氟伏沙明联合长效哌甲酯治疗难治性强迫症的疗效  

Efficacy of fluvoxamine combined with extended-release methylphenidate on treatment-refractory obsessive-compulsive disorder

作　　者：郑会蓉[1] 贾福军[1] 郭光全 全东明 李刚[1] 黄惠燕[2] ZHENG Huirong;JIA Fujun;GUO Guangquan;QUAN Dongming;LI Gang;HUANG Huiyan(Guangdong Mental Health Center,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Pharmacy,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省医学科学院,广东省人民医院广东省精神卫生中心,广州510080 [2]广东省医学科学院,广东省人民医院药学部,广州510080

出　　处：《中南大学学报（医学版）》2018年第11期1230-1235,共6页Journal of Central South University ：Medical Science

基　　金：广东省科技计划(2014A020212587);广东省自然科学基金(2018A030313989);广东省医学科研基金(B2013006);广州市科技计划(201804010331).

摘　　要：目的:观察氟伏沙明联合长效哌甲酯治疗难治性强迫症的临床效果,探讨该治疗对患者焦虑情绪和睡眠质量的影响。方法:采取随机、双盲、安慰剂对照研究,将44例强迫症患者随机分成两组,每组22例,研究组服用氟伏沙明和长效哌甲酯缓释片,对照组服用氟伏沙明和安慰剂,随访时间均为8周。采用耶鲁-布朗强迫症状量表(Yale-Brown Obsessive Compulsive Scale,Y-BOCS)、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评定临床疗效,采用匹兹堡睡眠质量指数量表(Pitt sburgh Sleep Quality Index,PSQI)评定睡眠质量,采用不良反应量表(Treatment Emergent Symptom Scale,TESS)评定不良反应。结果:研究组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗第8周末两组Y-BOCS,HAMA评分比较差异有统计学意义(P<0.05),两组PSQI评分差异无统计学意义(P>0.05)。TESS评分在治疗第2,4,6,8周末差异均无统计学意义(P>0.05)。结论:氟伏沙明联合长效哌甲酯治疗难治性强迫症具有较好的疗效,可改善患者的焦虑情绪,对患者睡眠质量无影响,安全性较好,值得进一步在临床推广。Objective:To observe the clinical efficacy of dopamine modulator methylphenidate (MPH)of extended-release formulations (MPH-ER)augmentation of ongoing fluvoxamine treatment in refractory obsessive-compulsive disorder (OCD)and its effects on patient's anxiety and sleep quality. Methods:A pilot randomized,placebo-controlled,and double-blind trial was conducted at an outpatient,single-center academic setting.Participants included 44 adults with serotonin reuptake inhibitor treatment-refractory OCD and they received a stable fluvoxamine pharmacotherapy with Yale-Brown Obsessive Compulsive Scale (Y-BOCS)scores higher than 20.The 44 patients were randomly assigned into a study group and a control group,with 22 patiencs in each group. Fluvoxamine and MPH-ER were given to the study group,while fluvoxamine and placebo were given to the control group,with 8 weeks of the treatment course.Y-BOCS,Hamilton Anxiety Scale (HAMA)were used to assess the efficacy,Pittsburgh Sleep Quality Index (PSQI)was used to evaluate the sleep quality,and Treatment Emergent Symptom Scale (TESS)was used to evaluate the side effects.Data were analyzed in the intention-to-treat sample. Results:The improvement in the Y-BOCS total score,Y-BOCS obsession subscale score and HAMA score were more prominent in the study group than those in the control group (P<0.001). There was no significant difference in PSQI score and TESS score between the two groups.MPH-ER was well tolerated. Conclusion:Fluvoxamine combined with MPH-ER is effective in the treatment of refractory obsessive-compulsive disorder.It can improve anxiety and has no adverse effect on sleep quality.

关 键 词：难治性强迫症 长效哌甲酯 焦虑 睡眠质量 

分 类 号：R749.7[医药卫生—神经病学与精神病学]