难治性强迫症治疗进展_West China Medical Journal

Authors：

 张蒙蒙 ,  杨彦春

四川大学华西医院心理卫生中心, 成都, 610041;

Corresponding author：

杨彦春, Email: yanchun_yang@hotmail.com

Keywords：

难治性强迫症; 增效剂; 外科手术; 深部脑电刺激

DOI：

10.7507/1002-0179.20140422

Video：

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Abstract Full text Figures/Tables Video References Cited by

强迫症是一种慢性精神疾病，具有较高的发病率、致残率，尽管5-羟色胺再摄取抑制剂（SRI）的应用使强迫症的治疗有了很大进步，但仍有约30%～40%的患者对治疗无反应。针对这部分难治性强迫症患者试图采用各种方式提高其治疗效果，治疗手段包括SRI联合各种增效剂、静脉滴注SRI、常规外科手术、深部脑电刺激等。

Citation： 张蒙蒙, 杨彦春. 难治性强迫症治疗进展. West China Medical Journal, 2014, 29(7): 1380-1383. doi: 10.7507/1002-0179.20140422 Copy

1.	Subramaniam M, Abdin E, Vaingankar JA, et al. Obsessivecompulsive disorder:prevalence, correlates, help-seeking and quality of Life in a multiracial Asian population[J]. Soc Psychiatry Psychiatr Epidemiol, 2012, 47(12):2035-2043.
2.	Ruscio AM, Stein DJ, Chiu WT, et al. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication[J]. Mol Psychiatry, 2010, 15(1):53-63.
3.	Koran LM, Hanna GL, Hollander E, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder[J]. Am J Psychiatry, 2007, 164(7 Suppl):5-53.
4.	Husted DS, Shapira NA. A review of the treatment for refractory obsessive-compulsive disorder:from medicine to deep brain stimulation[J]. CNS Spectr, 2004, 9(11):833-847.
5.	Goodman WK, Mcdougle CJ, Barr LC, et al. Biological approaches to treatment-resistant obsessive compulsive disorder[J]. J Clin Psychiatry, 1993, 54(Suppl):16-26.
6.	Mcdougle CJ, Goodman WK, Leckman JF, et al. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. A double-blind, placebo-controlled study in patients with and without tics[J]. Arch Gen Psychiatry, 1994, 51(4):302-308.
7.	Li X, May RS, Tolbert LC, et al. Risperidone and haloperidol augmentation of serotonin reuptake inhibitors in refractory obsessivecompulsive disorder:a crossover study[J]. J Clin Psychiatry, 2005, 66(6):736-743.
8.	Arumugham SS, Reddy JY. Augmentation strategies in obsessive-compulsive disorder[J]. Expert Rev Neurother, 2013, 13(2):187-202; quiz 203.
9.	Komossa K, Depping AM, Meyer M, et al. Second-generation antipsychotics for obsessive compulsive disorder[J]. Cochrane Database Syst Rev, 2010, 12(12):CD008141.
10.	Bloch MH, Landeros-Weisenberger A, Kelmendi B, et al. A systematic review:antipsychotic augmentation with treatment refractory obsessive-compulsive disorder[J]. Mol Psychiatry, 2006, 11(7):622-632.
11.	Bystritsky A, Ackerman DL, Rosen RM, et al. Augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder using adjunctive olanzapine:a placebo-controlled trial[J]. J Clin Psychiatry, 2004, 65(4):565-568.
12.	Maina G, Pessina E, Albert U, et al. 8-week, single-blind, randomized trial comparing risperidone versus olanzapine augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder[J]. Eur Neuropsychopharmacol, 2008, 18(5):364-372.
13.	Shapi ra NA, Ward HE, Mandoki M, et al. A double-blind, placebocontrolled trial of olanzapine addition in fluoxetine-refractory obsessive-compulsive disorder[J]. Biol Psychiatry, 2004, 55(5):553-555.
14.	Masi G, Pfanner C, Millepiedi S, et al. Aripiprazole augmentation in 39 adolescents with medication-resistant obsessive-compulsive disorder[J]. J Clin Psychopharmacol, 2010, 30(6):688-693.
15.	Ak M, Bulut SD, Bozkurt A, et al. Aripiprazole augmentation of serotonin reuptake inhibitors in treatment-resistant obsessivecompulsive disorder:a 10-week open-label study[J]. Adv Ther, 2011, 28(4):341-348.
16.	Sayyah M, Sayyah M, Boostani H, et al. Effects of aripiprazole augmentation in treatment-resistant obsessive-compulsive disorder (a double blind clinical trial)[J]. Depress Anxiety, 2012, 29(10):850-854.
17.	Muscatello MR, Bruno A, Pandolfo G, et al. Effect of aripiprazole augmentation of serotonin reuptake inhibitors or clomipramine in treatment-resistant obsessive-compulsive disorder:a double-blind, placebo-controlled study[J]. J Clin Psychopharmacol, 2011, 31(2):174-179.
18.	Storch EA, Goddard AW, Grant JE, et al. Double-blind, placebocontrolled, pilot trial of paliperidone augmentation in serotonin reuptake inhibitor-resistant obsessive-compulsive disorder[J]. J Clin Psychiatry, 2013, 74(6):e527-e532.
