氟伏沙明治疗少年儿童强迫症临床观察

目的:探讨氟伏沙明治疗少年儿童强迫症的疗效和安全性。方法:以氟伏沙明治疗少年儿童强迫症34例。疗程10周。根据临床症状改善和社会功能恢复程度,不良反应及实验室检查评定疗效与安全性。结果:氟伏沙明平均治疗剂量(108±20)mg/d,显效率61.8%,有效率94.1%。不良反应有口干,轻度兴奋。结论:氟伏沙明治疗少年儿童强迫症安全有效,不良反应少。     

氟伏沙明联合奥氮平治疗难治性强迫症临床观察

目的:研究氟伏沙明联合奥氮平对难治性强迫症的疗效。方法:对难治性强迫症患者75例,随机分为两组,分别为氟伏沙明单用组和联合奥氮平治疗组,治疗8周。采用Yale-Brown强迫症量表(Y-BOCS)、汉密尔顿抑郁量表(HAMD)和治疗中出现的症状量表(TESS)评价疗效和不良反应。结果:氟伏沙明联合奥氮平治疗难治性强迫症的疗效显著,不良反应少。结论:两药联合应用治疗难治性强迫症的疗效显著,值得推广。     

氟伏沙明联合思维阻断疗法治疗强迫症的效果观察

目的探讨氟伏沙明联合思维阻断疗法对强迫症的疗效。方法采用随机数字表法将56例存在强迫性思维并符合《国际疾病分类(第10版)》(ICD-10)诊断标准的强迫症患者分为氟伏沙明单一治疗组和氟伏沙明联合思维阻断疗法治疗组,观察12周。于治疗前、治疗第4、8、12周末采用耶鲁布朗强迫症状量表(Y-BOCS)进行评定,并采用生活质量综合评定问卷(GQOLI-74)评估治疗前后的生活质量。结果治疗前两组Y-BOCS和GQOLI-74评分差异无统计学意义(P0.05),治疗4周后两组Y-BOCS评分较治疗前低,差异有统计学意义(P0.05),治疗8周后联合组评分较对照组降低更明显,差异有统计学意义(P0.05);治疗12周后,联合组GQOLI-74心理功能和社会功能评分高于对照组(P0.05)。结论氟伏沙明联合思维阻断疗法治疗有强迫性思维的强迫症患者较单用氟伏沙明疗效更好,并能改善患者的生活质量。     

氟伏沙明合并氯氮平治疗强迫症的疗效比较

目的探讨氟伏沙明合并氯氮平治疗强迫症的疗效。方法45例强迫症患者随机分为氟伏沙明合并氯氮平治疗组和单独氟伏沙明治疗组。疗程8周。采用强迫症量表（Y—BOCS）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评定疗效。结果治疗结束时两组Y—BOCS、HAMA、HAMD的评分均显著降低,更以合并氯氮平组明显。结论氟伏沙明合并氯氮平治疗强迫症可以增加疗效。     

氟伏沙明治疗难治性强迫症4例

难治性强迫症是临床的难题之一,笔者应用氟伏沙明(商品名:兰释)治疗4例难治性强迫症, 效果较理想,现将结果报道如下.     

氟伏沙明的临床应用概况

作为选择性 5 -羟色胺再摄取抑制剂 (ｓｅｌｅｃｔｉｖｅｓｅｒｅｔｏｎｉｎｒｅｕｐｔａｋｅｉｎｈｉｂｉｔｏｒｓ,ＳＳＲＩｓ)的一种抗抑郁药 ,氟伏沙明问世已近 2 0年了 ,该药最早在欧洲使用 ,80年代中期进入美国 ,90年代后期来到中国。目前 ,该药主要用于抑郁症、强迫症、惊恐障碍的治疗。查阅医学文摘 (ｍｅｄｌｉｎｅ)有 15 3篇氟伏沙明双盲对照研究报告和综述 ,现将这些研究综述于后。1　抑郁症的治疗荷兰Ｋｌｏｋ(1981)报告[1] ,对 36例女性抑郁症采用氟伏沙明氯丙咪嗪对照 ,剂量均为 5 0ｍｇ ,每日3次治疗 4周。结果氟伏沙明的疗效…     

氟伏沙明与氯米帕明治疗青少年强迫症的对照研究

目的 比较氟伏沙明与氯米帕明治疗青少年期强迫症的疗效和不良反应.方法 共纳入强迫症患者42例,随机分为氟伏沙明组和氯米帕明组,疗程8周.应用耶鲁-布朗强迫症量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)评定疗效,治疗中需处理的不良反应症状量表(TESS)评价不良反应.结果 氟伏沙明组治疗总有效率86.4％,氯米帕明组治疗总有效率86.4％,两组比较差异无统计学意义(P＞0.05).两组治疗后第4、8周末Y-BOCS评分、HAMA评分与治疗前比较差异有显著统计学意义(P＜0.01).氟伏沙明组与氯米帕明组不良反应发生率差异有统计学意义(P＜0.05).结论 氟伏沙明对于青少年期强迫症状的治疗是安全有效的.     

