[摘要] 目的 探讨思瑞康合并氟西汀治疗难治性强迫症的疗效。方法 选择2005年3月~2006年5月于我科门诊及住院治疗的难治性强迫症患者70例，按就诊及确诊顺序编号，单号为观察组(n=36)，双号为对照组(n=34)。对照组给予氟西汀治疗，剂量20 mg, 每天早晨1次，口服。以病情逐渐加量，7~14天加至治疗量。观察组除给氟西汀治疗外，同时合并思瑞康治疗，思瑞康起始量100 mg/d,以每周100~200 mg,逐渐增加剂量，日剂量范围200~600 mg。疗程为8周。采用耶鲁布朗强迫量表评定患者的强迫程度，包括10项症状，每项症状采用5级评分，总分=各项目评分之和。分别于治疗前及治疗后2、4、6、8周末评定1次，一次评定15~20 min。组间比较采用t检验。结果 纳入观察组36例，对照组34例，分别脱落6例、4例，脱落病例均为不能及时复查和进行心理检验者。剩余观察组30例，对照组30例，患者均完成定期的复诊和心理测验，量表检测均经检验符合要求，进入结果分析，(1)两组治疗前后耶鲁布朗强迫量表总分结果：观察组从第2周末起耶鲁布朗强迫量表评分与治疗前相比差异有显著性 (P<0.05)，对照组第4周末耶鲁布朗强迫量表评分与治疗前比较差异有非常显著性 (P<0.01)。(2)两组间在4周末、6周末、8周末耶鲁布朗强迫量表评分值比较差异具有显著性或非常显著性 (P<0.05或P<0.01)；(3)在第4周末对照组副作用高于观察组，差异有显著性(P<0.05)。结论 小剂量思瑞康可作为常规的增效剂治疗难治性强迫症。

    [关键词] 难治性强迫症；思瑞康；氟西汀

    Comparative study on the efficacy of combining seroquel and fluoxetine in treatment of refractory obsessive-compulsive disorder

    LI Qiang,WANG Wei,CHEN Ce,et al.Department of Psychiatry, First Hospital of Xi’an Jiaotong University, Xi’an 710061,China

    [Abstract] Objective To explore the efficacy of combining seroquel and fluoxetine in the treatment of refractory obsessive-compulsive disorder.Methods Seventy refractory obsessive-compulsive patient,who were treated at the psycho out-patient clinic of First Hospital,Xi’an Jiaotong University,October 2005 to May 2006. There were numbered by the order of visiting and diagnosing,the patients with single numbers were considered as study group (n=36) and those with even number was control group (n=34). The patients in the control group were treated with 20 mg fluoxetine,once a day in the morning,taking orally.The dosage was increased gradually according to patient’s condition,and add to the treatment dosage after 7~14 days. Those in the study group were treated with 20 mg fluoxetine integrated with seroquel,fluoxetine dosage was begun from 100 mg a day,and was increased according to 100 mg to 200 mg a week,a day’s dosage limited in 200 mg to 600 mg.The progress was 8 weeks. Obsessive-compulsive level of patients was evaluated with Yale-Brown Obessive-CompulsiveScal(Y-BOCS),Obsessive-compulsive level of patients in the two groups was assessed before treatment and after treatment for 8 weeks,once for 15~20 minutes.Comparison of the two groups was performed with t test.Results Six and four patients in the study group with 36 patients and control group 34 patients were dropped,respectively, because they could not conduct reviews and detection. At Thirty patients in the study group and 30 patients in control group were all conducted regular reviews and psychological detection. The results of scale were all accorded with the criteria,and they were involved in the result analysis.(1)General scores of YBOCS before and after treatment in the two groups.The scales of YBOCS in study group were significantly at the second weekend than before treatment (P<0.05). The scales of YBOCS in control group were significantly higher at the 4.(2)The scales of Y-BOCS of study group and control group were significantly higher at the fourth and the sixth and eighth weekend (P<0.05 or P<0.01).(3)The scales of TESS in control group were significantly than in study group at the fourth weekend(P<0.05).Conclusion Small dose seroquel can be used as synergist of routine antidepressants in the treatment of patients with refractory obsessive-compulsive disorder. ......