19.	Sevincok L, Uslu A, Kaynak H, et al. Sulpiride addition in a case of fluvoxamine-refractory obsessive-compulsive disorder without comorbid psychopathology[J]. J Psychiatry Neurosci, 2000, 25(2):185.
20.	Iglesias Garcia C, Santamarina Montila S, Alonso Villa MJ. Ziprasidone as coadjuvant treatment in resistant obsessivecompulsive disorder treatment[J]. Actas Esp Psiquiatr, 2006, 34(4):277-279.
21.	Wu K, Hanna GL, Rosenberg DR, et al. The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder[J]. Pharmacol Biochem Behav, 2012, 100(4):726-735.
22.	Coric V, Taskiran S, Pittenger C, et al. Riluzole augmentation in treatment-resistant obsessive-compulsive disorder:an open-label trial[J]. Biol Psychiatry, 2005, 58(5):424-428.
23.	Grant P, Lougee L, Hirschtritt M, et al. An Open-Label trial of riluzole, a glutamate antagonist, in children with treatment-resistant[J]. J Child Adolesc Psychopharmacol, 2007, 17(6):761-767.
24.	Aboujaoude E, Barry JJ, Gamel N. Memantine augmentation in treatment-resistant obsessive-compulsive disorder:an open-label trial[J]. J Clin Psychopharmacol, 2009, 29(1):51-55.
25.	Ghaleiha A, Entezari N, Modabbernia A, et al. Memantine add-on in moderate to severe obsessive-compulsive disorder:randomized double-blind placebo-controlled study[J]. J Psychiatr Res, 2013, 47(2):175-180.
26.	Arrojo-Romero M, Tajes Alonso M, de Leon J. Lamotrigine augmentation of serotonin reuptake inhibitors in severe and longterm treatment-resistant obsessive-compulsive disorder[J]. Case Rep Psychiatry, 2013. http://dx.doi.org/10.1155/2013/612459.
27.	Bruno A, Micò U, Pandolfo G, et al. Lamotrigine augmentation of serotonin reuptake inhibitors in treatment-resistant obsessivecompulsive disorder:a double-blind, placebo-controlled study[J]. J Psychopharmacol, 2012, 26(11):1456-1462.
28.	Mowla A, Khajeian AM, Sahraian A, et al. Topiramate augmentation in resistant OCD:a double-blind placebo-controlled clinical trial[J]. CNS Spectr, 2010, 15(11):613-617.
29.	Crockett BA, Churchill E, Davidson JR. A double-blind combination study of clonazepam with sertraline in obsessive-compulsive disorder[J]. Ann Clin Psychiatry, 2004, 16(3):127-132.
30.	Koran LM, Aboujaoude E, Bullock KD, et al. Double-blind treatment with oral morphine in treatment-resistant obsessive-compulsive disorder[J]. J Clin Psychiatry, 2005, 66(3):353-359.
31.	Seedat S, Stein DJ. Inositol augmentation of serotonin reuptake inhibitors in treatment-refractory obsessive-compulsive disorder:an open trial[J]. Int Clin Psychopharmacol, 1999, 14(6):353-356.
32.	Pigott TA, Pato MT, L'heureux F, et al. A controlled comparison of adjuvant Lithium carbonate or thyroid hormone in clomipraminetreated patients with obsessive-compulsive disorder[J]. J Clin Psychopharmacol, 1991, 11(4):242-248.
33.	Fallon BA, Liebowitz MR, Campeas R, et al. Intravenous clomipramine for obsessive-compulsive disorder refractory to oral clomipramine:a placebo-controlled study[J]. Arch Gen Psychiatry, 1998, 55(10):918-924.
34.	Pallanti S, Quercioli L, Koran LM. Citalopram intravenous infusion in resistant obsessive-compulsive disorder:an open trial[J]. J Clin Psychiatry, 2002, 63(9):796-801.
35.	Bear RE, Fitzgerald P, Rosenfeld JV, et al. Neurosurgery for obsessive-compulsive disorder:contemporary approaches[J]. J Clin Neurosci, 2010, 17(1):1-5.
36.	Jung HH, Kim CH, Chang JH, et al. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder:long-term follow-up results[J]. Stereotact Funct Neurosurg, 2006, 84(4):184-189.
37.	Greenberg BD, Price LH, Rauch SL, et al. Neurosurgery for intractable obsessive-compulsive disorder and depression:critical issues[J]. Neurosurg Clin N Am, 2003, 14(2):199-212.
38.	Oliver B, Gascón J, Aparicio A, et al. Bilateral anterior capsulotomy for refractory obsessive-compulsive disorders[J]. Stereotact Funct Neurosurg, 2003, 81(1/4):90-95.
39.	郭烈美, 周洪语. 难治性强迫症的外科治疗[J]. 中国神经精神疾病杂志, 2008, 34(12):751-753.
40.	Greenberg BD, Malone DA, Friehs GM, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder[J]. Neuropsychopharmacology, 2006, 31(11):2384-2393.

