臺灣博碩士論文加值系統

中文摘要
背景:
強迫症（OCD）是一種影響功能,造成生活功能慢性衰弱的焦慮疾患，其症狀包含：侵入性想法和顯著補償重複性的行為。目前為止亞洲地區有關強迫症盛行率、發生率、共病症及危險因子之研究仍較少。且在現今的研究中，強迫症和焦慮症的因果關係仍然不明。在這一研究的具體目標，第一部分是評估在台灣地區強迫症的發生率，盛行率和精神共病症。本研究的第二部分，目的是調查是否焦慮疾病是否是強迫症（OCD）的相關危險因子。

方法:
本研究利用台灣全民健康保險研究資料庫2000年承保抽樣歸人檔來進一步台灣強迫症治療患者，以確定強迫症的發生率，盛行率和精神病合併症。我們確定分析性流行病學研究對象為2000-2008年強迫症患者；主要診斷依據國際疾病分類，第九版臨床修訂（ICD - 9 - CM）的診斷標準。從門診或住院中篩選患者。我們按照年齡分組分析研究對象，將所有病患分成七組（6-10、11-17、18-24、25-34、35-44、45-64歲和〉 65歲）。研究中直接以2004年台灣人口分佈調整年齡和性別差別。
本研究另一部份亦利用台灣全民健康保險研究資料庫2000年百萬歸人檔設計病例對照研究以探討強迫症及焦慮危險因子之關係，2000年至2011包括2662例新診斷強迫症的病例和13310名沒有強迫症的對照組。年齡、性別、人口學統計變量、共病精神病和強迫症之間關係採用卡方檢驗和t檢驗進行比較。焦慮疾患分為四組：廣泛性焦慮症（GAD），創傷後壓力症候群（PTSD），社交恐懼症和恐慌發作。之後進一步利用多重變項邏輯斯迴歸分析討論焦慮疾患與強迫症之因果關係、交互作用及疾病持續時間之影響。

結果:
本研究評估強迫症每年平均發生率為每十萬人有27.57人和一年期盛行率為每十萬人有65.05人。盛行率和發生率率在45歲之前隨著年齡的增加，高峰年齡在18-24歲男性和35-44歲女性。約57％的成年人（≥18歲）以及兒童和53％青少年患者（〈18歲）的有一個或多個合併的精神共病症。最常見的合併症診斷在成人和兒童青少年患者為憂鬱症。
多重變項邏輯斯迴歸分析顯示：創傷後壓力症候群和強迫症（OR1.91，95％CI為0.49至7.48）之間沒有明顯相關性。 GAD（OR3.77，95％CI為2.95〜4.8），恐慌發作（OR5.16，95％CI為3.61至5.76），社交恐懼症（OR17.8，95％CI為3.69至85.97）分別和強迫症有明顯相關性。只用廣泛性焦慮症和恐慌發作患者進行進一步的分析。調整變項後，急性發作廣泛性焦慮症和恐慌症且症狀持續，相對於慢性廣泛性焦慮症和恐慌症有較高罹患強迫症的風險。

結論:
在本研究中發現台灣地區比其他國家一般社區研究有較低的強迫症盛行率和臨床診斷強迫症的發生率。不同年齡層強迫症患者也有各種不同的精神共病症。本研究證實了強迫症和三個特定焦慮症，包括廣泛性焦慮症、社交恐懼症和恐慌發作之間的關聯。創傷後壓力症候群與強迫症無明顯相關。未來的研究應著重於尋找強迫症和焦慮症之間的額外心理和遺傳因素。
關鍵詞：強迫症，焦慮症，廣泛性焦慮症，恐慌症，全民健康保險，台灣。

Abstract
Background.
Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder significant in intrusive thoughts and compensation repetitive behaviors. Few studies have reported on this condition Asia. The relationship among OCD and anxiety disorders remained unknown. The first part of specific aim in this study was to estimate the prevalence, incidence and psychiatric comorbidities of OCD in Taiwan. The second part purpose of this study was to investigate whether specific anxiety disorders correlate with the risks of obsessive-compulsive disorder (OCD).
Methods.
The National Health Insurance Database was used to determine the incidence, prevalence and psychiatric comorbidity of OCD by following patients treated for OCD in Taiwan. We identified study subjects for 2000-2008 with a principal diagnosis of OCD according to the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic criteria. These patients received either outpatient or inpatient care for their condition. We analyzed study subjects by grouping them by age, breaking them into seven groups (6-10, 11-17, 18-24, 25-34, 35-44, 45-64 and 〉65 years). Rates were directly age- and sex-adjusted to the 2004 Taiwan population distribution.
We designed a population-based case-control study from the Taiwan National Health Insurance Database, which consisted of 2662 patients with newly diagnosis of OCD as cases and 13310 subjects without OCD controls during 2000 to 2011. Age, sex, demographic variables and covariate psychiatric disorders were compared between OCD cases and control using the chi-square test and t test. Anxiety disorders were classified into four groups: Generalized anxiety disorder (GAD), Post-traumatic stress disorder (PTSD), Social phobia, and Panic disorder.
Results.
The estimated mean annual incidence was 27.57 per 105 inhabitants and the one year prevalence was 65.05 per 105 inhabitants. Incidence and prevalence increased with age, peaking at age 18-24 years in males and at 35-44 years in females. About 57% of adults (〉18 years) and 53% of child and adolescent patients (〈18 years) had one or more comorbid psychiatric conditions. The most common comorbid diagnosis was depressive disorders for both adult and child-adolescent patients.
Multivariable logistic analysis showed no association was detected between PTSD and OCD (OR 1.91, 95% CI, 0.49 to 7.48). GAD (OR 3.77, 95% CI, 2.95 to 4.8), panic disorder (OR 5.16, 95% CI, 3.61 to 5.76), social phobia (OR 17.8, 95% CI, 3.69 to 85.97) were significant comorbidities associated with increased risk of OCD. The further analysis was performed using only the GAD and panic disorder. After adjusting for variables, GAD and panic disorder durations were not significantly related to the risk of OCD.
Conclusions.
We found a lower prevalence and incidence of clinically diagnosed OCD than that of community studies. Many Asian patients with OCD also had various psychiatric comorbidities, a clinically relevant finding. The study confirms the association between OCD and three specific anxiety disorders, including GAD, social phobia and panic disorder. PTSD does not correlate with the risk of OCD. Future studies should focus on finding the additional psychosocial and genetic factor between OCD and anxiety disorders.
Key words: Obsessive and compulsive disorder, Anxiety disorders, Generalized anxiety disorder, Panic disorder, National Health Insurance, Taiwan
 