喹硫平合并氟伏沙明治疗儿童强迫症的临床初步观察

目的 探讨喹硫平合并氟伏沙明治疗儿童强迫症的临床疗效和安全性.方法 将47例儿童强迫症患者根据患儿家庭经济条件分为氯米帕明组(氯米帕明100～150 mg/d单药治疗,9例),氟伏沙明组(氟伏沙明100～150 mg/d单药治疗,13例),喹硫平合并氟伏沙明组(氟伏沙明100～150 mg/d,喹硫平400～600 mg/d,25例).随访8周.采用Yale-Brown强迫症量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)和副反应量表(TESS)评定疗效和不良反应.结果 基线时3组间Y-BOCS、HAMA评分相似.随访第8周时喹硫平合并氟伏沙明组的Y-BOCS评分(12.4±4.7)低于氯米帕明组(15.9±3.8,t=2.654,P=0.021)和氟伏沙明组(16.1±3.9,t=2.576,P=0.037),HAMA评分(6.9±3.8)也低于氯米帕明组(9.9±4.1,t=2.197,P=0.027)和氟伏沙明组(10.1±3.6,t=2.236,P=0.017).结论 喹硫平合并氟伏沙明用于儿童强迫症的治疗有明确的疗效和安全性.     

氟伏沙明与氯丙咪嗪治疗强迫症的对照研究

目的比较氟伏沙明和氯丙咪嗪治疗强迫症的疗效和不良反应。方法用CCMD-3作为诊断标准,用Yale-Brown强迫量表和TESS量表评定临床疗效和不良反应,对58例强迫症患进行随机双盲的8周治疗。结果氟伏沙明有效率为70．2％,与氯丙咪嗪60．7％相近,两无显差异。氟伏沙明不良反应发生率36．7％,明显少于氯丙咪嗪75．0％。两有明显差异。结论氟伏沙明治疗强迫症,疗效与氯丙咪嗪相当,不良反应较轻,耐受性好。     

穴位刺激调控法合并氟伏沙明治疗强迫症的疗效观察

目的探讨穴位刺激调控法合并氟伏沙明治疗强迫症的疗效。方法采用随机开放对照研究,将52例符合CCMD-3强迫症诊断标准的患者随机分为研究组（穴位刺激调控法合并氟伏沙明治疗组）与对照组（单纯氟伏沙明治疗组）,分别在治疗后第2、4、8、12周末采用强迫症状评定量表（Y—BOCS）、临床总体印象量表（CGI—I）评定疗效,以临床记录评价副反应。结果治疗第2、4、8、12周末,研究组Y—BOCS的减分率高于对照组（P〈0．05及O．01）;治疗第4、8、12周末,研究组CGI—I总分低于对照组（P〈0．05及O．01）。结论穴位刺激调控法合并氟伏沙明治疗强迫症的疗效明显优于单纯应用氟伏沙明治疗。     

丁螺环酮对难治性强迫症治疗的增效作用

目的：比较氟伏沙明合并丁螺环酮与氟伏沙明治疗难治性强迫症的疗效。方法：将符合条件的60例难治性强迫症患者随机分成两组,分别给与氟伏沙明合并丁螺环酮（合用组）和氟伏沙明（对照组）,进行12周的系统治疗,使用Yale—Brown强迫量表（Y—BOCS）,汉密尔顿焦虑量表（HAMA）评估其疗效;以治疗中出现的症状量表（TESS）和有关的实验室检查评定不良反应。结果：治疗以后丽组患者的Y-BOCS评分均明显下降,合用组的治疗效果较好,两组之间差异存在显著性（P〈0．01）,并且合用组起效快;而两组HAMA量表的评分明显下降,合用组的治疗效果较好,两组之间差异存在显著性（P〈0．01）,合用组起效快;合用组的不良反应发生率高于对照组,但差异无显著性;两组药物引起的不良反应均为轻度或中度,表现有所不同,患者耐受性好。结论：氟伏沙明合并丁螺环酮治疗难治性强迫症的疗效优于单独使用氟伏沙明组,且合用组起效较快,不良反应较轻。     

Treatment of severe obsessive-compulsive disorder with fluvoxamine

Ten obsessive-compulsive patients received single-blind treatment with fluvoxamine, a selective serotonin reuptake inhibitor, for several weeks following at least 2 weeks of placebo. The group showed significant improvement, as measured by several clinical scales and self-ratings; six patients were judged responders. Fluvoxamine appears effective in treating severe obsessive-compulsive disorder.     

