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Abstract：
OBJECTIVE: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD).
METHODS: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA).
RESULTS: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD.
CONCLUSIONS: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.
METHODS: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA).
RESULTS: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD.
CONCLUSIONS: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.
摘要：
目的：总结成人强迫症（OCD）患者的循证药物治疗方法，指导临床干预。
方法：美国精神病学协会（APA）强迫症治疗指南（2013年）进行了系统评价，评估了成人强迫症药物治疗的疗效，包括选择性5-羟色胺再摄取抑制剂（SSRIs）的单一疗法，氯米帕明,5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）-以及氯米帕明的增强策略，抗精神病药和谷氨酸调节剂。我们在五个数据库中搜索了2013-2020年发表的文献，考虑到研究的设计，主要结果指标，出版物和语言的类型。选定的文章使用经过验证的工具评估其质量。根据ACC/AHA开发的证据水平对治疗建议进行分类。
结果：我们检查了57项新研究，以更新2013年APA指南。高质量的证据支持SSRIs作为强迫症的一线药物治疗。此外，用抗精神病药增强SSRIs(利培酮，阿立哌唑）是SSRI耐药OCD的最循证药物干预措施。
结论：SSRIs在8-12周的最高推荐或耐受剂量下仍然是成人强迫症的一线治疗。SSRI抗性强迫症的最佳增强策略包括低剂量利培酮或阿立哌唑。还详述了被认为无效或潜在有害的药物治疗。
方法：美国精神病学协会（APA）强迫症治疗指南（2013年）进行了系统评价，评估了成人强迫症药物治疗的疗效，包括选择性5-羟色胺再摄取抑制剂（SSRIs）的单一疗法，氯米帕明,5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）-以及氯米帕明的增强策略，抗精神病药和谷氨酸调节剂。我们在五个数据库中搜索了2013-2020年发表的文献，考虑到研究的设计，主要结果指标，出版物和语言的类型。选定的文章使用经过验证的工具评估其质量。根据ACC/AHA开发的证据水平对治疗建议进行分类。
结果：我们检查了57项新研究，以更新2013年APA指南。高质量的证据支持SSRIs作为强迫症的一线药物治疗。此外，用抗精神病药增强SSRIs(利培酮，阿立哌唑）是SSRI耐药OCD的最循证药物干预措施。
结论：SSRIs在8-12周的最高推荐或耐受剂量下仍然是成人强迫症的一线治疗。SSRI抗性强迫症的最佳增强策略包括低剂量利培酮或阿立哌唑。还详述了被认为无效或潜在有害的药物治疗。
