小剂量奥氮平作为增效剂辅助治疗31例难治性强迫症的对照研究

Small Olanzpine as an adjunctive treatment for refractory Obsessive - compulsive disorder

目的:探讨小剂量奥氮平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例难治性强迫症患者在原SSRI类药物治疗的基础上联合奥氮平治疗,同时以28例继续应用SSRI类药物治疗的难治性强迫症患者为对照。奥氮平起始量为第1周5mg/d,第2周为10mg/d,第3周为15mg/d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,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)分与治疗前分别为(29.8±5.4)分,(23.50±3.61)分,(26.95±10,61)分,治疗前后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:小剂量奥氮平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 Small Olanzpine as augmentation treatment in the patients with refractory obsessive - compulsive disorder （ROCD）. Methods： 31 patients with the ROCD were treated with Olanzpine based upon preceding SSRI antidepressants, Others 28 patients were treated with former medicine. Its beginning dosage was 5mg/d and gradually increased, and top dosage was 20mg/d for 8 weeks. Assessments included the Yale - Brown Obsessive Compulsive Scale （YBOCS） , Hamilton Rating Scale for Anxiety （HAMA）, Global Assessment Scale （GAS） and Treatment Emergent Symptoms Scale （TESS） before treatment and at the end of the 4m and 8th weeks of the study, respectively. Results： At the end of the 8th 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 ） ; According to the score - reducing rate of the YBOCS： recovery rate was 16%, effective rate 48% and ineffective rate 36% ; side effects were milder and tolerable. Conclusions： Small dose Olanzpine as synergist of SSRI antidepressants in the treatment of patients with refractory obsessive - compulsive disorder has promising prospect.