한국형 강박장애 치료 알고리듬 2007 (IV) : 공존질환이 동반된 경우

Abstract

Patients with obsessive-compulsive disorder (OCD) frequently exhibit complex clinical features, including comorbidity with other psychiatric disorders, which challenge diagnostic and therapeutic practice. This study presents a number of Korean experts’ ratings of the appropriateness of treatments for patients with comorbid OCD and other psychiatric disorders. Methods：The Korean Treatment Algorithm Project for Obsessive-Compulsive Disorder (KTAP-OCD 2007) developed a questionnaire that included questions about seven psychiatric comorbid conditions: major depressive disorder, bipolar disorder, panic or social anxiety disorder, schizophrenia, attention deficit hyperactive disorder (ADHD), oppositional/conduct/antisocial disorder, and Tourette disorder. Answers from 24 respondents were analyzed to assess first-line and second-line treatments for each comorbid condition. Results：Experts selected cognitive behavior therapy (CBT) in conjunction with medication as the treatment for comorbidity with major depressive disorder, anxiety disorders, ADHD, or Tourette disorder. They selected a selective serotonin reuptake inhibitor (SSRI) combined with atypical antipsychotics as the treatment of choice for patients with comorbid OCD and schizophrenia. When patients had comorbid OCD and bipolar disorder, experts preferred adjunctive serotonin reuptake inhibitors to CBT. In all cases, experts were less likely to select clomipramine for second-line treatment. Conclusion：The findings from the KTAP-OCD 2007 survey on psychiatric comorbid conditions were generally consistent with foreign guidelines. However, more guidelines might be required for comorbidity with bipolar disorder and the use of clomipramine.