Lydiard R B
Institute of Psychiatry, Medical University of South Carolina, Charleston.
Int Clin Psychopharmacol. 1994 Jun;9 Suppl 3:33-7. doi: 10.1142/9789814440912_0131.
Once widely regarded as a rare psychodynamic illness, obsessive-compulsive disorder (OCD) is now recognized as a common neurobiological condition affecting 1 in 50 US citizens. The etiology of the illness is still not clearly understood, but the observed therapeutic response in OCD patients to the potent serotonin uptake inhibitor clomipramine hydrochloride (CMI), guided research in the direction of neuronal brain function, and abnormalities of postsynaptic serotonin receptors are currently the leading hypotheses in the pathophysiology of OCD. Clomipramine, an analog of the tricyclic antidepressant imipramine, was the first effective antiobsessional agent available in the US. Clomipramine was, for some time, the treatment of choice for OCD given its superiority over other TCAs which lack potent serotonergic effects. Attention has now shifted to the selective serotonin reuptake inhibitors (SSRIs) whose potent and highly selective serotonin uptake properties account for their antiobsessional efficacy and favorable side effect profiles. The benefits of fluvoxamine, fluoxetine and sertraline have been shown in a number of clinical trials. This paper reviews the epidemiology, etiology, diagnosis and pharmacologic treatment studies of OCD. It summarizes two studies evaluating the efficacy of the SSRI sertraline, which is shown to be effective and well tolerated for both short- and long-term treatment of OCD.
强迫症（OCD）曾一度被广泛认为是一种罕见的心理动力性疾病，如今却被公认为是一种常见的神经生物学疾病，每50名美国公民中就有1人受其影响。该疾病的病因仍未完全明确，但强迫症患者对强效血清素摄取抑制剂盐酸氯米帕明（CMI）的治疗反应，引导了针对神经元脑功能的研究方向，且突触后血清素受体异常目前是强迫症病理生理学的主要假说。氯米帕明是三环类抗抑郁药丙咪嗪的类似物，是美国首个可用的有效抗强迫药物。由于氯米帕明比其他缺乏强效血清素能作用的三环类抗抑郁药更具优势，因此在一段时间内它一直是强迫症的首选治疗药物。如今，人们的注意力已转向选择性血清素再摄取抑制剂（SSRI），其强效且高度选择性的血清素摄取特性决定了它们的抗强迫疗效和良好的副作用特征。多项临床试验已证实氟伏沙明、氟西汀和舍曲林的疗效。本文综述了强迫症的流行病学、病因、诊断和药物治疗研究。它总结了两项评估SSRI舍曲林疗效的研究，结果表明舍曲林对强迫症的短期和长期治疗均有效且耐受性良好。
