KISEP Review Article J Korean Neuropsychiatr Assoc Vol 42, No 3 치료저항성강박장애의약물학적치료및통합적치료모형의제안 서울대학교의과대학정신과학교실 권준수 하태현 Pharmacotherapy and the Proposal o

Size: px

Start display at page:

Download "KISEP Review Article J Korean Neuropsychiatr Assoc Vol 42, No 3 치료저항성강박장애의약물학적치료및통합적치료모형의제안 서울대학교의과대학정신과학교실 권준수 하태현 Pharmacotherapy and the Proposal o"

영미 가
5 years ago
Views:

1 KISEP Review Article J Korean Neuropsychiatr Assoc Vol 42, No 3 치료저항성강박장애의약물학적치료및통합적치료모형의제안 서울대학교의과대학정신과학교실 권준수 하태현 Pharmacotherapy and the Proposal of the Integrative Therapy Model for Treatment Resistant Obsessive-Compulsive Disorder Jun Soo Kwon, MD, PhD and Tae Hyon Ha, MD Department of Psychiatry, Seoul National University Medical College, Seoul, Korea There have been considerable advances in our understanding of the neurobiology and the treatment of obsessive-compulsive disorder (OCD). However, it seems that many patients with OCD are not met with proper treatment, and even the patients who receive sufficient therapy the response rate is not high. This paper reviews the pharmacological treatments of OCD with special focus on therapeutic options for treatment resistance cases. In treating a resistant case, the clinical characteristics including comorbid conditions of the patient should be reevaluated. Through until recently, there has been no standarized guideline to treat resistance cases and much is up to clinician s preference, but thoughtful selection and combination of drugs with optimized psychosocial approach may improve the response rate. We propose an integrative therapy model for treatment resistant OCD to emphasize the need for the expansion of treatment resources. Treatment resistant OCD deserves more clinical and socioeconomic attentions and needs further research for management. (J Korean Neuropsychiatr Assoc 2003;42(3): ) KEY WORDS:Obsessive-Compulsive Disorder Psychopharmacotherapy Treatment resistance Therapy model. 302 서 론 -

2 강박장애의약물학적치료의일반적지침 강박장애의일차선택치료제 Clomipramine Fluoxetine 303

3 Fluvoxamine Sertraline Paroxetine Citalopram - 각 SRI의비교 304

4 강박장애의유지치료 강박장애의치료반응과관련된요인

5 강박장애의치료저항성 306

6 치료저항성강박장애의약물학적치료전략 Clomipramine 경구또는 clomipramine 정주투여 단가아민산화효소억제제 (MAOIs) - Clonazepam - Inositol Clonidine - 기타의약물들 307

7 SRI 병합요법 - 전형적항정신병약물의강화요법 Risperidone 강화요법 - - Olanzapine 강화요법 Clozapine Quetiapine 강화요법 Pindolol 강화요법 308

8 Tryptophan 강화요법 Buspirone, lithium, carbamazepine, trazodone, 갑상선호르몬강화요법 효과가기대되는새로운약물들 - - 신경외과적수술 강박장애의통합적치료모형 Treatment Start 1st Phase 2nd Phase 3rd Phase 0 week 12 week SRI Augmentation or Other drug 48 week Behavioral therapy Intensive CBT TMS or Psychosurgery Fig. 1. Flow chart of obsessive-compulsive disorder treatment. SRIselective serotonin reuptake inhibitor, CBTcognitive behavioral therapy, TMStranscranial magnetic stimulation 309

