OBJECTIVE: Although atypical antipsychotic agents have been found effective in the augmentation of serotonin reuptake inhibitors (SRIs) for treatment-resistant obsessive-compulsive disorder (OCD) in short-term trials, there are few data on the effectiveness and safety of these agents in clinical settings over the long term. METHOD: Subjects (N = 46) who responded to selective SRIs (SSRIs) in an initial 12-week trial were continued onSSRI monotherapy plus cognitive-behavioral therapy (CBT) for 1 year. Subjects (N = 44) who failed to respond to SSRIs were randomly assigned to 1 of 3 atypical antipsychotics -- olanzapine, quetiapine, or risperidone -- and were consecutively treated using SSRI + atypical antipsychotics combined with CBT for 1 year. This study was conducted from January 2006 to November 2007 at Osaka City University Graduate School of Medicine Hospital, Japan. RESULTS: Augmentation with atypical antipsychotics reduced mean +/- SD Yale-Brown Obsessive Compulsive Scale (YBOCS) total scores in SSRI-refractory OCD patients (at initial assessment = 29.3 +/- 9.9, after 1 year = 19.3 +/- 6.8). However, compared to SSRI responders (at initial assessment = 25.8 +/- 11.4, after 1 year = 13.7 +/- 4.6), total YBOCS scores in those who required atypical antipsychotic augmentation were initially higher, and they remained at higher levels than those of SRI responders after 1 year of the treatments. CONCLUSIONS: Our work does not sufficiently support the long-term effectiveness of the atypical antipsychotics in the augmentation of SSRIs for treatment-resistant OCD patients. Even though this approach seems useful for some types of OCD patients, such as those with symmetry/ordering and hoarding symptoms, these data emphasize the limitations of the current pharmacotherapeutic options in treatment-refractory OCD, and their chronic use raises a number of safety concerns. TRIAL REGISTRATION: (ClinicalTrials.gov) Identifier NCT00854919. Copyright 2009 Physicians Postgraduate Press, Inc.
RCT Entities:
OBJECTIVE: Although atypical antipsychotic agents have been found effective in the augmentation of serotonin reuptake inhibitors (SRIs) for treatment-resistant obsessive-compulsive disorder (OCD) in short-term trials, there are few data on the effectiveness and safety of these agents in clinical settings over the long term. METHOD: Subjects (N = 46) who responded to selective SRIs (SSRIs) in an initial 12-week trial were continued on SSRI monotherapy plus cognitive-behavioral therapy (CBT) for 1 year. Subjects (N = 44) who failed to respond to SSRIs were randomly assigned to 1 of 3 atypical antipsychotics -- olanzapine, quetiapine, or risperidone -- and were consecutively treated using SSRI + atypical antipsychotics combined with CBT for 1 year. This study was conducted from January 2006 to November 2007 at Osaka City University Graduate School of Medicine Hospital, Japan. RESULTS: Augmentation with atypical antipsychotics reduced mean +/- SD Yale-Brown Obsessive Compulsive Scale (YBOCS) total scores in SSRI-refractory OCDpatients (at initial assessment = 29.3 +/- 9.9, after 1 year = 19.3 +/- 6.8). However, compared to SSRI responders (at initial assessment = 25.8 +/- 11.4, after 1 year = 13.7 +/- 4.6), total YBOCS scores in those who required atypical antipsychotic augmentation were initially higher, and they remained at higher levels than those of SRI responders after 1 year of the treatments. CONCLUSIONS: Our work does not sufficiently support the long-term effectiveness of the atypical antipsychotics in the augmentation of SSRIs for treatment-resistant OCDpatients. Even though this approach seems useful for some types of OCDpatients, such as those with symmetry/ordering and hoarding symptoms, these data emphasize the limitations of the current pharmacotherapeutic options in treatment-refractory OCD, and their chronic use raises a number of safety concerns. TRIAL REGISTRATION: (ClinicalTrials.gov) Identifier NCT00854919. Copyright 2009 Physicians Postgraduate Press, Inc.
Authors: James F Leckman; Damiaan Denys; H Blair Simpson; David Mataix-Cols; Eric Hollander; Sanjaya Saxena; Euripedes C Miguel; Scott L Rauch; Wayne K Goodman; Katharine A Phillips; Dan J Stein Journal: Depress Anxiety Date: 2010-06 Impact factor: 6.505
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Authors: Dan J Stein; Daniel L C Costa; Christine Lochner; Euripedes C Miguel; Y C Janardhan Reddy; Roseli G Shavitt; Odile A van den Heuvel; H Blair Simpson Journal: Nat Rev Dis Primers Date: 2019-08-01 Impact factor: 52.329
Authors: Renata de Melo Felipe da Silva; Andre R Brunoni; Stephan Goerigk; Marcelo Camargo Batistuzzo; Daniel Lucas da Conceição Costa; Juliana Belo Diniz; Frank Padberg; Giordano D'Urso; Eurípedes Constantino Miguel; Roseli Gedanke Shavitt Journal: Neuropsychopharmacology Date: 2021-01-15 Impact factor: 7.853