Michael Van Ameringen1, William Simpson2, Beth Patterson3, Bernardo Dell'Osso4, Naomi Fineberg5, Eric Hollander6, Luchezar Hranov7, Georgi Hranov7, Christine Lochner8, Oguz Karamustafalioglu9, Donatella Marazziti10, Jose M Menchon11, Humberto Nicolini12, Stefano Pallanti13, Dan J Stein14, Joseph Zohar15. 1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada vanamer@mcmaster.ca. 2. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada MiNDS Neuroscience Graduate Program, McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada. 3. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. 4. Department of Psychiatry of the Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico of Milano, Milan, Italy. 5. National Obsessive Compulsive Disorders Treatment Service, Hertfordshire Partnership NHS Foundation Trust, Queen Elizabeth II Hospital, Welwyn Garden City, UK; University of Hertfordshire, Postgraduate Medical School, Hatfield, UK. 6. Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA. 7. University Hospital of Neurology and Psychiatry, St. Naum of Sofia, Sofia, Bulgaria. 8. MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa. 9. Sişli Etfal Teaching and Research Hospital of Istanbul, Istanbul, Turkey. 10. Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie", University of Pisa, Pisa, Italy. 11. IDIBELL-University Hospital of Bellvitage, CIBERSAM University of Barcelona, Barcelona, Spain. 12. Center for Genomic Sciences, Universidad Autónoma de la Ciudad de México and Carracci Medical Group, Mexico City, Mexico. 13. Institute of Neuroscience, Università di Firenze, Firenze, Italy. 14. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. 15. Chaim Sheba Medical Center, Department of Psychiatry, Tel Aviv, Israel.
Abstract
OBJECTIVE: It is unknown what next-step strategies are being used in clinical practice for patients with obsessive-compulsive disorder (OCD) who do not respond to first-line treatment. As part of a cross-sectional study of OCD, treatment and symptom information was collected. METHOD: Consecutive OCD out-patients in nine international centers were evaluated by self-report measures and clinical/structured interviews. OCD symptom severity was evaluated by the Yale Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impression-Severity Scale (CGI-S). Clinical response to current treatment was evaluated by the CGI-Improvement Scale (CGI-I ≤ 2). RESULTS: In total, 361 participants reported taking medication; 77.6% were taking a selective serotonin reuptake inhibitor; 50% reported use of at least one augmentation strategy. Antipsychotics were most often prescribed as augmenters (30.3%), followed by benzodiazepines (24.9%) and antidepressants (21.9%). No differences in OCD symptom severity were found between patients taking different classes of augmentation agents. CONCLUSIONS: Results from this international cross-sectional study indicate that current OCD treatment is in line with evidence-based treatment guidelines. Although augmentation strategies are widely used, no significant differences in OCD symptom severity were found between monotherapy and augmentation or between different therapeutic agents.
OBJECTIVE: It is unknown what next-step strategies are being used in clinical practice for patients with obsessive-compulsive disorder (OCD) who do not respond to first-line treatment. As part of a cross-sectional study of OCD, treatment and symptom information was collected. METHOD: Consecutive OCD out-patients in nine international centers were evaluated by self-report measures and clinical/structured interviews. OCD symptom severity was evaluated by the Yale Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impression-Severity Scale (CGI-S). Clinical response to current treatment was evaluated by the CGI-Improvement Scale (CGI-I ≤ 2). RESULTS: In total, 361 participants reported taking medication; 77.6% were taking a selective serotonin reuptake inhibitor; 50% reported use of at least one augmentation strategy. Antipsychotics were most often prescribed as augmenters (30.3%), followed by benzodiazepines (24.9%) and antidepressants (21.9%). No differences in OCD symptom severity were found between patients taking different classes of augmentation agents. CONCLUSIONS: Results from this international cross-sectional study indicate that current OCD treatment is in line with evidence-based treatment guidelines. Although augmentation strategies are widely used, no significant differences in OCD symptom severity were found between monotherapy and augmentation or between different therapeutic agents.