1、左洛复用于强迫及相左洛复用于强迫及相关障碍的治疗关障碍的治疗强迫与相关障碍的基本特征2强迫障碍的治疗方法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 20063强迫障碍的治疗药物Can J Psychiatry,Vol 51,Suppl 2,July 20064加拿大强迫障
2、碍治疗指南药物推荐Can J Psychiatry,Vol 51,Suppl 2,July 20065WFSBP强迫症循证治疗指南The World Journal of Biological Psychiatry,2008;9(4):2483126SSRI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.
3、2004 15(350)3:259-65.2.Borwin 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 11,14,24.78舍曲林与氯丙咪嗪治疗强迫障碍的疗效11强迫障碍的规范治疗流程14强迫障碍的治疗策略15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
4、始剂量(mg/d)a儿童(18yr)10102525成人(18-65 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 Neuropsychoph
5、armacology,2012:1-192.Journal of Psychopharmacology.2005;19(6):56759616强迫障碍药物治疗的剂量：加拿大指南17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):307-330.18SSRI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
6、SSRI治疗强迫症剂量与耐受程度关系Bloch MH,et al.Molecular Psychiatry 2010;15:850-855.19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 Disorder20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 200621强迫障碍的疗效评估22强迫障碍的疗效评估J Clin Pract,July 2007,61,7,1188119723 结结 语语
