诊断

帮助诊断强迫症的步骤可能包括:

  • 心理评估。这包括讨论您的想法、感受、症状和行为模式,以确定您是否有干扰生活质量的强迫行为。在您允许的情况下,可能还会与您的家人或朋友交谈。
  • 体格检查。可能要进行此检查,以排除其他可能导致症状的问题,并检查是否有任何相关的并发症。

诊断挑战

OCD 有时难以诊断,原因是其症状可能与强迫性人格障碍、焦虑障碍、抑郁症、精神分裂症或其他心理健康疾病的症状相似。此外,患者可能同时患有 OCD 和另一种心理健康疾病。配合医生的工作,以确保得到正确的诊断和治疗。

治疗

强迫症的治疗可能无法根治病症。但是,治疗可使症状在控制范围之内,不让它们支配您的日常生活。您可能会需要接受长期持续治疗或强度更高的治疗,具体取决于您 OCD 的严重程度。

OCD 的两种主要治疗方法是心理疗法和药物治疗。心理疗法也称为谈话治疗。通常,结合使用这两种治疗方法效果最好。

心理疗法

认知行为疗法(CBT)是一种心理疗法,对许多 OCD 患者有效。暴露和反应预防(ERP)是 CBT 疗法的一部分,让您长时间暴露于某个令您恐惧的物体或某个强迫思维(例如污垢)。然后让您学习如何不去做强迫性的仪式化动作。ERP 需要努力和练习,但您一旦学会管理自己的强迫思维和强迫行为,您将能够享受更好的生活质量。

药物

某些精神病药物有助于控制 OCD 的强迫思维和强迫行为。通常会先尝试使用抗抑郁药。

美国食品药品管理局(FDA)已批准的治疗 OCD 的抗抑郁药包括:

  • 氟西汀(Prozac),适用于成人和 7 岁及以上儿童。
  • 氟伏沙明(Luvox),适用于成人和 8 岁及以上儿童。
  • 帕罗西汀(Paxil),仅适用于成人。
  • 舍曲林(Zolof),适用于成人和 6 岁及以上儿童。
  • 氯米帕明(Anafrani),适用于成人和 10 岁及以上儿童。

但您的医生可能会开其他抗抑郁药和精神病药物。

Medicines: What to consider

When talking with your doctor about medicines for OCD, consider:

  • Medicine selection. In general, the goal is to effectively control symptoms at the lowest possible dose. OCD may sometimes require higher doses of medicines to be the most effective in controlling your symptoms. It's not unusual to try several drugs before finding one that works well. Your doctor might recommend more than one medicine to effectively manage your symptoms. It can take weeks to months to get better after starting a medicine for your symptoms.
  • Side effects. All psychiatric medicines may have side effects. Talk to your doctor about possible side effects and about any health monitoring needed while taking psychiatric drugs. And let your doctor know if you have troubling side effects.
  • Suicide risk. Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings. These are the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants. This is especially true in the first few weeks after starting or when the dose is changed. If suicidal thoughts occur, contact your doctor or get emergency help at once. Keep in mind that antidepressants are more likely to lower suicide risk in the long run by making your mood better.
  • Interactions with other substances. When taking an antidepressant, tell your doctor about any other prescription medicines available without a prescription, herbs or other supplements you take. Some antidepressants can make some other medicines less effective and cause dangerous reactions when combined with certain medicines or herbal supplements.
  • Stopping antidepressants. Antidepressants aren't thought to be addictive, but sometimes physical dependence can occur. Stopping treatment suddenly or missing several doses can cause withdrawal-like symptoms. This is sometimes called discontinuation syndrome. Don't stop taking your medicine without talking to your doctor, even if you're feeling better. You may have a relapse of OCD symptoms. Work with your doctor to lower your dose safely over time.

Talk to your doctor about the risks and benefits of using specific medicines.

其他治疗

有时,心理疗法和药物无法控制 OCD 的症状。在治疗无效的情况下,可提供其他治疗方案:

  • 强化门诊项目和住院治疗项目。强调 ERP 治疗原则的全面治疗项目可能对因症状严重而难以正常生活的 OCD 患者有所帮助。这些项目通常会持续几周。
  • 脑深部刺激(DBS)。FDA 已批准 DBS 用于治疗对传统治疗方法无反应的 OCD 成人患者(18 岁及以上)。DBS 需要在大脑的某些区域内植入电极。这些电极产生的电脉冲可以帮助控制不典型的脉冲。DBS 尚未普及,很少使用。
  • 经颅磁刺激(TMS)。FDA 已批准三种 TMS 设备(BrainsWay、MagVenture 和 NeuroStar)用于治疗 OCD 成人患者。这些设备用于传统治疗方法无效时。TMS 不需要实施手术。它利用磁场刺激大脑中的神经细胞,以改善 OCD 的症状。在 TMS 治疗过程中,医生会在您前额附近的头皮上放置一个电磁线圈。线圈会传送磁脉冲,刺激大脑中的神经细胞。