TABLE OF CONTENTS
中文摘要...............................................................................................................................I
ABSTRACT.......................................... ..IV
致謝......................................................VII
TABLE OF CONTENTS ..............................................................................................VIII
LIST OF TABLES........................................................................................................... .XI
LIST OF FIGURES........................................................................................................ XII

CHAPTER I INTRODUCTION.........................................................................................1
Section 1 -Background….....................................1
Section 2 - Introduction of incidence, prevalence and gender difference of obsessive-compulsive disorder ............3
Section 3- Psychiatric comorbidity of obsessive-compulsive disorder..................................5
Section 4 - Anxiety risk factors for obsessive-compulsive disorder .....................................6
Section 5 - Hypothesis ............................10
1 - Epidemiology of Obsessive-compulsive Disorder Patients............................................10
2 - Anxiety Risk Factor of Obsessive-compulsive Disorder Patients……………………..10
Section 6 - Specific aims and significance ..............11
Section 7 - Summary.....................................11

CHAPTER II METHODS AND MATERIALS………………………………………..13
Section 1 - Database ....................................13
Section 2 - Study subjects..............................13
Section 3 - Assessment of risk factors and covariates…………..15
Section 4 - Data analysis.................................17
Section 5 - Research ethics .............................18

Chapter III RESULTS......................................19
Section 1 – Description of incidence, prevalence rate and gender difference in the follow-up period ...................19
Section 2 - Description of adult comorbidity and gender difference in the follow-up period ..................................20
Section 3- Description of child and adolescent comorbidity and gender difference in the follow-up period ........................................21
Section 4 - Anxiety risk factors associated with obsessive-compulsive disorder in the follow-up period .............................................21
Section 5 – The duration effects and anxiety disorder interaction of obsessive-compulsive disorder in the follow-up period…………………………………...22
.
CHAPTER IV DISCUSSIONS............................24
Section 1- Character of obsessive-compulsive disorder patients................................24
Section 2 - Incidence, prevalence rate and gender difference......................................25
Section 3 - Adult comorbidity and gender difference……………………..27
Section 4 - Child and adolescent comorbidity and gender difference..............................29
Section 5 - Anxiety risk factors associated with obsessive-compulsive disorder................31
Section 6 - Duration effects of anxiety risk factors associated with obsessive-compulsive disorder…………………………….32
Section 7 - Interaction of anxiety risk factors associated with obsessive-compulsive disorder.......................34
Section 8 - Limitations............................35

CHAPTER V CONCLUSIONS AND SUGGESTIONS .........................................37
Section 1 - Conclusions...............................37
Section 2 - Suggestions................................38

CHAPTER VI REFERENCES............................41
 
LIST OF TABLES.............................XI
Table 1. Age-specific and sex-adjusted incidence rate of diagnosed obsessive-compulsive disorder patients in Taiwan,……………………………………………………………….57
Table 2. Age-specific and sex-adjusted prevalence rate (per 100,000 inhabitants) of diagnosed obsessive-compulsive disorder patients in Taiwan…………………………….58
Table 3. The number of comorbid psychiatric disorders in adult and child and adolescent patients with obsessive-compulsive disorder……………………………………………...59
Table 4. Comorbid psychiatric disorders among adult patients with obsessive-compulsive disorder……………………………………………….60
Table 5. Comorbid psychiatric disorders among child and adolescent patients with obsessive-compulsive disorder…………………………………………….61
Table 6. Comparison by sociodemographic factors and major psychiatric disorders between obsessive-compulsive disorder and controls …………………………….62
Table 7. Crude and adjusted odds ratio and 95% confidence interval of OCD associated with specific anxiety disorders………………………………………….63
Table 8. Crude and adjusted ORs of OCD among the case-control sampled patient during the follow-up years by the presence of GAD and panic disorder…………………………64
Table 9. Adjusted odds ratios of OCD in relation to duration of panic disorder………….65
Table 10. Crude and adjusted ORs of OCD among the case-control sampled patient during the follow-up years by the presence of GAD and panic disorder………………………....66



 
LIST OF FIGURES………………………………………………………XII
Figure legends………………..……………………………………………………67
Figure 1. Flow chart of selection subjects from the OCD patients with incidence, prevalence and comorbidity in Taiwan’s National Health Insurance Research Database…………………………………………………………………...68
Figure 2. Flow chart of selection subjects from the OCD patients with anxiety risk factors in Taiwan’s National Health Insurance Research Database......................69

 

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