of the patients who previously were unresponsive to medication and behavioral treatments are significantly improved after cingulotomy. Cingulotomy remains a last resort treatment for severely incapacitated patients who have not responded to all other state-of-the-art pharmacological and behavioral treatments for OCD and is not to be taken lightly.
本研究的目的是前瞻性评估强迫症（OCD）患者的强迫症症状长期变化情况，这些患者的强迫症诊断经结构化访谈确认，且有多次药物治疗失败及行为疗法尝试未成功的记录。
我们对18例行扣带回毁损术的患者进行了非盲法术前及随访评估，内容包括共病诊断、强迫症、抑郁和焦虑症状以及功能状态。
平均随访26.8个月时，5例患者（28%）达到治疗有效者的保守标准，另外3例（17%）为部分有效者。该组患者的平均功能状态显著改善，且未发现严重不良事件。强迫症症状的改善与抑郁和焦虑症状的改善密切相关。
临床改善率与之前在相同环境下进行的回顾性研究一致，表明之前对药物和行为治疗无反应的患者中，25%至30%在扣带回毁损术后有显著改善。扣带回毁损术仍是对所有其他针对强迫症的先进药物和行为治疗均无反应的严重失能患者的最后手段治疗方法，不可轻视。