9 Genetic Developmental Environmenatal Prevention Brain Dysfunction Orbitofrontal gyrus Others related Augmentation or Other drug Thalamus Caudate OCD Loop SRI TMS or Psychosurgery Neuropsychological Dysfunctions Executive function Nonverbal memory Visuospatial Organization Clinical Symptoms and Syndrome Cognitive Training Home-based Software Obsessions Compulsions Comorbid Conditions CBT Other Psychosocial treatment Intensive CBT Functional Impairment Relational Problems Secondary Comorbidity Family Education Poor Quality of Life Self-help group Or OCD arganization 1st line treatments Strategies for Resistance Treatments In the future Fig. 2. Integrative treatment model for obsessive-compulsive disorder. OCDobsessive-compulsive disorder, SRIselective serotonin reuptake inhibitor, CBTcognitive behavioral therapy, TMStranscranial magnetic stimulation. 310

10 결 중심단어 REFERENCES 1) Denys D, Van Megen H, Westenberg H. The adequacy of pharmacotherapy in outpatients with obsessive-compulsive disorder. Int Clin Psychopharmacol 2002;17: ) Cottraux J, Mollard E, Bouvard M, Marks I. Exposure therapy, fluvoxamine, or combination treatment in obsessive-compulsive disorder: one-year followup. Psychiatry Res 1993;49: ) The Clomipramine Collaborative Study Group. Clomipramine in the treatment of patients with obsessive-compulsive disorder. Arch Gen Psychiatry 1991;48: ) Dominguez RA. Serotonergic antidepressants and their efficacy in 론 obsessive compulsive disorder. J Clin Psychiatry 1992;53 Suppl: ) Hollander E, Kaplan A, Allen A, Cartwright C. Pharmacotherapy for obsessive-compulsive disorder. Psychiatr Clin North Am 2000;23: ) Bogetto F, Albert U, Maina G. Sertraline treatment of obsessivecompulsive disorder: efficacy and tolerability of a rapid titration regimen. Eur Neuropsychopharmacol 2002;12: ) Coulter DM, Pillans PI. Fluoxetine and extrapyramidal side effects. Am J Psychiatry 1995;152: ) Tollefson GD, Rampey AH Jr, Potvin JH, Jenike MA, Rush AJ, kominguez RA, et al. A multicenter investigation of fixed-dose fluoxetine in the treatment of obsessive-compulsive disorder. Arch Gen Psychiatry 1994;51: ) Riddle MA, Reeve EA, Yaryura-Tobias JA, Yang HM, Claghorn JL, Gaffney G, et al. Fluvoxamine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled, multicenter trial. J Am Acad Child Adolesc Psychiatry 2001;40: ) Goodman WK, Kozak MJ, Liebowitz M, White KL. Treatment of obsessive-compulsive disorder with fluvoxamine: a multicentre, double-blind, placebo-controlled trial. Int Clin Psychopharmacol 1996; 11: ) Sanchez C, Hyttel J. Comparison of the effects of antidepressants and their metabolites on reuptake of