CAJ | 학술논문

目的探讨舍曲林对强迫症临床症状、执行功能和职业功能的远期效果.方法对强迫症患者按随机分组原则,研究组48例以舍曲林治疗,对照组44例以氯米帕明治疗,好转后以相对稳定剂量维持,均辅以心理治疗和康复活动.于治疗前、治疗2周末、4周末、6周末、8周末各时点分别调查和比较两组患者的强迫症状检出率;随访2年,以耶鲁布朗强迫症量表(Y-BOCS)总分减分率评估8周末和2年的临床疗效,完成连线测验A和B(TMT-A和TMT-B)、Stroop测验、社会功能缺陷筛选量表(SDSS)以评估执行功能和社会职业功能,并进行组间比较.结果研究组治疗4周末的强迫观念(62.5％)和6周末的强迫行为检出率(18.8％)均显著低于对照组(分别为81.8％和38.6％,P＜0.05),但8周末(8.3％～22.9％)和2年的强迫症状检出率(6.3％～12.5％)与对照组(分别为20.5％～40.9％和15.9％～22.7％)之间差异无统计学意义(P＞0.05).8周末和2年的临床疗效两组之间差异也无统计学意义(P＞0.05).治疗2年后研究组的连线测验B时间[(46.4±6.4)s]和彩色文字的颜色阅读时间[Stroop-CW(132.2±14.9)s]均显著短于对照组[分别为(49.3±6.5)s和(138.8±15.7)s,P＜0.05].治疗第2年随访显示SDSS总分及职业功能因子分研究组均显著低于对照组(P＜0.01),而就业率研究组(72.9％)显著高于对照组(47.7％,P＜0.05).研究组不良反应总发生率(12.5％)显著低于对照组(43.2％,P＜0.05).结论舍曲林对强迫症临床症状的效果与氯米帕明相当,但远期对改善执行功能和职业功能显著更优.
목적 탐토사곡림대강박증림상증상、집행공능화직업공능적원기효과.방법 대강박증환자안수궤분조원칙,연구조48례이사곡림치료,대조조44례이록미파명치료,호전후이상대은정제량유지,균보이심리치료화강복활동.우치료전、치료2주말、4주말、6주말、8주말각시점분별조사화비교량조환자적강박증상검출솔;수방2년,이야로포랑강박증량표(Y-BOCS)총분감분솔평고8주말화2년적림상료효,완성련선측험A화B(TMT-A화TMT-B)、Stroop측험、사회공능결함사선량표(SDSS)이평고집행공능화사회직업공능,병진행조간비교.결과 연구조치료4주말적강박관념(62.5％)화6주말적강박행위검출솔(18.8％)균현저저우대조조(분별위81.8％화38.6％,P＜0.05),단8주말(8.3％～22.9％)화2년적강박증상검출솔(6.3％～12.5％)여대조조(분별위20.5％～40.9％화15.9％～22.7％)지간차이무통계학의의(P＞0.05).8주말화2년적림상료효량조지간차이야무통계학의의(P＞0.05).치료2년후연구조적련선측험B시간[(46.4±6.4)s]화채색문자적안색열독시간[Stroop-CW(132.2±14.9)s]균현저단우대조조[분별위(49.3±6.5)s화(138.8±15.7)s,P＜0.05].치료제2년수방현시SDSS총분급직업공능인자분연구조균현저저우대조조(P＜0.01),이취업솔연구조(72.9％)현저고우대조조(47.7％,P＜0.05).연구조불량반응총발생솔(12.5％)현저저우대조조(43.2％,P＜0.05).결론 사곡림대강박증림상증상적효과여록미파명상당,단원기대개선집행공능화직업공능현저경우.
Objective To explore the long-term effects of sertraline on clinical symptoms,executive and occupational functions of patients with obsessive-compulsive disorder.Methods By randomly grouped,48 cases with obsessive-compulsive disorder were treated with sertraline as the study group and 44 cases treated with clomipramine as the control one.They were maintained with relative stable drug dosage after ill-condition improving,and all the subjects were also treated with psychological treatment and rehabilitation activities.The incidences of obsessive-compulsive symptoms before and after 2,4,6 and 8 weeks of treatment were investigated and compared.Yale-Brown obsessive-compulsive scale(Y-BOCS) were used to evaluate the efficacy according to the Y-BOCS reducing rate.The trail making test A and B (TMT-A and TMT-B),Stroop test and the Social Disability Screening Schedule (SDSS) were used at 8th weekend and 2 year's follow-up to evaluate and compare the two groups' executive and occupational functions.Results The incidences of 4 weeks' obsessive symptoms (62.5％)and 6 weeks' compulsive symptoms(18.8％) showed significantly lower in the study group than those in the control one (81.8％ and 38.6％,P＜0.05).But the obsessive-compulsive symptoms incidences at 8 weeks(8.3％-22.9％) and 2 years' treatment(6.3％-12.5％) in study group showed no statistical meaning differences from the control (20.5％-40.9％ and 15.9％-22.7％,P＞0.05).The clinical efficacy also showed no statistical difference between the two groups (P＞0.05).After two years' treatment,the times of TMT-B ((46.4±6.4) s) and Stroop-CW ((132.2± 14.9) s)of the study group showed significantly shorter than those of the control ((49.3±6.5) s,(138.8± 15.7)s,P＜0.05),and the total score and occupational function score of SDSS were significantly lower (P＜0.01) but the employment rates (72.9％)higher in the study group than those in the control (47.7％,P＜0.05).The total side-effect rate of the study group (12.5％) showed significantly lower than that of the control (43.2％,P＜0.05).Conclusion Sertraline is as effective as clomipramine for treatment clinical symptoms of obsessive-compulsive disorder.But it shows better long-term efficacy in improving executive and occupational social functions.