阿立哌唑作为增效剂治疗难治性强迫症的临床观察

Aripiprazole as a Synergist for Refractory Obsessive-compulsive Disorder:A Clinical Study

目的:探讨阿立哌唑作为增效剂治疗难治性强迫症的疗效和耐受性。方法:选取59例难治性强迫症患者为研究对象,对31例在原SRI类似药物的基础上联合阿立哌唑治疗,同时以28例继续应用SRI类似药物治疗为对照。阿立哌唑起始量为第1周5mg·d-1,第2周为10mg·d-1,第3周为15mg·d-1,口服,之后可根据个体的疗效和耐受情况调整剂量,最大剂量不超过20mg·d-1,疗程8周;采用Yale-Brown强迫量表、汉密尔顿焦虑量表、总体评定量表及副反应评定量表分别在治疗前、治疗第4周末及治疗第8周末各评定1次,并进行对比分析。结果:治疗第8周末,研究组Yale-Brown强迫量表(12·0±5·4)分,汉密尔顿焦虑量表(13·7±3·2)分、大体评定量表总分(48·2±11·7)分,与治疗前(29·8±5·4)分、(23·50±3·61)分、(26·95±10·61)分比较差异均有显著性(P<0·01)。Yale-Brown强迫量表减分率判定:痊愈率16%,有效率48%,无效36%。不良反应程度较轻微,患者均可耐受并与对照组在各项量表评分上差异具有显著性。结论:小剂量阿立哌唑可作为常规抗抑郁剂的增效剂治疗难治性强迫症,疗效较好。

OBJECTIVE ： To explore the therapeutic effects and tolerance of aripiprazole as a synergist in the treatment of refractory obsessive-compulsive disorder （ROCD）. METHODS： A total of 59 ROCD cases were enrolled： 31 were assigned to receive aripiprazole in combination with preceding SSRI antidepressants, and 28 to receive preceding SSRI antidepressants alone as a control. The initial dose of Aripiprazole at first week was 5 mg/d, increased to 10 mg/d at second week, and 15mg/d at the third week. Then the dosage was adjusted according to individual efficacy and tolerance but with a maximal dose of no more than 20 mg/d. The course of treatment was 8 weeks. Assessments were scheduled before treatment, at the end of 4^th and 8^th weeks using Yale-Brown Obsessive Compulsive Scale （YBOCS）, Hamilton Rating Scale for Anxiety （HAMA）, Global Assessment Scale （GAS） and Treatment Emergent Symptoms Scale （TESS）, and a comparative analysis was performed. RESULTS： At the end of the 8^th weeks of the study, the total scores of the YBOCS （12.0±5.4）, HAMA （13.7±3.2） and GAS （48.2±11.7） had significant difference compared with pretreatment （as follows： 29.8 ±5.4, 23.50±3.61, 26.95 ±10.61 ） （P 〈 0.01）. The score-reducing rate of the YBOCS showed that the recovery rate was 16% , the effective rate was 48% and the ineffective rate was 36% . The side effects were mild and tolerable, and all the scores were significantly different from those in control group. CONCLUSION： Small dose of aripiprazole can serve as an effective synergist of SSRI antidepressants in the treatment of patients with refractory obsessive-compulsive disorder.