biogenic amines and on receptor binding. Cell Mol Neurobiol 1999;19: ) Jenike MA, Baer L, Summergrad P, Minichiello WE, Holland A, Seymour R. Sertraline in obsessive-compulsive disorder: a doubleblind comparison with placebo. Am J Psychiatry 1990;147: ) Chouinard G. Sertraline in the treatment of obsessive compulsive disorder: two double-blind, placebo-controlled studies. Int Clin Psychopharmacol 1992;7 Suppl 2: ) Greist JH, Jefferson JW, Kobak KA, Chouinard G, DuBoff E, Halaris A, et al. A 1 year double-blind placebo-controlled fixed dose study of sertraline in the treatment of obsessive-compulsive disorder. Int Clin Psychopharmacol 1995;10: ) Rasmussen S, Hackett E, DuBoff E, Greist J, Halaris A, Koran LM, et al. A 2-year study of sertraline in the treatment of obsessive-compulsive disorder. Int Clin Psychopharmacol 1997;12: ) Koran LM, Hackett E, Rubin A, Wolkow R, Robinson D. Efficacy of sertraline in the long-term treatment of obsessive-compulsive disorder. Am J Psychiatry 2002;159: ) March JS, Biederman J, Wolkow R, Safferman A, Mardekian J, Cook EH, et al. Sertraline in children and adolescents with obsessivecompulsive disorder: a multicenter randomized controlled trial. Jama 1998;280: ) Cook EH, Wagner KD, March JS, Biederman J, Landau P, Wolkow R, et al. Long-term sertraline treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 2001;40: ) Zohar J, Judge R. Paroxetine versus clomipramine in the treatment of obsessive-compulsive disorder. OCD Paroxetine Study Investigators. Br J Psychiatry 1996;169: ) Koponen H, Lepola U, Leinonen E, Jokinen R, Penttinen J, Turtonen J. Citalopram in the treatment of obsessive-compulsive disorder: an open pilot study. Acta Psychiatr Scand 1997;96: ) Montgomery SA, Kasper S, Stein DJ, Bang Hedegaard K, Lemming OM. Citalopram 20 mg, 40 mg and 60 mg are all effective and well tolerated compared with placebo in obsessive-compulsive disorder. Int Clin Psychopharmacol 2001;16: ) Piccinelli M, Pini S, Bellantuono C, Wilkinson G. Efficacy of drug treatment in obsessive-compulsive disorder. A meta-analytic review. Br J Psychiatry 1995;166: ) Lopez-Ibor JJ Jr, Saiz J, Cottraux J, Note I, Vinas R, Bourgeois M, et al. Double-blind comparison of fluoxetine versus clomipramine in the treatment of obsessive compulsive disorder. Eur Neuropsychopharmacol 1996;6: ) Freeman CP, Trimble MR, Deakin JF, Stokes TM, Ashford JJ. Fluvoxamine versus clomipramine in the treatment of obsessive compulsive disorder: a multicenter, randomized, double-blind, parallel group comparison. J Clin Psychiatry 1994 ; 55 : ) Mundo E, Maina G, Uslenghi C. Multicentre, double-blind, compari- 311

