Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: Results from a controlled trial
Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: Results from a controlled trial
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DOI：
10.1159/000064812
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发表时间：
2002-09-01
影响因子：
22.8
通讯作者：
Baer, L
中科院分区：
文献类型：
--
作者：
Mataix-Cols, D;Marks, IM;Baer, L
背景。近期在强迫症（OCD）方面的因素分析研究确定了一致的症状维度。对这些维度有效性的支持来自对精神共病、功能、脑成像、遗传传递以及对药物治疗反应的研究。本研究检验了先前确定的强迫症症状维度是否与强迫症的行为疗法（BT）的治疗依从性和反应相关。
方法：153名参与了一项计算机辅助与临床医生指导的强迫症行为疗法多中心随机对照试验的强迫症门诊患者被纳入研究。逻辑回归和多元回归模型用于检验对BT和放松治疗的依从性和反应的显著预测因素。
结果：所研究的患者在现象学上（包括“单纯”的强迫观念和精神仪式的存在）与先前的5 - 羟色胺再摄取抑制剂（SRI）试验以及临床流行病学研究中的患者具有可比性。在“囤积”维度上得分高的患者更有可能过早退出研究，并且改善程度较小。对于完成治疗的患者，结果的最强预测因素是治疗前的严重程度。初始抑郁评分与结果无关。在控制症状严重程度后，“性/宗教强迫观念”因子得分较高预示着BT治疗效果较差，尤其是在计算机辅助治疗时。
结论：BT尤其适用于具有攻击/检查、污染/清洁和对称/排序症状的强迫症患者。先前关于囤积症状患者BT治疗不成功的描述可能部分是由于他们更早退出治疗的倾向。有性/宗教强迫观念的患者，但不是有精神仪式的患者，可能对传统的BT技术反应较差。需要改进现有的治疗方法和/或开发新的治疗方法以提高这些患者对治疗的依从性和反应。版权所有（C）2002 S. Karger AG，巴塞尔
Background. Recent factor-analytic studies in obsessive-compulsive disorder (OCD) identified consistent symptom dimensions. Support for the validity of these dimensions. comes from studies of psychiatric comorbidity, functional, brain imaging, genetic transmission, and treatment response to medications. This study examined whether previously identified OCD symptom dimensions are associated with treatment compliance and response to behaviour therapy (BT) for OCD. Methods: One hundred and fifty-three OCD outpatients who participated in a multi-centre randomised controlled trial of computer-versus clinician-guided BT for OCD were included in the study. Logistic and multiple regression models tested for significant predictors of compliance with and response to BT and relaxation. Results: The patients studied were phenomenologically comparable (including the presence of 'pure' obsessions and mental rituals) to those in previous serotonin reuptake inhibitor (SRI) trials and those in clinical epidemiology studies. High scorers on the 'hoarding' dimension were more likely to drop out prematurely from the study and tended to improve less. For those completing treatment, the strongest predictor of outcome was pre-treatment severity. Initial depression scores were unrelated to outcome. After controlling for symptom severity, higher scores on the 'sexual/religious obsessions' factor predicted poorer outcome with BT, especially when computer-guided. Conclusions: BT is especially indicated for OCD patients With aggressive/checking, contamination/cleaning and symmetry/ordering symptoms. Previous accounts of unsuccessful BT in patients with hoarding symptoms may be due in, part to their propensity to drop out earlier from treatment. Patients with sexual/religious obsessions, but not those with mental rituals, might respond less well to traditional BT techniques. Existing treatments need to be refined and/or new treatments developed to improve these patients' adherence and response to treatment. Copyright (C) 2002 S. Karger AG, Basel.