J Affect Disord：强迫症共病具有临床意义

　　一项来自荷兰的最新研究指出，强迫症（OCD）共病具有临床意义，这与一种特殊易感性、慢性程度更高、OCD严重程度更高以及日常生活中的负面影响更多有关。这表明，对所有共病的诊断和治疗都具有临床意义，对于童年期创伤和严重神经过敏症病例，临床医生应当尤其注意是否存在共病。与继发性OCD相比，原发性OCD的发展和共病模式不同。

　　该研究为一项针对OCD患者的大样本临床研究，旨在确定患者的终生共病率和当前共病率、共病的发病和影响，同时检测各种各样的危险因素和临床特征以便确定单纯OCD与OCD伴当前共病是否不同。

　　该研究的数据来自荷兰强迫症协会（NOCDA）研究。研究对一个纳入382名当前强迫症（在上一个月期间）患者的样本进行了评价。

　　结果有55%的OCD患者发生了当前共病，而78%的OCD患者遭受终生共病的痛苦。共病与OCD程度更严重、焦虑和抑郁症状以及日常生活中负面影响较多相关。共病通常早于OCD并影响其病程和严重程度。童年期创伤和神经过敏症是OCD患者发生共病的易感因素。

　　同时也应当注意到由于该研究的结果基于横断层面的数据，预先排除了关于危险因素与OCD间联系的因果影响。

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Clinical relevance of comorbidity in obsessive compulsive disorder: The Netherlands OCD Association study.
BACKGROUND
This study describes lifetime and current rates of comorbidity, its onset and its consequences in a large clinical sample of patients with obsessive compulsive disorder (OCD). A wide range of risk factors and clinical characteristics were also examined to determine whether pure OCD is different from OCD with current comorbidity. Finally, the temporal sequencing of the disorders was examined.
METHOD
Data were obtained from the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. A sample of 382 participants with current OCD (during the past month) was evaluated.
RESULTS
Current comorbidity occurred in 55% of patients with OCD, while 78% suffered from lifetime comorbidity. Comorbidity is associated with more severe OCD, anxiety and depressive symptoms and more negative consequences on daily life. Multiple comorbid disorders often precede OCD and influence both its course and severity. Childhood trauma and neuroticism are vulnerability factors for the development of multiple comorbid disorders in OCD.
LIMITATIONS
It should be noted that causal inferences about the association between risk factors and OCD are precluded since our results were based on cross-sectional data.
CONCLUSION
(Multiple) comorbidity in OCD is clinically relevant since it is associated with a specific pattern of vulnerability, with greater chronicity, with more severe OCD and more negative consequences on daily life. This indicates that the diagnosis and treatment of all comorbid disorders is clinically relevant, and clinicians should be especially aware of multiple disorders in cases of childhood trauma and high levels of neuroticism. Primary OCD has a different developmental and comorbidity pattern compared to secondary OCD.