11 son of fluvoxamine and clomipramine in the treatment of obsessivecompulsive disorder. Int Clin Psychopharmacol 2000;15: ) Milanfranchi A, Ravagli S, Lensi P, Marazziti D, Cassano GB. A double-blind study of fluvoxamine and clomipramine in the treatment of obsessive-compulsive disorder. Int Clin Psychopharmacol 1997; 12: ) Mundo E, Bianchi L, Bellodi L. Efficacy of fluvoxamine, paroxetine, and citalopram in the treatment of obsessive-compulsive disorder: a single-blind study. J Clin Psychopharmacol 1997;17: ) Skoog G, Skoog I. A 40-year follow-up of patients with obsessivecompulsive disorder [see commetns]. Arch Gen Psychiatry 1999;56: ) Romano S, Goodman W, Tamura R, Gonzales J. Long-term treatment of obsessive-compulsive disorder after an acute response: a comparison of fluoxetine versus placebo. J Clin Psychopharmacol 2001;21: ) Ravizza L, Barzega G, Bellino S, Bogetto F, Maina G. Drug treatment of obsessive-compulsive disorder (OCD): long-term trial with clomipramine and selective serotonin reuptake inhibitors (SSRIs). Psychopharmacol Bull 1996;32: ) Mundo E, Bareggi SR, Pirola R, Bellodi L, Smeraldi E. Long-term pharmacotherapy of obsessive-compulsive disorder : a double-blind controlled study. J Clin Psychopharmacol 1997;17: ) Maina G, Albert U, Bogetto F. Relapses after discontinuation of drug associated with increased resistance to treatment in obsessive-compulsive disorder. Int Clin Psychopharmacol 2001;16: ) Ackerman DL, Greenland S, Bystritsky A, Morgenstern H, Katz RJ. Predictors of treatment response in obsessive-compulsive disorder: multivariate analyses from a multicenter trial of clomipramine. J Clin Psychopharmacol 1994;14: ) Ackerman DL, Greenland S, Bystritsky A. Clinical characteristics of response to fluoxetine treatment of obsessive-compulsive disorder. J Clin Psychopharmacol 1998;18: ) Drummond LM. The treatment of severe, chronic, resistant obsessivecompulsive disorder. An evaluation of an in-patient programme using behavioural psychotherapy in combination with other treatments. Br J Psychiatry 1993;163: ) Black DW, Monahan P, Gable J, Blum N, Clancy G, Baker P. Hoarding and treatment response in 38 nondepressed subjects with obsessive-compulsive disorder. J Clin Psychiatry 1998;59: ) Mataix-Cols D, Rauch SL, Manzo PA, Jenike MA, Baer L. Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessivecompulsive disorder. Am J Psychiatry 1999;156: ) Hollander E, Bienstock CA, Koran LM, Pallanti S, Marazziti D, Rasmussen SA, et al. Refractory obsessive-compulsive disorder: state-of-the-art treatment. J Clin Psychiatry 2002;63 Suppl 6: ) Eisen JL, Rasmussen SA, Phillips KA, Price LH, Davidson J, Lydiard RB, et al. Insight and treatment outcome in obsessive-compulsive disorder. Compr Psychiatry 2001;42: ) Attiullah N, Eisen JL, Rasmussen SA. Clinical features of obsessivecompulsive disorder. Psychiatr Clin North Am 2000;23: ) Perugi G, Akiskal HS, Pfanner C, Presta S, Gemignani A, Milanfranchi A, et al. The clinical impact of bipolar and unipolar affective comorbidity on obsessive-compulsive disorder. J Affect Disord 1997;46: ) Carrasco JL, Hollander E, Schneier FR, Liebowitz MR. Treatment outcome of obsessive compulsive disorder with comorbid social phobia. J Clin Psychiatry 1992;53: ) Gershuny BS, Baer L, Jenike MA, Minichiello WE, Wilhelm S. Comorbid posttraumatic stress disorder: impact on treatment outcome for obsessive-compulsive disorder. Am J Psychiatry 2002;159: ) Fallon BA, Javitch JA, Hollander E, Liebowitz MR. Hypochondriasis and obsessive compulsive disorder: overlaps in diagnosis and treatment. J Clin Psychiatry 1991;52: ) Fals-Stewart W, Angarano K. Obsessive-compulsive disorder among patients entering substance abuse treatment. Prevalence and accuracy of diagnosis. J Nerv Ment Dis 1994;182: ) Fals-Stewart W, Schafer J. The treatment of substance abusers diagnosed with obsessive-compulsive disorder: an outcome study. J Subst Abuse Treat 1992;9: ) McDougle