Greist J H
Madison Institute of Medicine, Wisconsin, USA.
Bull Menninger Clin. 1998 Fall;62(4 Suppl A):A65-81.
With the exception of neurosurgery, treatments for obsessive-compulsive disorder were largely ineffective until 1996. That year, clomipramine became available and the first article describing modern behavior therapy was published. Potent serotonin reuptake inhibitors and behavior therapy involving exposure and ritual prevention have been established as the cornerstones of effective treatment for obsessive-compulsive disorder. Methods for optimizing effectiveness of these two main modalities are more widely recognized, although overdosing may hamper effective pharmacotherapy. The comparative efficacies of pharmacotherapy and behavior therapy remain in dispute, although all meta-analyses have identified behavior therapy as more effective both in terms of magnitude of improvement short term and lasting gains long term. Finally, neurosurgery still merits consideration for the tiny minority of patients who are incapacitated by OCD and unresponsive to serotonin reuptake inhibitors and behavior therapy.
除神经外科外，直到1996年，强迫症的治疗方法大多无效。那一年，氯米帕明开始使用，并且第一篇描述现代行为疗法的文章发表。强效5-羟色胺再摄取抑制剂以及涉及暴露和仪式阻止的行为疗法已被确立为强迫症有效治疗的基石。尽管用药过量可能会妨碍有效的药物治疗，但优化这两种主要治疗方式有效性的方法得到了更广泛的认可。药物疗法和行为疗法的相对疗效仍存在争议，尽管所有的荟萃分析都认为行为疗法在短期改善程度和长期持久疗效方面都更有效。最后，对于极少数因强迫症而丧失能力且对5-羟色胺再摄取抑制剂和行为疗法无反应的患者，神经外科手术仍值得考虑。