1. Subramaniam M, Abdin E, Vaingankar JA, et al. Obsessivecompulsive disorder:prevalence, correlates, help-seeking and quality of Life in a multiracial Asian population[J]. Soc Psychiatry Psychiatr Epidemiol, 2012, 47(12):2035-2043.
2. Ruscio AM, Stein DJ, Chiu WT, et al. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication[J]. Mol Psychiatry, 2010, 15(1):53-63.
3. Koran LM, Hanna GL, Hollander E, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder[J]. Am J Psychiatry, 2007, 164(7 Suppl):5-53.
4. Husted DS, Shapira NA. A review of the treatment for refractory obsessive-compulsive disorder:from medicine to deep brain stimulation[J]. CNS Spectr, 2004, 9(11):833-847.
5. Goodman WK, Mcdougle CJ, Barr LC, et al. Biological approaches to treatment-resistant obsessive compulsive disorder[J]. J Clin Psychiatry, 1993, 54(Suppl):16-26.
6. Mcdougle CJ, Goodman WK, Leckman JF, et al. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. A double-blind, placebo-controlled study in patients with and without tics[J]. Arch Gen Psychiatry, 1994, 51(4):302-308.
7. Li X, May RS, Tolbert LC, et al. Risperidone and haloperidol augmentation of serotonin reuptake inhibitors in refractory obsessivecompulsive disorder:a crossover study[J]. J Clin Psychiatry, 2005, 66(6):736-743.
8. Arumugham SS, Reddy JY. Augmentation strategies in obsessive-compulsive disorder[J]. Expert Rev Neurother, 2013, 13(2):187-202; quiz 203.
9. Komossa K, Depping AM, Meyer M, et al. Second-generation antipsychotics for obsessive compulsive disorder[J]. Cochrane Database Syst Rev, 2010, 12(12):CD008141.
10. Bloch MH, Landeros-Weisenberger A, Kelmendi B, et al. A systematic review:antipsychotic augmentation with treatment refractory obsessive-compulsive disorder[J]. Mol Psychiatry, 2006, 11(7):622-632.
11. Bystritsky A, Ackerman DL, Rosen RM, et al. Augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder using adjunctive olanzapine:a placebo-controlled trial[J]. J Clin Psychiatry, 2004, 65(4):565-568.
12. Maina G, Pessina E, Albert U, et al. 8-week, single-blind, randomized trial comparing risperidone versus olanzapine augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder[J]. Eur Neuropsychopharmacol, 2008, 18(5):364-372.
13. Shapi ra NA, Ward HE, Mandoki M, et al. A double-blind, placebocontrolled trial of olanzapine addition in fluoxetine-refractory obsessive-compulsive disorder[J]. Biol Psychiatry, 2004, 55(5):553-555.
14. Masi G, Pfanner C, Millepiedi S, et al. Aripiprazole augmentation in 39 adolescents with medication-resistant obsessive-compulsive disorder[J]. J Clin Psychopharmacol, 2010, 30(6):688-693.
15. Ak M, Bulut SD, Bozkurt A, et al. Aripiprazole augmentation of serotonin reuptake inhibitors in treatment-resistant obsessivecompulsive disorder:a 10-week open-label study[J]. Adv Ther, 2011, 28(4):341-348.
16. Sayyah M, Sayyah M, Boostani H, et al. Effects of aripiprazole augmentation in treatment-resistant obsessive-compulsive disorder (a double blind clinical trial)[J]. Depress Anxiety, 2012, 29(10):850-854.
17. Muscatello MR, Bruno A, Pandolfo G, et al. Effect of aripiprazole augmentation of serotonin reuptake inhibitors or clomipramine in treatment-resistant obsessive-compulsive disorder:a double-blind, placebo-controlled study[J]. J Clin Psychopharmacol, 2011, 31(2):174-179.
18. Storch EA, Goddard AW, Grant JE, et al. Double-blind, placebocontrolled, pilot trial of paliperidone augmentation in serotonin reuptake inhibitor-resistant obsessive-compulsive disorder[J]. J Clin Psychiatry, 2013, 74(6):e527-e532.
19. Sevincok L, Uslu A, Kaynak H, et al. Sulpiride addition in a case of fluvoxamine-refractory obsessive-compulsive disorder without comorbid psychopathology[J]. J Psychiatry Neurosci, 2000, 25(2):185.
