阿立哌唑合并5-羟色胺再摄取抑制剂与氯米帕明治疗5-羟色胺再摄取抑制剂无效强迫障碍的临床对照研究

A controlled clinical study of aripiprazole combined with SSRIs vs.chlorimi-pramine in treatment of SSRIs refractory obsessive-compulsive disorder

目的探索5-羟色胺再摄取抑制剂(SSRIs)治疗无效的强迫障碍的治疗方案。方法将73例强迫障碍患者随机分为3组:(1)增效剂组26例,在原用SSRIs药物剂量不变的基础上加用阿立哌唑治疗,起始量为5 mg·d^(-1),最大剂量不超过20 mg·d^(-1);(2)换药组24例,停用SSRIs药,换为氯米帕明单药治疗,初始剂量50～75 mg·d^(-1),逐渐增加至150～225 mg·d^(-1);(3)对照组23例,继续使用原SSRIs药单药治疗。疗程均为12 wk。用Yale-Brown强迫量表(Y-BOCS)、大体评定量表(GAS)评定疗效,并观察不良反应。结果治疗wk 8、wk 12末增效剂组和换药组Y-BOCS、Y-BOCS强迫思维、Y-BOCS强迫行为和GAS评分均无显著差异(P>0.05)。治疗wk 12末,增效剂组4项评分均与对照组有非常显著差异(P<0.01),换药组除Y-BOCS强迫思维外其余3项评分与对照组比较均有显著差异(P<0.01)。增效剂组、换药组和对照组显效率分别为50%、38%、13%:换药组和增效剂组显效率无显著差异(x^2=0.79,P>0.05),增效剂组和对照组有非常显著差异(x^2=7.58,P<0.01),换药组和对照组相比无显著差异(x^2=3.70,P=0.055)。换药组不良反应发生率和增效剂组相比无显著差异(P>0.05);2组和对照组相比,均有显著差异(P<0.05)。结论对于SSRIs治疗效果不理想的强迫障碍,可使用阿立哌唑增效或换为氯米帕明作为候选的治疗方案,二者疗效和安全性相近。

AIM To explore the treatment （SSRIs） refractory obsessive-compulsive disorder plan in the treatment of selective serotonin reuptake inhibitors METHODS Seventy-three patients with obsessive compulsive disorder were randomly assigned to three groups： （1） augmentation treatment group （n = 26） was treated by aripiprazole based upon preceding SSRIs, with the initial dose 5 mg·d-1 and maximum dose 20 mg·d-1; （2） switch treatment group （n = 24） stopped taking SSRIs with the change of chlorimipramine, from initial dose 50 - 75 mg·d-1 increased up to 150 - 225 mg·d-1 gradually; （3） control group （n = 23） continued the SSRIs monotherapy as before. The treatment course was 12 weeks in all three groups. Yale-Brown Obsessive Compulsive Scale （Y-BOCS） and Global Assessment Scale （GAS） were used to evaluate the therapeutic efficacy, and adverse drug reactions were observed. RESULTS At the end of wk 8 and wk 12 of the treatment, there were no significant differences between the augmentation treatment group and the switch treatment group in scores of the Y-BOCS, Y-BOCS obsessions, Y-BOCS compulsions and GAS （P 〉 0.05）. At the end of wk 12, there were significant differences in the four scores between the augmentation treatment group and the control group （P 〈 0.01）, and except scores of Y-BOCS obsessions, there were significant differences in other three scores between the switch treatment group and the control group （P 〈 0.01） . The significant improvement rate of the augmentation treatment group, switch treatment group and control group was 50%, 38% and 13% respectively： there were no significant differences between the augmentation treatment group and the switch treatment group or the control group （χ2 = 0.79, P 〉 0.05; χ2 = 3.70, P = 0.055 ）. But the differences between the augmentation treatment group and the control group were significant （χ2 = 7.58, P 〈 0.01） . Furthermore, the adverse reaction incidence between the augmentation treatment group and the switch treatment group had no differences （P 〉 0.05）, and they both had significant difference compard with the control group （P 〈 0.05）. CONCLUSION Aripiprazole augmentation and chlormipramine switch could be the candidate treatment plan in the treatment of SSRIs refractory obsessive-compulsive disorder. The curative effect and the safety were similar in these two plans.