CJ, Goodman WK, Leckman JF, Barr LC, Heninger GR, 312 Price LH. The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. J Clin Psychopharmacol 1993;13: ) Thiel A, Zuger M, Jacoby GE, Schussler G. Thirty-month outcome in patients with anorexia or bulimia nervosa and concomitant obsessivecompulsive disorder. Am J Psychiatry 1998;155: ) Jenike MA, Baer L, Minichiello WE, Schwartz CE, Carey RJ Jr. Concomitant obsessive-compulsive disorder and schizotypal personality disorder. Am J Psychiatry 1986;143: ) McKay D, Neziroglu F. Social skills training in a case of obsessivecompulsive disorder with schizotypal personality disorder. J Behav Ther Exp Psychiatry 1996;27: ) Baer L, Jenike MA, Black DW, Treece C, Rosenfeld R, Greist J. Effect of axis II diagnoses on treatment outcome with clomipramine in 55 patients with obsessive-compulsive disorder. Arch Gen Psychiatry 1992;49: ) Cavedini P, Erzegovesi S, Ronchi P, Bellodi L. Predictive value of obsessive-compulsive personality disorder in antiobsessional pharmacological treatment. Eur Neuropsychopharmacol 1997;7: ) Ricciardi JN, Baer L, Jenike MA, Fischer SC, Sholtz D, Buttolph ML. Changes in DSM-III-R axis II diagnoses following treatment of obsessive-compulsive disorder. Am J Psychiatry 1992;149: ) Bolton D, Raven P, Madronal-Luque R, Marks IM. Neurological and neuropsychological signs in obsessive compulsive disorder: interaction with behavioural treatment. Behav Res Ther 2000;38: ) Saxena S, Brody AL, Maidment KM, Dunkin JJ, Colgan M, Alborzian S, et al. Localized orbitofrontal and subcortical metabolic changes and predictors of response to paroxetine treatment in obsessivecompulsive disorder. Neuropsychopharmacology 1999;21: ) The Expert Consensus Panel for obsessive-compulsive disorder. Treatment of obsessive-compulsive disorder. J Clin Psychiatry 1997;58 Suppl 4: ) Jenike MA. Augmentation strategies for treatment-resistant obsessivecompulsive disorder. Harv Rev Psychiatry 1993;1: ) Todorov C, Freeston MH, Borgeat F. On the pharmacotherapy of obsessive-compulsive disorder: is a consensus possible? Can J Psychiatry 2000;45: ) Fallon BA, Campeas R, Schneier FR, Hollander E, Feerick J, Hatterer J, et al. Open trial of intravenous clomipramine in five treatmentrefractory patients with obsessive-compulsive disorder. J Neuropsychiatry Clin Neurosci 1992;4: ) Koran LM, Sallee FR, Pallanti S. Rapid benefit of intravenous pulse loading of clomipramine in obsessive-compulsive disorder. Am J Psychiatry 1997;154: ) Fallon BA, Liebowitz MR, Campeas R, Schneier FR, Marshall R, Davies S, et al. Intravenous clomipramine for obsessive-compulsive disorder refractory to oral clomipramine: a placebo-controlled study. Arch Gen Psychiatry 1998;55: ) Vallejo J, Olivares J, Marcos T, Bulbena A, Menchon JM. Clomipramine versus phenelzine in obsessive-compulsive disorder. A controlled clinical trial. Br J Psychiatry 1992;161: ) Jenike MA, Baer L, Minichiello WE, Rauch SL, Buttolph ML. Placebo-controlled trial of fluoxetine and phenelzine for obsessivecompulsive disorder. Am J Psychiatry 1997;154: ) al Jeshi A. Moclobemide response in obsessive-compulsive disorder. Can J Psychiatry 1999;44: ) Hewlett WA, Vinogradov S, Agras WS. Clomipramine, clonazepam, and clonidine treatment of obsessive-compulsive disorder. J Clin Psychopharmacol 1992;12: ) Fux M, Levine J, Aviv A, Belmaker RH. Inositol treatment of obsessive-compulsive disorder. Am J Psychiatry 1996;153: ) Fux M, Benjamin J, Belmaker RH. Inositol versus placebo augmentation of serotonin reuptake inhibitors in the treatment of obsessivecompulsive disorder: a double-blind cross-over study. Int J Neuropsychopharmcol 1999;2: ) Seedat S, Stein DJ. Inositol augmentation of serotonin reuptake inhibitors in treatment-refractory obsessive-compulsive disorder: an open trial. Int Clin Psychopharmacol 1999;14: ) Knesevich JW. Successful treatment of obsessive-compulsive disorder with clonidine hydrochloride. Am J Psychiatry 1982;139:

