目的 评估具有高强迫信念和低强迫信念的强迫障碍(obsessive-compulsive disorder,OCD)患者的不恰当感(not just right experiences,NJREs)特征,分析其与强迫症状的关系.方法2021年3月至2023年10月,纳入北京安定医院门诊就诊的OCD患者142例、焦虑障碍患者51例,应用耶鲁-布朗强迫量表(Yale-Brown obsessive-compulsive scale,Y-BOCS)、强迫信念问卷(obsessive belief questionnaire,OBQ-44)、不恰如其分体验问卷修订版(revised version of the not just right experi-ence questionnaire,NJRE-Q-R)、贝克抑郁量表(Beck depression inventory,BDI)、贝克焦虑量表(Beck anxiety inventory,BAI)评估被试的临床症状.使用K均值聚类法进行聚类分析,将OCD分为高强迫信念组(OCD with high obsessive beliefs,OCD-H;n=77)和低强迫信念组(OCD with low obsessive be-liefs,OCD-L;n=65).采用SPSS 23.0进行统计分析.用卡方检验、单因素方差分析比较OCD-H组、OCD-L组及焦虑障碍组的一般资料及临床资料,用多因素Logistic回归分析模型分析OCD的危险因素,用多元线性回归分析探索OCD-H和OCD-L组强迫症状的影响因素.结果OCD-H组、OCD-L组与焦虑障碍组在 Y-BOCS[(23.14±6.60)分,(17.77±6.48)分,(8.70±6.80)分]、OBQ-44[(162.69±33.15)分,(86.54±19.09)分,(103.12±45.67)分]、NJRE-Q-R 种类量表[(4.58±2.61)分,(2.92±2.15)分,(2.86±1.72)分]、NJRE-Q-R 严重程度量表[(32.86±8.97)分,(24.75±9.71)分,(18.86±8.51)]上的得分差异有统计学意义(F=68.87,102.29,11.06,32.01,均 P＜0.001).Logistic 回归分析显示,NJRE-Q-R 严重程度是 OCD 的危险因素(B=0.124,OR=1.132,95％CI=1.071～1.197,P＜0.001).在 OCD-H 组,Y-BOCS 得分受病程、BDI、OBQ-44 因子 1 和因子 3 影响(B=0.020,0.201,0.133,0.126,均P＜0.05).在OCD-L组,Y-BOCS得分受BDI、NJREs种类及严重程度影响(B=0.265,0.852,0.191,均P＜0.05).结论 不同强迫信念水平的OCD患者均表现出NJREs现象,其种类和程度高于焦虑障碍组.NJREs是OCD患病的危险因素,尤其是对于低强迫信念者.NJREs可能是低强迫信念OCD患者的潜在病因和干预靶点,值得进一步临床研究.
The characteristics of"not just right experiences"in patients with obsessive-compulsive disorder with different levels of obsessive beliefs and their relationship with obsessive-compulsive symptoms
Objective To evaluate the characteristics of not just right experiences(NJREs)with high and low obsessive-compulsive beliefs in obsessive-compulsive disorder(OCD)patients,and to analyze their relationship with OCD symptoms.Methods A total of 142 patients with OCD and 51 patients with anxiety disorders were included in the outpatient department of Beijing Anding Hospital.The Yale-Brown ob-sessive-compulsive scale(Y-BOCS),obsessive belief questionnaire(OBQ-44),revised version of the not just right experience questionnaire(NJRE-Q-R),Beck depression inventory(BDI),and Beck anxiety inven-tory(BAI)were used to evaluate clinical symptoms in patients with OCD and anxiety disorders.Cluster a-nalysis was used to divide OCD into high obsessive beliefs group(OCD-H,n=77)and low obsessive beliefs group(OCD-L,n=65).The SPSS 23.0 software was used for data analysis.Chi-square test and one-way a-nalysis of variance were used to compare the demographic and clinical data of OCD-H,OCD-L,and anxiety groups.Multivariate Logistic regression analysis was used to analyze the risk factors for OCD,and multiple linear regression analysis was used to analyze the influencing factors of obsessive compulsive symptoms in the OCD-H and OCD-L groups,respectively.Results There were significant differences in the scores of Y-BOCS((23.14±6.60),(17.77±6.48),(8.70±6.80)),OBQ-44((162.69±33.15),(86.54±19.09),(103.12±45.67)),NJRE-Q-R checklist scale((4.58±2.61),(2.92±2.15),(2.86±1.72)),NJRE-Q-R severity scale((32.86±8.97),(24.75±9.71),(18.86±8.51))among OCD-H,OCD-L,and anxiety groups(F=68.87,102.29,11.06,32.01,all P＜0.001).Multivariate Logistic regression analysis showed the NJRE-Q-R severity score was a risk factor for OCD(B=0.124,OR=1.132,95％CI=1.071-1.197,P＜0.001).For the OCD-H group,Y-BOCS scores were influenced by disease duration,BDI scores,OBQ-44 factor 1 and factor 3 scores(B=0.020,0.201,0.133,0.126,all P＜0.05).For the OCD-L group,the Y-BOCS scores were influenced by the scores of BDI and the checklist and severity score of NJRE-Q-R(B=0.265,0.852,0.191,all P＜0.05).Conclusions NJREs are prevalent in OCD patients regardless of the level of OCD beliefs,with higher degrees than anxiety disorders.NJREs are a risk factor for OCD,especially for patients with low obsessive compulsive beliefs.NJREs may be a potential cause and intervention target for OCD patients especially with low OCD beliefs.
Not just right experiencesIncompletenessObsessive beliefsObsessive-com-pulsive disorderAnxiety disorders
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