Longitudinal course of pharmacotherapy in obsessive-compulsive disorder.
Longitudinal course of pharmacotherapy in obsessive-compulsive disorder.
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DOI：
10.1097/yic.0b013e3283613e4d
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发表时间：
2013-07
影响因子：
2.6
通讯作者：
Rasmussen SA
中科院分区：
文献类型：
--
作者：
Grant JE;Mancebo MC;Weinhandl E;Odlaug BL;Eisen JL;Rasmussen SA
虽然数据完全支持使用5-羟色胺再摄取抑制剂（SRI）治疗强迫症（OCD），但缺乏对强迫症过程中药物治疗中断的研究。这项为期5年的前瞻性研究旨在更好地了解强迫症患者使用SRI的长期过程。共有252名患有精神疾病诊断和统计手册（第4版）强迫症的成年门诊患者在社区接受药物治疗，对SRI的中止和恢复进行了检查。每周强迫症症状，药物和剂量变化的数据，每年获得纵向间隔随访评估。在5年的随访期间，151名患者至少进行了一次为期12周或更长时间的SRI试验。在随访期间，共有110例患者（43.7%）至少停药一次（即停药≥4周）。在停药时有症状的患者中，SRI停药后OCD恶化的累积发生率为9.8%，而在停药时部分或完全缓解的患者中，相应的累积发生率为33.3%。在SRI停药后OCD恶化的患者中，恶化的中位时间为39周。这是第一项关于强迫症使用SRI的纵向研究，发现SRI达到部分或完全缓解的患者不太可能停止用药，停药后强迫症恶化的累积发生率与SRI停药时强迫症的严重程度呈负相关。
Although data fully support the use of serotonin reuptake inhibitors (SRIs) in the treatment of obsessive–compulsive disorder (OCD), investigations on pharmacotherapy discontinuation during the course of OCD are lacking. This 5-year prospective study sought to better understand the long-term course of SRI utilization among individuals with OCD. A total of 252 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, 4th ed. OCD, treated with medication in the community, were examined for discontinuation and resumption of SRIs. Data on weekly OCD symptoms, medications, and dosage changes were obtained annually using the Longitudinal Interval Follow-up Evaluation. During the 5-year follow-up period, 151 patients had at least one trial of an SRI for 12 weeks or more. A total of 110 patients (43.7%) discontinued their medication (i.e. ceased taking medication for ≥4 weeks) at least once during the follow-up period. In patients symptomatic at the time of discontinuation, the cumulative incidence of worsening of OCD after SRI discontinuation was 9.8%, whereas in patients in partial or full remission at the time of discontinuation, the corresponding cumulative incidence was 33.3%. Among patients with worsening of OCD upon SRI discontinuation, the median time to worsening was 39 weeks. This first longitudinal study on the use of SRIs in OCD found that patients who had achieved partial or full remission on SRIs were less likely to discontinue medication, and the cumulative incidence of worsening of OCD after discontinuation was negatively associated with OCD severity at the time of SRI discontinuation.