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如何使用SSRI治疗强迫症?

作者:小田 译 来源:医学论坛网 日期:2016-01-03
导读

          强迫症(OCD)患者常处于痛苦之中,并可能致残,因此应该给予其治疗。那么如何治疗?发表于Aust Prescr杂志的一篇文章对此进行了详细的阐述,以下为药物治疗要点。

关键字:  SSRI | 强迫症 

        强迫症(OCD)患者常处于痛苦之中,并可能致残,因此应该给予其治疗。那么如何治疗?发表于Aust Prescr杂志的一篇文章对此进行了详细的阐述,以下为药物治疗要点。

药物治疗方法

        治疗药物常从SSRI开始,因不同药物的应答率相似,所以处方何种SSRI常取决于医生对药物的熟悉度或满足减少药物相互作用的需求。有关氯丙咪嗪优于SSRI的试验尚不具说服力。其中,在不同研究中,舍曲林用药剂量范围为50-200 mg/d。

        一些患者对标准剂量的SSRI即有应答,但多数患者需要较大剂量。应告知接受较大剂量SSRI治疗的患者以下两点:SSRI起效可能延缓,药物的全部作用可能需要在治疗12周后才全部显现。根据患者对药物的应答和耐受情况,推荐每两周增加一次剂量。应使用至少12周并达到最大剂量方可判断一种SSRI药物是否有效。

        一般推荐SSRI成功治疗应持续至少12个月。若干研究显示,在此期间治疗的患者可持续获益。因多数研究显示,12周以内停药的复发率超过50%,所以应慎重考虑此时停药。医生还需评估患者生活环境是否对复发有影响。SSRI撤药应缓慢进行,持续数月,当症状严重时需优先咨询专业医师。

        此外,暴露联合SSRI反应预防治疗比单独使用任何一种方法均更有效。当患者对药物治疗无应答时,常推荐增加暴露联合反应预防治疗。

        总之,心理干预和选择性5-羟色胺再摄取抑制剂(SSRI)是一线治疗方案,应用该类药物治疗后,多数患者的症状可得到缓解。OCD患者对SSRI的应答率较抑郁患者慢,因此可每隔两周根据患者的反应性增加一次剂量,在较高治疗范围内瞄准剂量。治疗后改善常在12周时达到高峰,应继续治疗至少12个月。OCD治疗停止后复发风险高。

        参考文献:Brakoulias V. Aust Prescr.2015 Aug;38(4):121-3. Epub 2015 Aug 3.

原文

Managing obsessive compulsive disorder.
Brakoulias V1.
Author information
• 1Psychiatry, Sydney Medical School, University of Sydney.
Abstract
Unlike obsessive compulsive personality traits or occasional repetitive habits, obsessive compulsive disorder can be highly distressing and associated with significant disability. Treatment should always be offered. Psychological interventions and selective serotonin reuptake inhibitors are first-line treatments for obsessive compulsive disorder. Patients with obsessive compulsive disorder respond to selective serotonin reuptake inhibitors at a slower rate than those with depression. The dose of a selective serotonin reuptake inhibitor can be increased at two-week intervals depending on the patient's response. Aim for doses in the higher therapeutic range. Improvements from treatment usually plateau at 12 weeks. Successful treatment should continue for at least 12 months. There is a significant risk of relapse when treatment is stopped.

It is generally recommended that successful treatment with an SSRI should be continued for at least
12 months. Several studies have shown that patients continue to benefit during this period.14,15 A decision to cease successful treatment should be considered carefully as most studies report relapse rates of over 50% within 12 weeks.16 A patient’s life circumstances will need to be evaluated to gauge the risk of relapse and the effect it may have on them. Withdrawing an SSRI should occur slowly, over several months, and preferably with guidance from a psychiatrist when symptoms have been severe.

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