如果您考虑接受 DBSTMS 治疗,请咨询医生,确保您了解其所有利弊以及潜在健康风险。

生活方式与家庭疗法

强迫症是一种慢性医疗状况,这意味着该状况可能成为您生活的一部分。虽然专业人士应治疗 OCD,但您可以做一些事情来进一步完善您的治疗计划:

  • 练习您学到的知识。与您的心理健康专业人员合作,找出帮助控制症状的方法。定期练习这些方法。
  • 遵医嘱服药。即使自我感觉良好,也不要忽略用药。如果您停药,OCD 的症状就有可能复发。
  • 关注警示体征。您和您的医生可能发现了导致您 OCD 症状的问题。制订计划,您就知道在症状复发时如何应对。如果您注意到症状发生任何变化,或者您感觉发生了任何变化,请联系医生或治疗师。
  • 在服用其他药物前先咨询医生。在您服用另一位医生开的处方药前,或者在您服用任何一种非处方药、维生素、草药或其他补充剂前,请先联系您的 OCD 治疗医生。这将有助于减少可能的药物相互作用。

妥善处理与支持

应对强迫症可能有很大的难度。药物可能有不利的副作用,而患上需要长期治疗的状况可能令您不安或愤怒。

下面是一些有助于应对 OCD 的方法:

  • 了解 OCD了解您的状况可以帮助您坚持治疗计划。
  • 专注于目标。牢记您的恢复目标,并且告诫自己 OCD 的恢复是一个持续的过程。
  • 加入互助组。接触其他面临相同挑战的人可为您提供支持,并帮助您应对挑战。
  • 寻找健康的宣泄途径。探索可释放精力的健康渠道,例如业余爱好和娱乐活动。经常运动、健康饮食和保证充足的睡眠。
  • 学习放松和压力管理。除了专业治疗之外,还可借助压力管理方法释放压力和焦虑,例如冥想、视觉化、肌肉松弛、按摩、深呼吸、瑜伽或太极。
  • 坚持您的日常活动。尽量避免没有意义的活动。照常上班或上学。与家人和朋友共度时光。不要让 OCD 妨碍您的正常生活。

准备您的预约

您可以先去您的初级医护团队处看诊。由于强迫症往往需要专科医治,您可能需要去看心理健康专业人员,例如精神病医生或心理医生。

What you can do

To prepare for your appointment, think about your needs and goals for treatment. Make a list of:

  • Any symptoms you've noticed, including the types of obsessions and compulsions you've had and things that you may be staying away from or no longer doing because of your distress.
  • Key personal information, including any major stresses, recent life changes and family members with similar symptoms.
  • All medicines, vitamins, herbal remedies or other supplements, as well as the doses.
  • Questions to ask your doctor or therapist.

Questions to ask might include:

  • Do you think I have OCD?
  • How do you treat OCD?
  • How can treatment help me?
  • Are there medicines that might help?
  • Will exposure and response prevention therapy help?
  • How long will treatment take?
  • What can I do to help myself?
  • Are there any brochures or other printed material that I can have?
  • Can you recommend any websites?

Don't hesitate to ask any other questions during your appointment.

医生可能做些什么

医生可能会问您一些问题,例如:

  • 有些想法是否一遍又一遍地在您的脑海里浮现,总是挥之不去?
  • 您是否必须以特定方式布置物品?
  • 您是否必须反复洗手、统计物品数量或检查物品?
  • 您何时开始出现症状?
  • 症状是持续性的还是偶尔出现?
  • 有没有什么因素似乎会改善症状?
  • 有没有什么因素似乎会加重症状?
  • 这些症状给您的日常生活造成了什么影响?您是否会因自己的症状而逃避任何事情?
  • 一天中,您通常在强迫思维或强迫行为上花费多长时间?
  • 您的任何亲戚是否患过心理健康疾病?
  • 您是否曾经受到任何创伤或承受巨大压力?

您的医生或心理健康专业人员会根据您的回答、症状以及需要提出更多问题。提前准备好如何回答这些问题将帮助您充分利用就诊时间。

在 Mayo Clinic 治疗

March 01, 2024
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