Successful fluvoxamine treatment of a case of refractory obsessive-compulsive disorder

Fluvoxamine, a potent and selective serotonin uptake inhibitor, effectively reduced compulsive handwashing and other rituals in a patient previously refractory to behaviour therapy, clomipramine, MAO inhibitors and other pharmacotherapy. Treatment effect was delayed but broadly patholytic, reducing anxiety and depression scores as well as ratings of obsessiveness.     

The psychological treatment of obsessive-compulsive disorder.

The psychological treatment of obsessive-compulsive disorder (OCD) with exposure and response prevention (ERP) methods is one of the great success stories within the field of mental health. Within the span of about 20 years, the prognosis for individuals with OCD has changed from poor to very good as a result of the development of ERP. This success not with-standing, the procedures are far from perfect because a substantial minority of patients still either refuse treatment, drop out prematurely, or fail to benefit. I begin this article with a review of the development of ERP from early animal research on avoidance learning conducted during the 1950s. Next, I discuss the mechanisms of ERP. The bulk of the article reviews the treatment-outcome literature on ERP for OCD and includes comparisons with cognitive therapy--the "new kid on the block" with respect to psychological treatments for OCD.     

强迫症病理心理机制危险因子研究

目的:应用心理解剖的方法探讨强迫症的危险因素。方法:选择60例强迫症患者作为强迫症组,另选取相匹配的健康人群60名作为对照组,对他们进行问卷调查。采用条件Logistic回归方程对结果进行分析。结果:有3个因素作为强迫症的重要危险因素保留在最后方程中,分别为童年创伤性经历(OR=2.001,95%CI=1.696~3.005),不当的养育方式(OR=1.024,95%CI=1.005~1.044),负性生活事件(OR=0.962,95%CI=0.934~0.992)。结论:强迫症是不同的危险因素同时存在和相互作用的结果。     

Oniomania--successful treatment with fluvoxamine and cognitive-behavioral psychotherapy

Compulsive buying (oniomania) is a disorder that has begun to receive attention from researchers in recent years. It has been estimated that disorder affects from 2 to 8% of the general adult population in the US (official data for Croatia are not available). About 90% of those affected are female. Onset occurs in the late teens or early twenties, and the disorder is generally chronic. Psychiatric comorbidity is frequent, particularly mood, anxiety, substance use, eating and personality disorders. Treatment has not been well delineated, but individual and group psychodynamic psychotherapy, cognitive-behavioural therapy and 12-step programmes may be helpful. Serotonin (5-hydroxytryptamine; 5-HT) re-uptake inhibitors may help some patients regulate their buying impulses. We have presented the case of a 32-year old woman with a history of excessive pathological buying treated successfully with combined therapy (fluvoxamine and cognitive-behavioral psychotherapy).     

Predictors of treatment response to fluvoxamine in obsessive-compulsive disorder: An fMRI study

Recent neuroimaging studies suggest that the pathophysiology of obsessive-compulsive disorder (OCD) may involve more widely distributed large-scale brain systems, including the parietal, occipital, and cerebellar areas, rather than the conventional orbitofronto-striatal model. We hypothesized that not only orbitofrontal cortex and caudate nucleus activities but also posterior brain regions might be associated with subsequent treatment response to serotonin reuptake inhibitors in OCD. The participants were 17 patients with OCD. Each patient was required to undergo fluvoxamine pharmacotherapy for 12 weeks. Before treatment, fMRI images of the subjects were obtained in the context of a symptom-provocation paradigm. The percentage changes in total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, from pre- to post-treatment, served as the index of treatment response. Statistical Parametric Mapping was used to identify brain loci where pre-treatment brain activation significantly correlated with the subsequent treatment response. Fifteen of 17 patients completed the 12-week treatment. During the symptom provocation task, patients showed brain activation in the left superior temporal gyrus (STG), left precuneus, left frontal cortices, right cerebellum, and right frontal cortices. We found that pre-treatment activation in the right cerebellum (Z-score = 5.10, x,y,z=22,-84,-18) and the left STG (Z-score = 4.95, x,y,z=-62,-22,0) was positively correlated with the improvement in the Y-BOCS score. Our results suggest that pre-treatment activation in the right cerebellum and in the left STG predict subsequent reduction in OCD symptom severity. There is every possibility that fMRI can be used as a tool to predict treatment response.