立体定向手术联合认知疗法对强迫症的疗效观察

The clinical observation of stereotactic surgery and psychotherapy on obsessive-compulsive disorders

目的研究立体定向毁损术联合认知疗法治疗强迫症(OCD)的疗效及安全性。方法对32例强迫症患者行立体定向双侧内囊前肢、尾状核下束毁损术,术后1个月后对患者进行为期半年的心理治疗,分别在术前2 d与术后1、2、6个月进行临床疗效总评量表(CGI)、Yale-Brown强迫量表(Y-BOCS)、汉密顿抑郁量表(HAMD)及汉密顿焦虑量表(HAMA)对疗效进行评定,采用韦氏记忆量表(WMS)及韦氏成人智力量表(WAIS)评估手术的安全性。结果术后1、2、6个月与术前相比,CCI、Y-BOCS、HAMD、HAMA评分差异有统计学意义(P<0.05或P<0.01),WMS及WAIS评分差异无统计学意义(P>0.05),且无严重并发症和后遗症。结论立体定向手术联合认知疗法可以有效缓解患者的强迫症状,提高药物敏感性,明显改善患者的生存质量。

Objective To analyze the therapeutic effect and security of affective on obsessive-compulsive disorders （OCD） in cure of stereotactic surgery and psychotherapy. Methods 32 patients who suffered affective on OCD were treated by stereotaetie technique combined with psychotherapy.The therapeutic effects were estimated with clinical global impressions scale （CGI）,Yale-Brown obsessive-compulsive scale （Y-BOCS）,Hamihon depression scale （HAMD）, Hamilton anxiety scale （HAMA）,Weehsler memory scale （WMS） and Wechsler adult intelligence scale （WAIS） at the two days before surgery and one month,two month,sixth month after surgery. Results The score of the CGI,Y-BOCS, HAMD,HAMA,WMS and WAIS before surgery showed more score decrease compare with the second week and one month,two month,sixth month after surgery （P 〈 0.05 or P 〈 0.01）.WMS and WAIS score was no statistically significant difference （P 〉 0.05）,and no serious complications and sequelae. Conclusion Stereotactic surgery combined with cogni- tive therapy can effectively alleviate the patient＇s symptoms, improve drug sensitivity, improve survival quality of pa- tients.