有与无自知力的强迫症临床对照研究

A controlled clinical research of OCD patients with and without insight

目的探讨有与无自知力强迫症的临床差异。方法将86例强迫症患者分为有自知力的64例和无自知力的24例两组,采用自编一般情况调查表、强迫症状量表(Y-BOCS)、自知力与治疗态度问卷(ITAQ)、Hamilton抑郁量表(HAMD)、Hamilton焦虑量表(HAMA)、社会功能缺陷量表(SDSS)、临床总体印象量表(CGI-SI)为评定工具,对两组患者进行评定。结果与有自知力的强迫症患者比较,无自知力的强迫症患者起病年龄早(P<0.05),病程及自患病到就诊的时间长(P<0.01),就诊年龄(P<0.05)、未婚率、误诊率及不接受治疗的比例较高(均P<0.05),病情较重(P<0.01),治疗效果较差(P<0.01)以及社会功能缺陷严重(P<0.05)。结论无自知力的强迫症患者具有症状复杂、起病年龄早、病程迁延、治疗效果差、预后不良等特点。建议在制定诊断与分类标准时,应充分考虑到无自知力强迫症的复杂性和特殊性,以减少误诊和误治。无自知力的强迫症能否作为一个独立的疾病单元,需要深入研究。

Objective To explore the clinical difference of OCD patients with and without insight. Methods 86 patients with OCD including 62 patients with insight and 24 patients without insight were assessed with self-designed general condition questionnaire, Yale-Brown obsessive-compulsive scale （Y-BOCS）, Hamilton depression rating scale （HAMD）, Hamilton anxiety rating scale （HAMA）, social disability screening schedule （SDSS） and clinical global impression - severity of illness （CGI-SI）. Results Compared with patients with insight, patients without insight showed earlier onset age （P 〈 0.05 ） , longer illness course and longer time-span from onset to hospital visit （ P 〈 0.01 ）, older age when visiting hospital （ P 〈 0.05 ）, higher unmarried rate （ P 〈 0.05 ）, higher misdiagnosis rate, higher non-treatment rate （ P 〈 0.05 ）, more severe condition （ P 〈 0.01 ）, poorer outcome （ P 〈 0.01 ） and more severe social disability （ P 〈 0.05 ）. Conclusion OCD patients without insight are characterized by complicated symptoms, earlier onset age, delayed illness course, unsatisfactory efficacy and poor outcome. The complexity and particularity of OCD patients without insight should be fully considered when establishing diagnosti.c and classification criteria. Further studies should be carried out to determine whether the OCD without insight is a independent clinical subtype.