舍曲林联合小剂量利培酮治疗难治性强迫症临床研究

Study of sertraline combined with risperidone in the treatment of refractory obsessive compulsive disorder

目的探讨舍曲林联合利培酮治疗难治性强迫症的临床疗效及不良反应。方法选取60例符合中国精神障碍分类与诊断标准第3版(CCMD-3)强迫症诊断标准,且至少服用过2种以上类型不同的抗强迫药物治疗无效的患者,随机分为2组,实验组给予舍曲林合并利培酮治疗,对照组单用舍曲林同时治疗12周。应用耶鲁-布朗强迫量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)评定心理状态及症状严重程度,采用Y-BOCS量表减分率标准评定疗效,应用副反应量表(TESS)评定治疗过程中的不良反应。结果 2组疗效比较:治疗12周后,实验组总有效率90%,对照组总有效率60%,2组间总有效率比较,χ2=4.2,P<0.05,提示舍曲林联合利培酮疗效优于单用舍曲林治疗。实验组与对照组量表评分比较显示:实验组在2周末Y-BOCS、HAMA评分与治疗前比较差异有统计学意义,而对照组4周时与治疗前比较差异有统计学意义。2组在4周末、8周末、12周末Y-BOCS、HAMA评分值比较差异有统计学意义(P<0.05)。从2组治疗前后自身评分比较看,除对照组在2周末与治疗前评分比较差异无统计学意义外,其余各周评分与治疗前比较差异均有统计学意义(P<0.01)。实验组与对照组不良反应比较显示:2组乏力困倦、焦虑、恶心、心动过速、便秘的发生率差异均无统计学意义(P>0.05)。TESS评分比较显示:在治疗第2、4、8、12周末,2组TESS评分经统计学分析,差异均无统计学意义(P>0.05)。结论 舍曲林联合小剂量利培酮与舍曲林单药治疗难治性强迫症比较,疗效更好、起效更快。舍曲林联合小剂量利培酮治疗难治性强迫症同单用舍曲林治疗不良反应相当,均有较好依从性。

Objective To compare the clinical efficacy and the side reaction of sertraline combined with risperidone in the treatment of refractory obsessive compulsive disorder（OCD）.Methods Sixty patients with OCD were randomly assigned to two groups,study group（n=30） treated with sertraline combined with risperidone,and control group（n=30） treated with sertraline only.Yale Brown Obsessive-Compulsive Scale（Y-BOCS） and Hamilton Anxiety Scale（HAMA） were used to evaluate the effects before and after treatment of 2 weeks,4 weeks,8 weeks and 12 weeks.Side Reaction Scale（TESS） was used to evaluate the side effects after treatment of 2 weeks,4 weeks,8 weeks and 12 weeks.Results After 12 weeks treatment,the total efficiency was 90% in study group,and that in control group was 60%.There were significant differences between two groups（P0.05）.Compared to that before treatment,the scores of Y-BOCS and HAMA were lower in study group at 2 weeks after treatment;But in control group,the scores of Y-BOCS and HAMA were lower in study group than study group at 4 weeks after treatment compared to that before treatment.Between the two groups,the scores of Y-BOCS and HAMA were different at 4 weeks,8 weeks,12 weeks after treatment（P0.05）.There were no differences on the scores of TESS between the two groups（P0.05）.Conclusion The method of sertraline combined with small dose of risperidone is more effective than sertraline monotherapy in the treatment of refractory obsessive compulsive disorder.The method of sertraline combined with small dose of risperidone has good compliance as the same as sertraline.