Koran L M, Pallanti S, Paiva R S, Quercioli L
Department of Psychiatry and Behavioral Sciences, Stanford University Medical Centre, OCD Clinic, CA 94305, USA.
Eur Neuropsychopharmacol. 1998 May;8(2):121-6. doi: 10.1016/s0924-977x(97)00048-5.
We compared gradually increased to pulse loaded doses of open-label, intravenous clomipramine (CMI) in patients with obsessive-compulsive disorder (OCD).
We treated adult outpatients with DSM-III-R OCD, who had no prior exposure to effective treatments. Pulse loading patients received 150 mg on day 1; 150 mg or 200 mg on day 2. Gradual dosing patients received 25 mg per day increased to 200 mg per day over 2 weeks and then continued for a mean of 43 days (n=40). After i.v. dosing, all patients received oral CMI; the total treatment period was 6 months.
Pulse loading completers (n=7) had a rapid, dramatic response (mean Y-BOCS score decrease of 32% five days after pulse-loading). At this point (day 7), completers in the gradual intravenous group (n=20) exhibited no mean change in Y-BOCS score. The pulse loading group reached both a 25% or greater and a 50% or greater decrease in Y-BOCS score statistically and clinically significantly faster than the gradual group.
Pulse-loaded intravenous CMI for the treatment of OCD deserves further study.
我们比较了强迫症（OCD）患者中，开放标签静脉注射氯米帕明（CMI）从逐渐增加剂量到脉冲负荷剂量的疗效。
我们治疗了成年门诊DSM-III-R强迫症患者，这些患者之前未接受过有效治疗。脉冲负荷组患者第1天接受150毫克；第2天接受150毫克或200毫克。逐渐给药组患者每天接受25毫克，在2周内增加至每天200毫克，然后持续平均43天（n = 40）。静脉给药后，所有患者接受口服CMI；总治疗期为6个月。
脉冲负荷组完成治疗者（n = 7）有快速、显著的反应（脉冲负荷5天后平均Y-BOCS评分下降32%。此时（第7天），逐渐静脉给药组完成治疗者（n = 20）的Y-BOCS评分无平均变化。脉冲负荷组在Y-BOCS评分下降25%或更多以及50%或更多方面，在统计学和临床上均显著快于逐渐给药组。
脉冲负荷静脉注射CMI治疗强迫症值得进一步研究。
