摘要
背景:5-羟色胺再摄取抑制剂(SRIs)和认知行为心理治疗(CBT)是强迫症(OCD)的一线治疗方法。由于反应往往不充分,近年来研究人员调查了CBT和SRI的结合,无论是从头开始还是顺序结合,都可以减轻强迫症状。 目的:本文的目的是评估联合治疗是否似乎与单独单药治疗相比增加了益处,并且顺序策略可能有效地将部分或非应答者转变为一线治疗转变为应答者。 方法:我们回顾了有关成人和儿科OCD患者的药理学和CBT组合及序贯治疗的现有文献,然后我们对这两种有希望的策略进行了单独的分析。搜索结果包括开放标签试验和随机对照试验(RCTs)。 结果:我们确定了十项对照研究,评估从头开始与单独CBT联合治疗的疗效,以及从头开始与单独使用药物治疗的六种评估组合策略。 11项研究,其中只有两项是RCT,已发表在连续治疗上。在大多数关于该主题的研究中,尚未发现CBT和SRI从头开始的组合明显优于单独的单一疗法,除了严重抑郁症患者可能从组合中获益更多而不仅仅是CBT。已发现在药物治疗后顺序施用CBT有助于促进对部分药物反应和促进耐药患者反应的患者的缓解。 结论:合并抑郁症的OCD患者应首先接受药物治疗,最终与CBT相关;对于所有剩余的患者,从文献中有明确的证据表明结合ab initio CBT和药物没有附加益处。因此,文献中不支持在受OCD影响的所有成年患者中常规使用组合方法。现有证据支持将CBT顺序添加到SRI的有效性。
关键词: 强迫症,认知行为疗法,增强疗法,联合疗法,5-羟色胺再摄取抑制剂,治疗抵抗强迫症,暴露和反应预防
Current Medicinal Chemistry
Title:Combining Drug and Psychological Treatments for Obsessive- Compulsive Disorder: What is the Evidence, When and for Whom
Volume: 25 Issue: 41
关键词: 强迫症,认知行为疗法,增强疗法,联合疗法,5-羟色胺再摄取抑制剂,治疗抵抗强迫症,暴露和反应预防
摘要: Background: Serotonin reuptake inhibitors (SRIs) and cognitive-behavioral psychotherapy (CBT) are first-line treatments for obsessive-compulsive disorder (OCD). Since response is often inadequate, in recent years researchers investigated whether combining CBT and SRIs, either ab initio or sequentially, results in a greater reduction of obsessivecompulsive symptoms.
Objective: The aims of the present paper are to assess if combination treatment seems adding benefits as compared to either monotherapy alone and if sequential strategies may be effective in converting partial or non responders to a first-line treatment into responders.
Method: We reviewed available literature on pharmacological and CBT combination and sequential treatments for adult and pediatric OCD patients and then we conducted a separate analysis for studies concerning these two promising strategies. Search results included openlabel trials and randomized controlled trials (RCTs).
Results: We identified ten controlled studies assessing the efficacy of combination treatments ab initio versus CBT alone and six evaluating combination strategies ab initio versus medications alone. Eleven studies, only two of which were RCTs, have been published on sequential treatments. The combination ab initio of CBT and SRIs has not been found to be clearly superior to either monotherapy alone in most studies conducted on this topic, except for patients with severe depression who might benefit more from the combination versus only CBT. A sequential administration of CBT after medications has been found useful in promoting remission in patients who partially responded to drugs and in promoting response in resistant patients.
Conclusion: OCD patients with comorbid major depression should receive medication firstly, eventually associated with CBT; for all remaining patients there is clear evidence from the literature of no additive benefits of combining ab initio CBT and medication. Therefore, the routine use of a combination approach in all adult patients affected by OCD is not supported by the literature. The available evidence supports the effectiveness of the sequential addition of CBT to SRIs.
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Combining Drug and Psychological Treatments for Obsessive- Compulsive Disorder: What is the Evidence, When and for Whom, Current Medicinal Chemistry 2018; 25 (41) . https://dx.doi.org/10.2174/0929867324666170712114445
DOI https://dx.doi.org/10.2174/0929867324666170712114445 |
Print ISSN 0929-8673 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-533X |
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