强迫症怎样治疗好

强迫症如何治疗好配图，仅供参考

CURRENT TREATMENTS FOR OCD
Despite a lack of understanding about the precise neurobiological mechanisms underlying OCD,treatments have been developed that are at least partially effective in alleviating symptoms. These treatments can be subdivided into either pharmacological or behavioral therapies.
# Pharmacological Therapies
The current first-line drugs in the treatment of OCD are selective serotonin reuptake inhibitors (SSRIs). The SSRIs fluoxetine,fluvoxamine,sertraline,and paroxetine have been approved by the Food and Drug Administration (FDA) for the treatment of OCD,although paroxetine is not approved for use in pediatric cases. SSRIs act by blocking the presynaptic serotonin transporter (5-HTT) that normally mediates the reuptake of synaptically released serotonin. All of the currently available SSRIs that have been investigated seem to exhibit similar efficacy in treating OCD symptoms. On average,SSRI responders see a modest but significant reduction of symptoms,whereas 40-60% of patients are unresponsive to SSRI monotherapy .
Notably,higher doses of SSRIs over longer periods of time (2-3 months) are necessary to achieve optimal anti-obsessional benefits in comparison to their implementation in the treatment of major depression . This delay in therapeutic benefit in the treatment of OCD is suggested to reflect the time course of serotonin receptor desensitization resulting from chronically elevated synaptic serotonin levels . Long-term modifications at serotonin receptors are also indicated by the fact that acute interventions known to decrease serotonin transmission fail to disrupt the ongoing benefits of SSRI treatment in OCD patients .
The tricyclic antidepressant clomipramine is often still considered a first-line drug in treating OCD symptoms,and there is some evidence to suggest superior efficacy relative to SSRIs; however,clomipramine is less well tolerated than the SSRIs and causes a broad range of side effects—likely due to anticholinergic effects . Thus,clomipramine may be best utilized for patients that are refractory to SSRI treatment.
Augmenting agents are employed when there is a partial response to SSRI monotherapy. Since this is the most likely outcome for the majority of cases,the use of augmenting agents is common,and this strategy is generally favored over switching to a different SSRI monotherapy since a partial response has been established. Examples of augmenting agents that are commonly employed include the antipsychotics risperidone and haloperidol. A detailed guideline (algorithm) for OCD pharmacotherapy can be found elsewhere .
# Behavioral Therapies
A specific form of cognitive-behavioral therapy called exposure and response prevention (ERP) is an established and effective treatment for some OCD symptoms . ERP involves having the OCD patient repeatedly expose themselves to anxiety-inducing stimuli linked to frequent obsessions (e.g. contact with contaminated objects),followed by a prevention of the rituals that typically ensue (e.g. hand washing). In this way the patient undergoes habituation to the aversive stimuli with repeated exposures. The response prevention aspect is critical in allowing the patient to learn that the decreasing anxiety experienced with repeated exposure is not linked to the completion of compulsion-induced rituals . ERP has been shown to be equally or perhaps more effective in treating OCD symptoms than pharmacological treatments alone,and the rate of relapse following cessation of treatment is significantly lower for ERP compared to pharmacological treatments alone . Thus,cognitive-behavioral therapy may be implemented as a first-line treatment and is a particularly valuable treatment option for SSRI refractory patients and patients that refuse pharmacological treatment altogether. Other structured psychotherapies such as cognitive therapy without ERP are also a valuable treatment option,particularly in cases where specific OCD symptoms are not amenable to ERP therapy .
# Combined Therapy
There is some evidence that combined pharmacological and behavioral treatments (SSRIs or clomipramine combined with cognitive-behavioral therapy) are more effective than SSRI or clomipramine monotherapy,although it is unclear at this time if combined regimes offer significant benefits over cognitive-behavioral therapy alone . Even the most rigorous treatment regimes available today offer incomplete reprieve for most. Advances in our understanding of the basic neurobiological mechanisms underlying OCD are necessary to guide the development of improved treatment options.","department":"