难治性OCD的处理.docVIP

Managing Treatment-Resistant OCD By Jamie D. Feusner, M.D., and Alexander Bystritsky, M.D., Ph.D. | 2005年7月1日 Obsessive-compulsive disorder is a prevalent, disabling and chronic illness. Serotonin reuptake inhibitors are the first-line of treatment; however a large proportion of patients will have either a partial or nonresponse. This review outlines the strategies for treatment-resistant OCD, including augmentation agents, alternative monotherapies, intravenous strategies and newer nonpharmacologic somatic treatments under development. Psychiatric Times July 2005 Vol. XXII Issue 8 Obsessive-compulsive disorder is a severe, chronic condition that affects 2% to 3% of the U.S. population, or 4 million to 7 million people (Weissman et al., 1994). It is characterized by recurrent thoughts, images, feelings or behaviors that persist against the patients wishes and is usually accompanied by severe anxiety and marked impairment of function. Obsessive-compulsive disorder was listed as the 10th leading cause of disability worldwide by a World Health Organization study. The total cost of the disorder in the United States is estimated to be over $8 billion (Murray and Lopez, 1996). Serotonin reuptake inhibitors are the first line of pharmacological treatment for OCD. Approximately 40% to 60% of patients treated with SRIs alone will have a response. This is conventionally defined as at least a 25% reduction on the widely used Yale-Brown Obsessive-Compulsive Scale (YBOCS), with an average of 23% to 43% reduction in symptoms (Greist et al., 1995; Pallanti et al., 2002a). Due to the often incomplete reduction of symptoms in patients who respond to SRIs and those patients who do not show a response, additional treatment strategies are often necessary in OCD. The focus of this review will be primarily on somatic treatments. In this article, treatment-resistant will be defined as less than a 35% reduction of symptoms as measured by the YBOCS after two SRI trials, with or without