Quetiapine addition to serotonin reuptake inhibitor treatment in patients with treatment-refractory obsessive-compulsive disorder: an open-label study. Amisulpiride augmentation in treatment resistant obsessive-compulsive disorder: an open trial. Association study of the serotonin transporter gene polymorphism in obsessive-compulsive disorder. Serotonin Transporter Imaging with [123I]β-CIT SPECT before and after One Year of Citalopram Treatment of Obsessive-Compulsive Disorder A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision A long-term trial of the effectiveness and safety of atypical antipsychotic agents in augmenting SSRI-refractory obsessive-compulsive disorder. Double-blind comparison of fluoxetine versus clomipramine in the treatment of obsessive compulsive disorder Adding quetiapine to SRI in treatment-resistant obsessive–compulsive disorder: a randomized controlled treatment study Long-term outcomes of obsessive-compulsive disorder: follow-up of 142 children and adolescents. Augmentation strategy with olanzapine in resistant obsessive compulsive disorder: an Italian long-term open-label study Guidelines for the pharmacological treatment of anxiety disorders, obsessive–compulsive disorder and posttraumatic stress disorder in primary care A double-blind, placebo-controlled trial of olanzapine addition in fluoxetine-refractory obsessive-compulsive disorder Decrease in thalamic volumes of pediatric patients with obsessive-compulsive disorder who are taking paroxetine. Quetiapine augmentation of serotonin reuptake inhibitors in obsessive-compulsive disorder Citalopram 20 mg, 40 mg and 60 mg are all effective and well tolerated compared with placebo in obsessive-compulsive disorder Platelet serotonin transporter in children and adolescents with obsessive-compulsive disorder or Tourette's syndrome. Cognitive-behavioral therapy for medication nonresponders with obsessive-compulsive disorder: a wait-list-controlled open trial. Risperidone and haloperidol augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder: a crossover study. Quetiapine Addition to Serotonin Reuptake Inhibitors in Patients With Severe Obsessive-Compulsive Disorder: A Double-Blind, Randomized, Placebo-Controlled Study Quetiapine augmentation in patients with treatment resistant obsessive–compulsive disorder: a single-blind, placebo-controlled study Predictors of response to pharmacotherapy with citalopram in obsessive-compulsive disorder Fluvoxamine in obsessive-compulsive disorder: similar efficacy but superior tolerability in comparison with clomipramine.
OBJECTIVE Although patients with obsessive-compulsive disorder ( OCD ) benefit from treatment with serotonin reuptake inhibitors ( SRIs ) , it is estimated that 40 % to 60 % of the patients remain unimproved . The objective of this study was to examine whether addition of the atypical antipsychotic quetiapine to SRIs is useful for patients with OCD who do not respond to SRI monotherapy . METHOD Ten patients with OCD ( DSM-IV criteria ) who had not responded to at least 3 previous treatments with an SRI at maximum dose and duration were assigned to receive quetiapine in addition to an SRI for 8 weeks . Treatment response was assessed using the Yale-Brown Obessive-Compulsive Scale ( YBOCS ) . RESULTS Seven of 10 patients responded to the quetiapine addition . The mean + /- SD baseline YBOCS score of 31.4 + /- 7.8 dropped to a mean of 20.8 + /- 8.4 at endpoint with a mean reduction of 35.4 % . CONCLUSION This is the first study to show that treatment-refractory OCD patients may benefit from addition of quetiapine to ongoing SRI therapy Despite the effectiveness of clomipramine and selective serotonin reuptake inhibitors ( SSRIs ) in the treatment of obsessive-compulsive disorder ( OCD ) , 40 % to 60 % of patients who receive an adequate treatment with these agents have significant persisting symptoms . Newer atypical antipsychotic drugs showed efficacy as augmenting agents in patients with OCD resistant to serotonin reuptake inhibitors ( SRIs ) . The objective of this study was to evaluate the efficacy and safety of amisulpiride augmentation in treatment resistant OCD . A total of 20 patients diagnosed with OCD according to DSM-IV criteria and having a history of resistance to treatment with SRIs were included in the study .  