Obsessive-compulsive hoarding: Symptom severity and response to multimodal treatment
Obsessive-compulsive hoarding: Symptom severity and response to multimodal treatment
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DOI：
10.4088/jcp.v63n0105
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发表时间：
2002-01-01
影响因子：
5.3
通讯作者：
Bystritsky, A
中科院分区：
文献类型：
--
作者：
Saxena, S;Maidment, KM;Bystritsky, A
背景：强迫性囤积和储蓄症状，在许多强迫症（OCD）患者中发现，是一种临床综合征的一部分，与药物治疗和认知行为治疗（CBT）反应不良有关。我们试图确定强迫性囤积综合征患者是否比非囤积强迫症患者有更严重的症状和功能损害，以及他们是否对先前发现的治疗难治性强迫症有效的强化、多模式治疗有反应。方法：我们研究了190例连续的DSM-IV强迫症患者，他们接受了大约6周的公开治疗，在重度强迫症患者的部分住院计划中接受了强化CBT、药物治疗和心理社会康复。190名患者中有20人（11%）被确诊患有强迫性囤积综合症。治疗前后采用耶鲁-布朗强迫症量表（YBOCS）、汉密尔顿抑郁评定量表（HAM-D）、汉密尔顿焦虑评定量表（HAM-A）和总体评定量表（GAS）进行评定。我们比较了强迫性寄宿生与非囤积强迫症患者的症状严重程度和治疗反应。结果：强迫性寄宿症患者的年龄明显大于非囤积症患者（p < 0.001）。在治疗前（p = 0.04）和治疗后（p = 0.002），囤积者的GAS得分显著低于非囤积者，HAM-A得分显著高于非囤积者，但预处理YBOCS得分相似。两组治疗后的YBOCS评分均有显著改善（p < 0.001），但非囤积者的YBOCS评分明显低于囤积者（p = 0.02）。结论：强迫性囤积症是一种明显的。更残疾的强迫症变体，对治疗反应不强，但根据其具体特征和相关缺陷进行强化、多模式治疗，仍可能显著改善。
Background: Compulsive hoarding and saving symptoms, found in many patients with obsessive-compulsive disorder (OCD), are part of a clinical syndrome that has been associated with poor response to medications and cognitive-behavioral therapy (CBT). We sought to determine whether patients with the compulsive hoarding syndrome had more severe symptoms and functional impairment than nonhoarding OCD patients and whether they would respond to intensive, multimodal treatment previously found to be effective for treatment-refractory OCD.Method: We studied 190 consecutive patients with DSM-IV OCD treated openly for approximately 6 weeks with intensive CBT, medication, and psychosocial rehabilitation in a partial hospitalization program for severely ill OCD patients. Twenty of the 190 patients (11%) were identified as having the compulsive hoarding syndrome. All patients were assessed before and after treatment with the Yale-Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Global Assessment Scale (GAS). We compared the symptom severity and response to treatment of compulsive boarders versus nonhoarding OCD patients.Results: Compulsive boarders were significantly older than nonhoarders (p < .001). Hoarders had significantly lower GAS scores and higher HAM-A scores than nonhoarders both before (p = .04) and after (p = .002) treatment, but had similar pretreatment YBOCS scores. Both groups improved significantly with treatment as assessed by YBOCS score (p < .001), but nonhoarders had significantly greater decreases in YBOCS scores than hoarders (p = .02).Conclusion: While the compulsive hoarding syndrome appears to be a distinct. more disabling, variant of OCD that does not respond as robustly to treatment, it may still improve significantly with intensive, multimodal treatment tailored to its specific features and associated deficits.