Hollander E
Mount Sinai School of Medicine, New York, USA.
Int Clin Psychopharmacol. 1996 Dec;11 Suppl 5:75-87.
Obsessive-compulsive spectrum disorders comprise a unique category of related disorders with important diagnostic, aetiological and therapeutic implications. This group of disorders may overlap with obsessive-compulsive disorder (OCD) in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to selective anti-obsessional behavioural and pharmacotherapies. OCD-related disorders can be viewed along a continuum with risk avoidance on the compulsive end and risk seeking at the other. This dimension may be defined within a framework which relates hyperfrontality and increased serotonergic sensitivity with compulsive disorders and hyperfrontality and low presynaptic serotonergic levels with impulsive disorders. Most biological models of OCD-related disorders stress the importance of serotonin in their pathophysiology and these disorders have also been shown to be preferentially responsive to selective serotonergic reuptake inhibitors (SSRIs). This paper reviews the management of the OCD spectrum and the evidence for efficacy of the SSRIs and the differential treatment responses of the compulsive and impulsive disorders with regard to therapeutic dosage, response lag time and maintenance of symptom remission.
强迫谱系障碍包括一类独特的相关障碍，具有重要的诊断、病因学和治疗意义。这组障碍在症状表现、人口统计学特征、家族史、神经生物学、共病情况、临床病程以及对选择性抗强迫行为疗法和药物疗法的反应等方面可能与强迫症（OCD）存在重叠。与强迫症相关的障碍可被视为一个连续体，一端是强迫行为导致的风险回避，另一端是冒险行为。这个维度可以在一个框架内定义，该框架将额叶功能亢进和血清素敏感性增加与强迫性障碍相关联，将额叶功能亢进和突触前血清素水平降低与冲动性障碍相关联。大多数与强迫症相关障碍的生物学模型都强调血清素在其病理生理学中的重要性，并且这些障碍也已被证明对选择性血清素再摄取抑制剂（SSRI）有优先反应。本文综述了强迫谱系障碍的管理以及SSRI疗效的证据，以及强迫性和冲动性障碍在治疗剂量、反应延迟时间和症状缓解维持方面的不同治疗反应。
