Thiel A, Züger M, Jacoby G E, Schüssler G
Department of Psychological Medicine and Psychotherapy, University of Innsbruck, Austria.
Am J Psychiatry. 1998 Feb;155(2):244-9. doi: 10.1176/ajp.155.2.244.
The present study examines whether concomitant obsessive-compulsive disorder (OCD) indicates a poorer prognosis for patients with anorexia or bulimia nervosa.
Seventy-five female inpatients who met DSM-IV criteria for anorexia or bulimia nervosa took part in the follow-up study; 29 of these patients met criteria for concomitant OCD. All patients were investigated twice: during inpatient treatment and at follow-up 30 months after discharge. A semistructured diagnostic interview was used as well as the Eating Disorder Inventory and the Hamburg Obsession-Compulsion Inventory--Short Form.
At follow-up, 51% (N = 38) of the patients no longer fulfilled DSM-IV criteria for anorexia or bulimia nervosa, but this improvement was not significantly correlated with the earlier presence of concomitant OCD. Analysis of variance for repeated measures revealed significant improvement over time on six of the eight Eating Disorder Inventory subscales for all patients regardless of OCD presence. Furthermore, no significant group effects or group-by-time interactions were identified. Clinically significant change, as reflected by improvement in scores on the Eating Disorder Inventory, was seen somewhat more often in patients without concomitant OCD, but this trend was not statistically significant. The patients whose eating disorders were most improved at follow-up also showed the highest reduction of obsessions and compulsions.
The results suggest that concomitant OCD does not indicate a significantly poorer prognosis for patients with anorexia or bulimia nervosa.
本研究旨在探讨合并强迫症（OCD）是否预示着神经性厌食症或神经性贪食症患者的预后更差。
75名符合DSM-IV神经性厌食症或神经性贪食症标准的女性住院患者参与了这项随访研究；其中29名患者符合合并OCD的标准。所有患者均接受了两次调查：住院治疗期间和出院后30个月的随访。采用了半结构化诊断访谈以及饮食失调量表和汉堡强迫症量表简版。
随访时，51%（N = 38）的患者不再符合DSM-IV神经性厌食症或神经性贪食症的标准，但这种改善与早期合并OCD并无显著相关性。重复测量方差分析显示，无论是否存在OCD，所有患者在饮食失调量表的八个子量表中的六个上，随着时间推移都有显著改善。此外，未发现显著的组效应或组×时间交互作用。饮食失调量表得分改善所反映的临床显著变化，在未合并OCD的患者中出现得略多一些，但这一趋势无统计学意义。随访时饮食失调改善最明显的患者，其强迫观念和强迫行为的减少也最为显著。
结果表明，合并OCD并不预示着神经性厌食症或神经性贪食症患者的预后显著更差。
