氯咪帕明和西酞普兰对强迫症患者生活质量影响的1年随访

Effects of clomipramine and citalopram on the quality of life in patients with obsessive-compulsive disorder: One-year follow up

目的:观察氯咪帕明和西酞普兰对强迫症患者生活质量的影响。方法:于2002-01-01/2004-12-31选择广西壮族自治区龙泉山医院精神科收治的强迫症患者110例。均符合中国精神疾病分类与诊断标准第三版关于强迫症的诊断标准,并经氯咪帕明或西酞普兰系统治疗达临床治愈或显著进步、Yale-Brown强迫量表<16分、出院后回归社会≥18个月、第1次随访后1年内在家继续遵医嘱服用单一用药。自愿接受检查,对实验知情同意。排除有严重器质性疾病及酒精、药物依赖者。其中氯咪帕明组和西酞普兰组各55例。调查量表包括:①一般情况调查表(自编),内容包括:一般人口学资料、家族史、病前个性特征、病前社会心理因素、疾病诊疗情况。②强迫症状及药物副反应评定,采用Yale-Brown强迫量表、不良反应症状量表评定疾病严重程度及治疗中出现的药物副反应。③生活质量评定量表,采用汪向东编制的生活满意度评定量表,其中包括生活满意度评定量表、生活满意度指数A和生活满意度指数B3个分量表,其分值越高生活满意度越好;同时采用中国十二地区精神疾病流行病学协作调查组修订的社会功能缺陷筛选表,其分值越高社会功能缺陷越严重。自编一般状况调查表、Yale-Brown强迫量表、不良反应症状量表分别于入组时和入组1年时评定两次。生活质量评定量表和社会功能缺陷筛选表于入组1年时评定1次。结果:两组患者因部分病例一般资料收集不全面,或量表评定不规范,最后纳入分析为102例,其中氯咪帕明组52例,脱落3例,脱落率6%;西酞普兰组50例,脱落5例,脱落率9%。①两组患者在性别组成、平均年龄、受教育年限、发病年龄、病程、Yale-Brown强迫量表两次评分差异均无显著性意义(P>0.05);入组时和入组1年时西酞普兰组不良反应症状量表评分均低于氯咪帕明组,差异均有非常显著性意义[分别为(28.87±2.17),(31.21±2.44)分;(23.54±4.98),(28.54±4.71)分,t=5.123,5.205,P<0.01]。②西酞普兰组生活满意度评定量表评分显示热情与冷漠,愿望与已实现两因子分显著高于氯咪帕明组[分别为(4.52±1.44),(3.06±1.72)分;(3.72±1.66),(2.68±1.73)分,t=4.656,3.098,P<0.01],决心与不屈服、自我评价、心境3个因子分也高于氯咪帕明组[分别为(4.26±1.05),(3.84±0.98)分;(3.64±1.37),(3.05±1.08)分;(2.40±1.97),(1.62±1.78)分,t=2.087,2.409,2.096,P<0.05]。③西酞普兰组患者家庭外社会活动缺陷程度显著低于氯咪帕明组患者,差异有非常显著性意义[分别为(0.59±0.49),(0.88±0.47)分,t=3.048,P<0.01],社会性退缩、个人生活自理、对外界兴趣、责任心和计划性缺陷程度也低于氯咪帕明组患者,差异有显著性意义[分别为(0.59±0.37),(0.78±0.42)分;(0.26±0.34),(0.47±0.49)分;(0.41±0.39),(0.65±0.56)分;(0.49±0.57),(0.78±0.64)分,t=2.427,2.526,2.519,2.419,P<0.05],两组患者其余各项社会功能缺陷程度比较差异均无显著性意义(P>0.05)。④生活质量影响因素的单因素相关分析:主观生活满意度与药物副反应得分呈负相关,与西酞普兰呈正相关;客观生活质量与强迫症状、药物副反应得分呈负相关,与西酞普兰呈正相关。结论:西酞普兰对患者生活质量效果好于氯咪帕明,长期维持治疗的强迫症患者病情稳定时,药物副作用是直接影响患者生活质量的较强因素。

