Dominguez R A, Mestre S M
Department of Psychiatry, University of Miami School of Medicine, Fla.
J Clin Psychiatry. 1994 Oct;55 Suppl:86-92.
Often obsessive compulsive disorder (OCD) patients are labeled as treatment refractory when some first-line options have not been fully explored. Most patients should be encouraged to participate in behavior therapy, even when pharmacotherapy alone has been partially successful. Antiobsessional agents such as clomipramine, fluoxetine, and fluvoxamine should be considered first-line drugs. Their prescription for a sufficient time and at therapeutic doses is imperative. Enhancement strategies for a selected group of OCD patients include low-dose high-potency neuroleptics. In addition, clonazepam can be helpful in augmenting the response to a first-line drug. Results from controlled studies with lithium and buspirone have been disappointing. If most of these pharmacologic alternatives fail, MAOIs appear to be the next best choice. Since in the future most referrals for treatment-refractory OCD patients will emanate from nonpsychiatrists, following a systemic strategy in their evaluation and pharmacologic management is most important.
当一些一线治疗方案尚未得到充分探索时，强迫症（OCD）患者常常被贴上难治性的标签。即使单独药物治疗仅取得部分成功，大多数患者也应被鼓励参与行为疗法。氯米帕明、氟西汀和氟伏沙明等抗强迫药物应被视为一线药物。必须给予足够的用药时间和治疗剂量。对于特定的一组强迫症患者，增效策略包括使用低剂量高效能抗精神病药物。此外，氯硝西泮有助于增强对一线药物的反应。锂盐和丁螺环酮的对照研究结果令人失望。如果这些药物替代方案大多无效，单胺氧化酶抑制剂似乎是次优选择。鉴于未来大多数难治性强迫症患者的转诊将来自非精神科医生，在对他们进行评估和药物管理时遵循系统策略至关重要。