12 70) Shapira NA, Keck PE Jr, Goldsmith TD, McConville BJ, Eis M, McElroy SL. Open-label pilot study of tramadol hydrochloride in treatment-refractory obsessive-compulsive disorder. Depress Anxiety 1997;6: ) Stern L, Zohar J, Cohen R, Sasson Y. Treatment of severe, drug resistant obsessive compulsive disorder with the 5HT1D agonist sumatriptan. Eur Neuropsychopharmacol 1998;8: ) Koran LM, Pallanti S, Quercioli L. Sumatriptan, 5-HT(1D) receptors and obsessive-compulsive disorder. Eur Neuropsychopharmacol 2001; 11: ) Altemus M, Greenberg BD, Keuler D, Jacobson KR, Murphy DL. Open trial of flutamide for treatment of obsessive-compulsive disorder. J Clin Psychiatry 1999;60: ) Casas M, Alvarez E, Duro P, Garcia-Ribera C, Udina C, Velat A, et al. Antiandrogenic treatment of obsessive-compulsive neurosis. Acta Psychiatr Scand 1986;73: ) Eriksson T. Antiandrogenic treatment for obsessive-compulsive disorder. Am J Psychiatry 2000;157: ) Figueroa Y, Rosenberg DR, Birmaher B, Keshavan MS. Combination treatment with clomipramine and selective serotonin reuptake inhibitors for obsessive-compulsive disorder in children and adolescents. J Child Adolesc Psychopharmacol 1998;8: ) Pallanti S, Quercioli L, Paiva RS, Koran LM. Citalopram for treatment-resistant obsessive-compulsive disorder. Eur Psychiatry 1999; 14: ) Bejerot S, Bodlund O. Response to high doses of citalopram in treatment-resistant obsessive-compulsive disorder. Acta Psychiatr Scand 1998;98: ) Marazziti D, Dell Osso L, Gemignani A, Ciapparelli A, Presta S, Nasso ED, et al. Citalopram in refractory obsessive-compulsive disorder: an open study. Int Clin Psychopharmacol 2001;16: ) Delgado PL, Goodman WK, Price LH, Heninger GR, Charney DS. Fluvoxamine/pimozide treatment of concurrent Tourette s and obsessive-compulsive disorder. Br J Psychiatry 1990;157: ) McDougle CJ, Goodman WK, Leckman JF, Lee NC, Heninger GR, Price LH. Haloperidol addition in fluvoxamine-refractory obsessivecompulsive disorder. A double-blind, placebo-controlled study in patients with and without tics. Arch Gen Psychiatry 1994;51: ) Agid O, Lerer B. Risperidone augmentation of paroxetine in a case of severe, treatment-refractory obsessive-compulsive disorder without comorbid psychopathology. J Clin Psychiatry 1999;60: ) Fitzgerald KD, Stewart CM, Tawile V, Rosenberg DR. Risperidone augmentation of serotonin reuptake inhibitor treatment of pediatric obsessive compulsive disorder. J Child Adolesc Psychopharmacol 1999;9: ) Kawahara T, Ueda Y, Mitsuyama Y. A case report of refractory obsessive-compulsive disorder improved by risperidone augmentation of clomipramine treatment. Psychiatry Clin Neurosci 2000;54: ) McDougle CJ, Epperson CN, Pelton GH, Wasylink S, Price LH. A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 2000;57: ) Saxena S, Wang D, Bystritsky A, Baxter LR Jr. Risperidone augmentation of SRI treatment for refractory obsessive-compulsive disorder. J Clin Psychiatry 1996;57: ) Potenza MN, Wasylink S, Longhurst JG, Epperson CN, McDougle CJ. Olanzapine augmentation of fluoxetine in the treatment of refractory obsessive-compulsive disorder. J Clin Psychopharmacol 1998; 18: ) Koran LM, Ringold AL, Elliott MA. Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry 2000;61: ) Steinert T, Schmidt-Michel PO, Kaschka WP. Considerable improvement in a case of obsessive-compulsive disorder in an emotionally unstable personality disorder, borderline type under treatment with clozapine. Pharmacopsychiatry 1996;29: ) Atmaca M, Kuloglu M, Tezcan E, Gecici O. Quetiapine augmentation in patients with treatment resistant obsessive-compulsive disorder: a single-blind, placebo-controlled study. Int Clin Psychopharmacol 2002;17: ) Dannon PN, Sasson Y, Hirschmann S, Iancu I, Grunhaus LJ, Zohar J. Pindolol augmentation in treatment-resistant obsessive compulsive disorder: a double-blind placebo controlled trial. Eur Neuropsychopharmacol 2000;10: ) Blier P, Bergeron R. Sequential administration of augmentation straegies in treatment-resistant obsessive-compulsive disorder: preliminary findings. Int Clin Psychopharmacol 1996;11: ) Goodman WK, McDougle CJ, Barr LC, Aronson SC, Price LH. Biological approaches to treatment-resistant obsessive compulsive disorder. J Clin Psychiatry 1993;54 Suppl: ) Dominguez RA, Mestre SM. Management of treatment-refractory obsessive compulsive disorder patients. J Clin Psychiatry 1994;55 Suppl: ) Nelson EC. An open-label study of nefazodone in the treatment of depression with and without comorbid obsessive compulsive disorder. Ann Clin Psychiatry 1994;6: ) Grossman R, Hollander E. Treatment of obsessive-compulsive disorder with venlafaxine. Am J Psychiatry 1996;153: ) Rauch SL, O Sullivan RL, Jenike MA. Open treatment of obsessivecompulsive disorder with venlafaxine: a series of ten cases. J Clin Psychopharmacol 1996;16: ) Koran LM, Quirk T, Lorberbaum JP, Elliott M. Mirtazapine treatment of obsessive-compulsive disorder. J Clin Psychopharmacol 2001;21: ) Hay P, Sachdev P, Cumming S, Smith JS, Lee T, Kitchener P, et al. Treatment of obsessive-compulsive disorder by psychosurgery. Acta Psychiatr Scand 1993;87: ) Dougherty DD, Baer L, Cosgrove GR, Cassem EH, Price BH, Nierenberg AA, et al. Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder. Am J Psychiatry 2002;159: ) Kim CH, Chang JW, Koo MS, Kim JW, Suh HS, Park IH, et al. Anterior cingulotomy for refractory obsessive-comphlsive disorder. Acta Psychiatr Scand 2003;107: ) DeVeaugh-Geiss J. Diagnosis and treatment of obsessive compulsive disorder. Annu Rev Med 1993;44: ) Foster PS, Eisler RM. An integrative approach to the treatment of obsessive-compulsive disorder. Compr Psychiatry 2001;42: ) O Connor K, Todorov C, Robillard S, Borgeat F, Brault M. Cognitive-behaviour therapy and medication in the treatment of obsessivecompulsive disorder: a controlled study. Can J Psychiatry 1999;44: ) Savage CR, Baer L, Keuthen NJ, Brown HD, Rauch SL, Jenike MA. Organizational strategies mediate nonverbal memory impairment in obsessive-compulsive disorder. Biol Psychiatry 1999;45: ) Christensen KJ, Kim SW, Dysken MW, Hoover KM. Neuropsychological performance in obsessive-compulsive disorder. Biol Psychiatry 1992;31: ) Veale DM, Sahakian BJ, Owen AM, Marks IM. Specific cognitive deficits in tests sensitive to frontal lobe dysfunction in obsessivecompulsive disorder. Psychol Med 1996;26: ) Wolff M, Alsobrook JP 2nd, Pauls DL. Genetic aspects of obsessivecompulsive disorder. Psychiatr Clin North Am 2000;23:

KISEP Overview 강박장애의약물치료전략 김세주 1 권준수 2 김찬형 1 ABSTRACT Pharmacotherapeutic Strategy for Obsessive-Compulsive Disorder Se Joo Kim, MD, 1 Jun S

KISEP Overview 강박장애의약물치료전략 김세주 1 권준수 2 김찬형 1 ABSTRACT Pharmacotherapeutic Strategy for Obsessive-Compulsive Disorder Se Joo Kim, MD, 1 Jun S KISEP Overview 16 3 2005 강박장애의약물치료전략 김세주 1 권준수 2 김찬형 1 ABSTRACT Pharmacotherapeutic Strategy for Obsessive-Compulsive Disorder Se Joo Kim, MD, 1 Jun Soo Kwon, MD 2 and Chan-Hyung Kim, MD 1 1 Department