AIM： To observe the effects of clomipramine and citalopram on the quality of life in patients with obsessive-compulsive disorder. METHODS： Totally 110 patients with obsessive-compulsive disorder, who were treated at Department of Psychiatry, Longquanshan Hospital of Guangxi Zhuang Autonomous Region from January 1^st, 2002 to December 31^st, 2004, were enrolled. The patients were those that accorded with the third edition diagnostic criteria of obsessive-compulsive disorder of Chinese mental disorder classification, those that had recovered or significantly improved with the treatment of clomipramine or citalopram, those that had less than 16 points of Yale-Brown Obsessive-compulsive Rating Scale, those that lived in the home for at least 18 months, and those that took single medicine at home under supervision of a physician within 1 year after the first follow-up. They received the examination voluntarily and knew the experiment and agreed to participate in the experiment. The patients who had severe organic disease or alcohol and drug dependence were excluded. There were clomipramine group （n =55） and citalopram group （n =55）. The scale included ①self-made general inventory was composed of demographic data, family history, personality characteristics before onset, social psychic factor before onset and disease diagnosis. ②compulsive symptom and side effect： Disease severity and side effect were evaluated by Yale-Brown Obsessive-compulsive Rating Scale and treatment emergent symptoms scale （TESS）, respectively. ③Quality of life was assessed by Life Satisfaction Scales compiled by Wang, which was composed of 3 sub-scales, namely Life Satisfaction Rating Sales （LSR）, Life Satisfaction Index A and Life Satisfaction Index B. The higher the score, the better the life satisfaction was. At the same time, Social Disability Screening Schedule （SDSS） revised by mental disorder epidemiology research team from 12 areas of China was used. The higher the score, the more severe the social disability was. Self-made general inventory, Yale-Brown Obsessive-compulsive Rating Scale and TESS were performed at the beginning and 1 year after entering the group, respectively. Life Satisfaction Scales and SDSS were conducted 1 year after entering the group. RESULTS： Because of incomplete collection data or irregular evaluation of general data in patients of the two groups, totally 102 patients were involved in the result analysis, of which 52 cases in the clomipramine group, 3 dropped out, with the drop-out rate of 6% and 50 cases in the citalopram group, 5 dropped out, with the drop-out rate of 9%. ①There was no significant difference of sex, mean age, education duration, age of onset, course, two scores of Yale-Brown Obsessive-compulsive Rating Scale between the two groups （P 〉 0.05）. The score of TESS in the citalopram group was lower than that in the clomipramine group at the time of entering group and 1 year after entering the group, and there were extremely significant differences [（28.87±2.17）, （31.21±2.44） points; （23.54±4.98）, （28.54±4.71） points, t =5.123, 5.205,P 〈 0.01]. ②In the citalopram group LSR showed that scores of enthusiasm and unconcerned, aspiration and implement were obviously higher than those in the clomipramine group [（4.52±1.44）, （3.06±1.72） points; （3.72±1.66）, （2.68±1.73） points,t =4.656,3.098,P 〈 0.01]. Scores of determination and unyieldingness, serf-evaluation, mental state were higher than those in the clomipramine group [（4.26±1.05）, （3.84±0.98） points; （3.64±1.37）,（3.05±1.08） points; （2.40±1.97）, （1.62±1.78） points,t =2.087,2.409,2.096,P 〈 0.05]. ③Degree of social activity impairment in the citalopram group was markedly lower than that in the clomipramine group, and there were extremely significant differences [（0.59±0.49）, （0.88±0.47） points,t =3.048,P 〈 0.01]. Degree of social retraction, personal care, interests to surrounding, responsibility and designed impairment were lower than those in the clomipramine group, and there were significant differences [（0.59±0.37）, （0.78±0.42） points; （0.26±0.34）, （0.47±0.49） points; （0.41 ±0.39）, （0.65±0.56） points; （0.49±0.57）, （0.78±0.64） points,t =2.427,2.526,2.519,2.419,P 〈 0.05]. There was no significant difference of the other social disability in the two groups （P 〉 0.05）. ④univariate correlation analysis of quality of life： The subjective life satisfaction degree was negatively correlated with side effect, while positively correlated with citalopram. The objective quality of life was negatively correlated with compulsive symptom and side effect, while positively correlated with citalopram. CONCLUSION： Citalopram has better effect on patient＇s quality of life than clomipramine. When the pathogenetic condition of compulsive patients is stable after a long-term therapy, the side effect is the directly strong influential factor of patient＇s quality of life.