외상 후 강박장애의 연속 증례 : 6개월 추적 조사

Abstract

결론적으로 국내에서도 외상후 강박장애가 적지 않게 PTSD와 공존한다는 점을 보고하는 바이며, 치료에 잘 반응하지 않음을 재확인하였다. 향후 임상가들은 외상 환자의 평가에 OCD가 공존할 가능성을 염두해 두어야 하겠고, 연구과제로서 실제 임상 현장에서 얼마나 많은 환자가 PTSD와 OCD가 공존하는지, 그리고 이 환자들의 특징과 치료 전략에 대한 연구가 필요하겠다.

A number of recent case reports and series indicate that obsessive compulsive disorder (OCD) can develop after traumatic experience as a comorbid conditon to post-traumatic stress disorder (PTSD). These descriptive studies consistently addressed that those patients respond poorly to treatments and had an unfavorable outcome. However, this conclusion was not supported by prospective follow up with objective measurement of symptomatology. This report presents three single trauma-related PTSD patients who developed full-blown OCD concurrently with or after the initiation of PTSD. These patients represent 10% of new PTSD outpatients at a PTSD clinic during one year period and 25% of PTSD patients who had been admitted. In all three cases compulsion seemed to distract or serve as avoidance to intrusive symptoms of PTSD. Despite Eye Movement Desensitization and Reprocessing (EMDR) and/or exposure therapy for PTSD together with at least two antidepressant trials for PTSD and OCD, at six month follow-up PTSD partially improved and OCD remained unchanged. This finding is consistent with previous reports from western literature.