强迫症治疗中心理干预的方法学特征

Methodological characteristics of psychological intervention in the treatment of obsessive-compulsive disorder

目的:强迫症发病原因不清,治疗方法多样,各有利弊。本文对强迫症的药物和心理疗法进行回顾总结,重点分析其心理治疗的方法学特征。资料来源:应用计算机检索中国期刊全文数据库1994-01/2005-12期间与强迫症有关的文献,限定文章语言种类为中文,检索词为“强迫症,治疗,心理,药物”。资料选择:对资料进行初审,选择与强迫症治疗方法内容相关的文献和研究综述,包括药物、心理、神经外科及其他方面,并查找全文。资料提炼:共收集到43篇与强迫症治疗方法内容相关的文献和研究综述,排除30篇重复性研究或与本文主题联系不紧密的研究性原著。纳入13篇,其中2篇是关于强迫症的综述性研究文章,11篇是关于强迫症的治疗方法研究性原著。资料综合:强迫症主要为认知和行为障碍。病程持续时间长。强迫症的治疗方法多种多样,主要包括药物治疗、心理治疗、神经外科手术治疗及其他治疗。药物治疗常采用氯丙咪嗪和选择性五羟色胺回收抑制剂-氟西汀、氟伏草胺、帕罗西汀、舍曲林。心理治疗方法较多,有认知行为疗法(思维阻断法、暴露疗法和反应预防、系统脱敏法)及精神分析疗法和森田疗法。神经外科手术治疗采用双侧扣带回切断术、边缘白质切断术、内囊前肢切断术、尾状下束切断术。结论:根据对强迫症病因的认识,依据治疗方法的理论依据和实施方式,对强迫症采取有针对性的治疗方法,综合运用药物治疗和心理治疗,可能会取得更好的疗效。对难治性强迫症,神经外科手术治疗是一种有效的治疗措施。

OBJECTIVE： The pathogenesis of obsessive compulsive disorder is not clear, it has various therapeutic methods with their own advantages and shortcomings. The aim of the paper is to summarize retrospective the drug therapy and psychotherapy in the treatment of obsessive-compulsive disordear, and analyze importantly the methodological characteristics of its psycbotherapy. DATA SOURCES： An online search of China journal full-text database （CJFD） was undertaken with computer to identify the literatures about obsessive compulsive disorder published in Chinese between January 1994 and December 2004 by using the keywords of “obsessive-compulsive disordear, therapy, psychology, drug”. STUDY SELECTION： The data were checked preliminarily, the articles and reviews related to the therapeutic methods of obsessive-compulsive disorder were selected, including drug, psychology, neurosurgery and other aspects, and then the full-texts were searched. DATA EXTRACTION： Totally 43 articles and reviews related to the therapeutic methods of obsessive-compulsive disorder were collected, 30 repetitive studies or original works not closely correlated with the topic of the paper were deleted. Of the 13 included articles, 2 were reviews about obsessive-compulsive disorder were and 11 were the original works about the therapeutic methods of obsessive compulsive disorder. DATA SYNTHESIS： Obsessive-compulsive disorder was mainly manifested with cognitive and behavioral disorders, it could last for a long time. The therapeutic methods for obsessive-compulsive disorder were various, including drug therapy, psychotherapy, neurosurgery and other therapies. The drug therapy usually adopted monochlorimipramine and selective serotonin re-uptake inhibitors-fluoxetine, fluvoxamine, paroxetine and sertraline. There were many psychotherapies, including cognitive-behavioral therapy （thought stopping, exposure method, reaction prevention and systematic desensitization）, psychoanalytic therapy and Morita therapy. Neurosurgery could be performed by amputation of bilateral gyrus cinguli, amputation of marginal white matter, amputation of anterior limb of internal capsule, and amputation of caudate inferior tractotomy. CONCLUSION： Based on the cognition to the etiological factors of obsessive-compulsive disorder and according to the theoretical evidence and implementing pattern of the therapeutic methods, it may obtain better curative effects to adopt therapeutic methods aiming at the symptoms and comprehensively use drug therapy and psychotherapy. Neurosurgery is an effective therapy for the difficultly cured obsessive-compulsive disorder.