强迫症的临床特征

・论著・

强迫症的临床特征

林雄标　胡纪泽

【摘要】　目的:探讨强迫症(OCD)的临床表现。　方法:对40例符合DSM -ⅣO CD 诊断标准病人进行以下量表和问卷评定:强迫症量表(Y -BOCS),Hamilton 抑郁量表(HAM D),Hamilt on 焦虑量表(HAM A ),M ar ks 恐怖强迫量表(M SCP OR ),临床疗效总评量表(CGI )和艾森克个性问卷(EPQ );并对65名正常人进行EPQ 测试。　结果:15岁以前发病患者的M SCP OR 的工作适应能力下降(W D)分显著高于15岁以后发病患者;合病组病人的HA M D 和EP Q 的神经质分显著高于非合病组;洗涤/回避组的HA M A 评分显著较高,迟缓/仪式化组的发病年龄显著较低,两组的M SCPO R 的WD 评分均显著高于强迫检查行为组。　结论:15岁以前发病,合病组,主要表现迟缓/仪式化或洗涤/回避症状的病人是OCD 较为严重的亚型。

【关键词】　强迫症 临床特征

Clinical characters of obsessive compulsive disorder L in X iongbiao ,H u J iz e .K angning H osp ital of Shenz hen ,Guangdong 518003

【Abstract 】　Obj ective :T o ex plor e the clinical featur es and subtypes of obsessive com pulsive disor der (O CD ).　Method :Fo r ty cases o f OCD w ere assessed with Y ale-Bro w n o bsessive com pulsive sca le (Y-BO CS),Hamilto n depressio n scale (HA M D ),Ham ilt on anx iety sca le (HA M A ),clinical g lo ba l impr essio n (CG I )and Ey senk personality questio nnaire (EP Q ),a nd 65no rmal contr ols w er e measur ed w ith EP Q .　Results :T he scor es o f w or k disability (WD )item of M ar ks scale for compulsions ,pho bias ,obsessions and ritua ls (M SCPO R)wer e significant ly higher on pa tients who se o nset a ge w ere less than 15.T he como rbid g r oup had significantly hig her in patients who se onset ag e w er e less than 15.T he como rbid g ro up had sig nificantlly higher sco res of HAM D and neur oticism subscale of EPQ .T he sco res of HAM A wer e higher in patients char acterized by w ashing/pho bic avo id behavior ,and the onset age w as young er in patients char act erized by slow ness/ritual beha vio r.Bo th g r oups had hig her sco r es in w or k disa bility item o f M SCPO R.　Conclusion :It is sug gested that slo wness/r itual behavio r and w ashing /av oid behav io r ar e sever e subtypes of O CD ,and the patients with these subtypes usually have como rbidities,w hose o nset a ge ar e less than 15.

【Key Words 】　O bsessiv e compulsiv e diso rder Clinical featur e

美国全国同病率调查(NCS)结果表明,强迫症(OCD)是仅次于抑郁症、酒依赖和恐怖症的第4位常见病[1],临床表现主要为认知与行为障碍。由于病程多变,部分患者疗效不好,因此,OCD 亚型的划分渐受到人们关注,现结合临床对此进行探讨。作者单位:518003　广东深圳市康宁医院

1　对象和方法1.1　对象

研究组:为1999年我院门诊及住院病人,以SCID -P 定式检查提纲收集临床资料: 符合DSM -Ⅳ中OCD 诊断标准; Yale-Brow n 强迫症量表(Y-BOCS)评分>16分[2]

; Hamilton 抑郁量表(H AMD )评分<21分; 未服精神药物或停药4周以上; 病程1年以上; 无心、肝、肾等严重躯体疾病。共40例,男26例,女14例。年龄15～37岁,平均(25.1±5.4)岁。已婚11例,未婚29例。职业:中学生8例,工人5例,干部4例,技术人员7例,待业或病休13例,其它3例。文化程度:初中6例,高中22例,大专及以上12例。起病年龄9～30岁,平均(18.9±5.5)岁,男性(18.3±5.4)岁,女性(20.2±5.5)岁,25岁以前起病者34例。病程1～15年,平均(6.2±4.1)年。有精

・

332・J Clin Psychol M ed ,2000,Vol 10,No.6