Jenike M A
Harvard Medical School, Boston, MA.
Psychopharmacol Bull. 1993;29(4):487-99.
There is overwhelming evidence that specific pharmacologic agents are effective in lessening symptoms of OCD in many patients. In addition, considerable evidence indicates that the behavioral techniques of exposure and response prevention are effective. Although complete cure occurs infrequently, the combination of both pharmacotherapy and behavioral treatment optimizes the individual patient's potential for recovery and the majority of patients can now expect to lead relatively normal lives, to work, and to function well in families and in social situations. There is no controlled, and almost no anecdotal evidence, to suggest that traditional psychodynamic psychotherapy or psychoanalysis are effective in treating the symptoms of OCD. However, wise clinicians frequently use psychotherapy as an adjunct to more specific treatments to help deal with other problems that the patient might have. Even though many patients became vigorously opposed to psychodynamic treatments and psychoanalysis after experiencing such treatments for years without any improvement in their obsessions and compulsions, they are now realizing that psychotherapy may have a place in the treatment plan for many patients who, after responding to medication and behavior therapy, need to explore the deeply rooted thought patterns that developed in response to obsessive-compulsive behaviors and to work to free themselves from these patterns. For example, it may no longer be adaptive for the patient to attempt to control others, or to set up a restricted or extremely regimented environment. Even trying to distinguish a "normal" thought or worry from an obsession may require the help of a therapist. There may well be a place for psychodynamic therapies for some patients (often with onset of OCD in childhood) who are left with developmental scars after their OCD is well-treated. Although controlled evidence is lacking, there may well be a role for neurosurgical procedures in the management of very severely-ill OCD patients who have failed to respond to more conventional treatments. With the development of new technologies, controlled trials may now be feasible.
有大量证据表明，特定的药物制剂对减轻许多强迫症患者的症状有效。此外，相当多的证据表明，暴露与反应阻止的行为技术也是有效的。虽然完全治愈的情况很少见，但药物治疗和行为治疗相结合能使个体患者的康复潜力最大化，现在大多数患者有望过上相对正常的生活、工作，并在家庭和社交场合中正常发挥功能。没有对照研究，几乎也没有轶事证据表明传统的心理动力心理治疗或精神分析对治疗强迫症症状有效。然而，明智的临床医生经常将心理治疗作为更具体治疗的辅助手段，以帮助处理患者可能存在的其他问题。尽管许多患者在多年接受此类治疗而强迫观念和强迫行为毫无改善后，强烈反对心理动力治疗和精神分析，但他们现在意识到，心理治疗在许多患者的治疗计划中可能占有一席之地，这些患者在对药物治疗和行为治疗产生反应后，需要探索因强迫行为而形成的根深蒂固的思维模式，并努力摆脱这些模式。例如，患者试图控制他人或建立一个受限或极其严格的环境可能不再具有适应性。甚至试图区分“正常”的想法或担忧与强迫观念也可能需要治疗师的帮助。对于一些强迫症得到良好治疗后仍留有发育创伤的患者（通常强迫症起病于童年），心理动力疗法很可能有其用武之地。虽然缺乏对照证据，但对于那些对更传统治疗无反应的重症强迫症患者，神经外科手术在治疗中很可能也能发挥作用。随着新技术的发展，对照试验现在可能可行。