20. Iglesias Garcia C, Santamarina Montila S, Alonso Villa MJ. Ziprasidone as coadjuvant treatment in resistant obsessivecompulsive disorder treatment[J]. Actas Esp Psiquiatr, 2006, 34(4):277-279.
21. Wu K, Hanna GL, Rosenberg DR, et al. The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder[J]. Pharmacol Biochem Behav, 2012, 100(4):726-735.
22. Coric V, Taskiran S, Pittenger C, et al. Riluzole augmentation in treatment-resistant obsessive-compulsive disorder:an open-label trial[J]. Biol Psychiatry, 2005, 58(5):424-428.
23. Grant P, Lougee L, Hirschtritt M, et al. An Open-Label trial of riluzole, a glutamate antagonist, in children with treatment-resistant[J]. J Child Adolesc Psychopharmacol, 2007, 17(6):761-767.
24. Aboujaoude E, Barry JJ, Gamel N. Memantine augmentation in treatment-resistant obsessive-compulsive disorder:an open-label trial[J]. J Clin Psychopharmacol, 2009, 29(1):51-55.
25. Ghaleiha A, Entezari N, Modabbernia A, et al. Memantine add-on in moderate to severe obsessive-compulsive disorder:randomized double-blind placebo-controlled study[J]. J Psychiatr Res, 2013, 47(2):175-180.
26. Arrojo-Romero M, Tajes Alonso M, de Leon J. Lamotrigine augmentation of serotonin reuptake inhibitors in severe and longterm treatment-resistant obsessive-compulsive disorder[J]. Case Rep Psychiatry, 2013. http://dx.doi.org/10.1155/2013/612459.
27. Bruno A, Micò U, Pandolfo G, et al. Lamotrigine augmentation of serotonin reuptake inhibitors in treatment-resistant obsessivecompulsive disorder:a double-blind, placebo-controlled study[J]. J Psychopharmacol, 2012, 26(11):1456-1462.
28. Mowla A, Khajeian AM, Sahraian A, et al. Topiramate augmentation in resistant OCD:a double-blind placebo-controlled clinical trial[J]. CNS Spectr, 2010, 15(11):613-617.
29. Crockett BA, Churchill E, Davidson JR. A double-blind combination study of clonazepam with sertraline in obsessive-compulsive disorder[J]. Ann Clin Psychiatry, 2004, 16(3):127-132.
30. Koran LM, Aboujaoude E, Bullock KD, et al. Double-blind treatment with oral morphine in treatment-resistant obsessive-compulsive disorder[J]. J Clin Psychiatry, 2005, 66(3):353-359.
31. Seedat S, Stein DJ. Inositol augmentation of serotonin reuptake inhibitors in treatment-refractory obsessive-compulsive disorder:an open trial[J]. Int Clin Psychopharmacol, 1999, 14(6):353-356.
32. Pigott TA, Pato MT, L'heureux F, et al. A controlled comparison of adjuvant Lithium carbonate or thyroid hormone in clomipraminetreated patients with obsessive-compulsive disorder[J]. J Clin Psychopharmacol, 1991, 11(4):242-248.
33. Fallon BA, Liebowitz MR, Campeas R, et al. Intravenous clomipramine for obsessive-compulsive disorder refractory to oral clomipramine:a placebo-controlled study[J]. Arch Gen Psychiatry, 1998, 55(10):918-924.
34. Pallanti S, Quercioli L, Koran LM. Citalopram intravenous infusion in resistant obsessive-compulsive disorder:an open trial[J]. J Clin Psychiatry, 2002, 63(9):796-801.
35. Bear RE, Fitzgerald P, Rosenfeld JV, et al. Neurosurgery for obsessive-compulsive disorder:contemporary approaches[J]. J Clin Neurosci, 2010, 17(1):1-5.
36. Jung HH, Kim CH, Chang JH, et al. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder:long-term follow-up results[J]. Stereotact Funct Neurosurg, 2006, 84(4):184-189.
37. Greenberg BD, Price LH, Rauch SL, et al. Neurosurgery for intractable obsessive-compulsive disorder and depression:critical issues[J]. Neurosurg Clin N Am, 2003, 14(2):199-212.
38. Oliver B, Gascón J, Aparicio A, et al. Bilateral anterior capsulotomy for refractory obsessive-compulsive disorders[J]. Stereotact Funct Neurosurg, 2003, 81(1/4):90-95.
39. 郭烈美, 周洪语. 难治性强迫症的外科治疗[J]. 中国神经精神疾病杂志, 2008, 34(12):751-753.
40. Greenberg BD, Malone DA, Friehs GM, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder[J]. Neuropsychopharmacology, 2006, 31(11):2384-2393.

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