左洛复用于强迫及相关障碍治疗课件.ppt

1、左洛复用于强迫及相关障碍的治疗DSM-5中的强迫及相关障碍Obsessive-Compulsive and Related Disorderscompulsive and related disorder due to another medical condition)n其他特定的强迫及相关障碍其他特定的强迫及相关障碍(other specified obsessive-compulsive and related disorder)n非特定的强迫及相关障碍（非特定的强迫及相关障碍（unspecified obsessive-compulsive and related disorder)2

2、强迫及相关障碍的基本特征3强迫障碍的治疗方法n森田治疗Common components of CBT for OCD Education Exposure Response prevention Cognitive interventions Family involvement Problem solving Relapse preventionCan J Psychiatry,Vol 51,Suppl 2,July 20064强迫障碍的治疗药物Can J Psychiatry,Vol 51,Suppl 2,July 20065加拿大强迫障碍治疗指南药物推荐Can J Psychiatry

3、,Vol 51,Suppl 2,July 20066WFSBP强迫症循证治疗指南The World Journal of Biological Psychiatry,2008;9(4):2483127SSRI为强迫障碍治疗一线用药 新英格兰医学杂志临床实践指南指出：SSRIs是治疗强迫症最有效的药物1 美国FDA批准推荐舍曲林为治疗强迫症药物之一3 世界生物精神病学联盟(WFSBP)药物治疗指南推荐：SSRIs是治疗强迫症的一线用药2 舍曲林治疗强迫症具有A级证据，属一级推荐用药21.Jenike MA,et al.N Engl J Med.2004 15(350)3:259-65.2.Bor

4、win Bandelow,et al.The World Journal of Biological Psychiatry.2008(9)4:248-312.3.Lorrin M,et al.Practice Guideline For The Treatment of Patients With Obsessive-Compulsive Disorder 11,14,24.89舍曲林与氯丙咪嗪治疗强迫障碍的疗效强迫障碍的规范治疗流程15强迫障碍的治疗策略强迫障碍药物治疗的剂量西酞普兰ES西酞普兰氟西汀氟伏沙明帕罗西汀舍曲林起始剂量起始剂量(mg/d)a儿童(18yr)10102525成人(1

5、8-65 yr)20102050205065 yr20520502050维持剂量维持剂量(mg/d)儿童(18yr)102525-20025-200成人(18-65 yr)4010100100-30040-6020065 yr205100100-30020-40200最大剂量最大剂量儿童(18yr)6020200200成人(18-65 yr)6020603006020065 yr40206030040200超大剂量超大剂量120601204501004001.International Journal of Neuropsychopharmacology,2012:1-192.Journal

6、of Psychopharmacology.2005;19(6):56759617强迫障碍药物治疗的剂量：加拿大指南18强迫障碍药物治疗：较高剂量与药代动力学特征1.Lorrin M,et al.Practice Guideline For The Treatment of Patients With Obsessive-Compulsive Disorder.2.Goodnick PJ.Clin Pharmacokinet.1994;27(4):307-330.19SSRI治疗强迫障碍的线性量效关系SSRI治疗强迫障碍的线性量效关系SSRI治疗强迫症剂量与耐受程度关系Bloch MH,et

7、al.Molecular Psychiatry 2010;15:850-855.20大剂量舍曲林治疗强迫症疗效更佳治疗期（周）Y-BOCS总分Ninan PT,et al.J Clin Psychiatry 2006;67:15-22.66名经16周一般剂量舍曲林治疗无效的OCD患者随机分为高剂量组（n=30）和一般剂量组（n=36）继续治疗12周From:APA Practice Guideline For The Treatment of Patients With Obsessive-Compulsive Disorder21强迫障碍药物治疗的疗程1.Lorrin M,et al.Practice Guideline For The Treatment of Patients With Obsessive-Compulsive Disorder.2.Can J Psychiatry,Vol 51,Suppl 2,July 200622强迫障碍的疗效评估23强迫障碍的疗效评估J Clin Pract,July 2007,61,7,1188119724