Dolberg O T, Iancu I, Sasson Y, Zohar J
Psychiatric Division, Sheba Medical Center, Ramat-Gan, Israel.
Clin Neuropharmacol. 1996 Apr;19(2):129-47. doi: 10.1097/00002826-199619020-00002.
The outlook for patients with obsessive-compulsive disorder (OCD) began to change in the early 1980s with the introduction of clomipramine (CMI), a serotonergic antidepressant. The observation that only drugs with a serotonergic profile are effective in OCD has been the basis for the serotonergic hypothesis of OCD. The serotonin-selective reuptake inhibitors are effective alternatives for CMI and can be used when the patient cannot use or tolerate CMI. In this review, we examine the pathophysiology of OCD, based on drug response profile, peripheral markers of serotonergic function, pharmacologic challenge studies, and neuroimaging. We also consider the medications found to be effective in OCD, the length of treatment, with special regard for maintenance therapy, and such issues as the approach for the treatment-resistant patient, augmentation strategies, and nonpharmacological treatments.
20世纪80年代初，随着5-羟色胺能抗抑郁药氯米帕明（CMI）的引入，强迫症（OCD）患者的预后开始发生变化。只有具有5-羟色胺能特性的药物对强迫症有效的这一观察结果，一直是强迫症5-羟色胺能假说的基础。5-羟色胺选择性再摄取抑制剂是氯米帕明的有效替代药物，当患者不能使用或耐受氯米帕明时可以使用。在这篇综述中，我们基于药物反应情况、5-羟色胺能功能的外周标志物、药理学激发研究和神经影像学，研究强迫症的病理生理学。我们还会考虑在强迫症治疗中被发现有效的药物、治疗时长，特别关注维持治疗，以及难治性患者的治疗方法、增效策略和非药物治疗等问题。
