Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder
Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder
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DOI：
10.1176/appi.ajp.162.1.151
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发表时间：
2005-01-01
影响因子：
17.7
通讯作者：
Tu, X
中科院分区：
文献类型：
--
作者：
Foa, EB;Liebowitz, MR;Tu, X
目的：本研究的目的是测试氯丙咪嗪和暴露和仪式预防在成人强迫症（OCD）治疗中的相对和联合疗效。5-羟色胺再摄取抑制剂（Serotonin reuptake inhibitors，SRI）和认知行为疗法（cognitive behavior therapy，通过暴露和仪式预防）都是治疗强迫症的既定疗法，但它们的相对和联合疗效尚未得到最终证明。一项双盲、随机、安慰剂对照试验，比较暴露和仪式预防、氯丙咪嗪及其组合（暴露和仪式预防加氯丙咪嗪），和药丸安慰剂在一个中心的药物治疗专家，另一个在暴露和仪式预防的专业知识，第三个在这两种方式的专业知识。参与者是患有强迫症的成人门诊患者（N=122名入组者）。干预措施包括4周的强化暴露和仪式预防，随后是8周的每周维护会议，和/或氯丙咪嗪管理12周。最大剂量为250 mg/天。主要结果的措施是耶鲁-布朗强迫症量表总分和临床总体印象改善scale.Results确定的反应率：在第12周，所有积极治疗的效果均优于安慰剂上级。暴露和仪式预防与暴露和仪式预防加氯丙咪嗪的效果无差异，均上级单独氯丙咪嗪。治疗和完全缓解率分别为62%和86%。氯丙咪嗪组分别为4296和48%，氯丙咪嗪+氯丙咪嗪组分别为70%和795，安慰剂组分别为8%和10%。密集接触和仪式预防可能上级氯丙咪嗪和。暗示着与其他SRI的单药治疗。
Objective: The purpose of the study was to test the relative and combined efficacy of clomipramine and exposure and ritual prevention in the treatment of obsessive-compulsive disorder (OCD) in adults. Serotonin reuptake inhibitors (SRIs) and cognitive behavior therapy by exposure and ritual prevention are both established treatments for OCD, yet their relative and combined efficacy have not been demonstrated conclusively.Method: A double-blind, randomized, placebo-controlled trial comparing exposure and ritual prevention, clomipramine, their combination (exposure and ritual prevention plus clomipramine), and pill placebo was conducted at one center expert in pharmacotherapy, another with expertise in exposure and ritual prevention, and a third with expertise in both modalities. Participants were adult outpatients (N=122 entrants) with OCD. Interventions included intensive exposure and ritual prevention for 4 weeks, followed by eight weekly maintenance sessions, and/ or clomipramine administered for 12 weeks. with a maximum dose of 250 mg/ day. The main outcome measures were the Yale-Brown Obsessive Compulsive Scale total score and response rates determined by the Clinical Global impression improvement scale.Results: At week 12, the effects of all active treatments were superior to placebo. The effect of exposure and ritual prevention did not differ from that of exposure and ritual prevention plus clomipramine, and both were superior to clomipramine only. Treated and completer response rates were, respectively, 62% and 86%. for exposure and ritual prevention, 4296 and 48% for clomipramine, 70% and 795 for exposure and ritual prevention plus clomipramine, and 8% and 10% for placebo.Conclusions: Clomipramine, exposure and ritual prevention, and their combination are all efficacious treatments for OCD. Intensive exposure and ritual prevention may be superior to clomipramine and. by implication, to monotherapy with the other SRIs.