Amisulpiride 200 mg/day was added to ongoing SRI treatment and titrated up to 600 mg/day in flexible doses . The mean amisulpiride dose was 325 + /- 106 mg/day . The patients were assessed with the Yale-Brown obsessive-compulsive scale ( Y-BOCS ) at baseline and at week 12 of amisulpiride treatment . Side effects were monitored by the UKU side effect rating scale . The reduction in Y-BOCS scores between the baseline ( 26.7 + /- 6.3 ) and the end of the treatment ( 12.5 + /- 2.8 ) was statistically significant ( p=0.0001 ) . The most commonly observed side effects included weight gain ( 14 patients , 70 % ) , mild sedation ( 13 patients , 65 % ) and asthenia ( 7 patients , 35 % ) . This study has several limitations and , hence , the results are preliminary and require confirmation in a r and omized controlled trial . In conclusion , this study suggests that amisulpiride may be a promising option as an augmentation strategy in treatment resistant OCD The hypothesis implicating the serotonergic system in the pathophysiology of obsessive-compulsive disorder ( OCD ) is supported by the therapeutic efficacy of selective serotonin reuptake inhibitors ( SSRIs ) . Since SSRIs act on the serotonin transporter ( 5-HTT ) , it has been suggested that the 5-HTT gene ( SCL6A4 ) could be a good c and i date for OCD . The SCL6A4 gene has a 44-bp insertion/deletion polymorphism in its promoter region ( 5-HTTLPR ) . Previous studies have revealed an association between OCD and the l allele . We analysed the  5-HTTLPR polymorphic system  in 115 Mexican OCD patients and 136 controls . No significant association was found between l allele and OCD ( chi2 = 1.54 , d.f . = 1 , p = 0.21 ) . Furthermore , we assessed alternative methods that employ family-based design s in a sample of 43 trios .  Haplotype-based haplotype relative risk and transmission disequilibrium analysis did not show a preferential transmission of l allele to OCD prob and s. Our results indicate the need to analyse larger sample s using family-based methods Background : Two thirds of patients with obsessive-compulsive disorder ( OCD ) respond to treatment with selective serotonin reuptake inhibitors ( SSRIs ) . The neurobiological mechanisms of SSRI action and failure to respond to SSRI treatment remain to be eluci date d. Objectives : The aim of this pilot study was to quantify changes in the availability of serotonin transporter ( SERT ) in the course of SSRI treatment and to relate these changes to improvements of clinical symptoms . Methods : Ten patients with OCD were investigated at baseline and 5 of them after 1 year of SSRI treatment with citalopram 60 mg per day using brain single photon emission computed tomography and [123I]β-CIT .  Specific-to-nondisplaceable [123I]β-CIT binding ratios ( V3″ ) were calculated in SERT-rich brainstem , midbrain and thalamus using a magnetic resonance imaging-based region of interest ( ROI ) analysis . Symptom severity was evaluated with the Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) . Results : V3″ differed significantly between pretreatment and follow-up scans in all three brain regions , thalamus , midbrain as well as in brainstem . In thalamic ROI , differ ences in SERT availability and Y-BOCS ratings correlated . In midbrain , a trend toward a significant association was found . In brainstem , no relationship was revealed . Conclusions : Higher occupancy of SERT by citalopram seems to be associated with better clinical response after 1 year of SSRI treatment of patients with OCD BACKGROUND To date , only 1 controlled study has found a drug ( haloperidol ) to be efficacious in augmenting response in patients with obsessive-compulsive disorder ( OCD ) refractory to serotonin reuptake inhibitor ( SRI ) monotherapy ; patients with comorbid chronic tic disorders showed a preferential response . This report describes the first controlled study of risperidone addition in patients with OCD refractory to treatment with SRI alone . METHODS Seventy adult patients with a primary DSM-IV diagnosis of OCD received 12 weeks of treatment with an  SRI . Thirty-six patients were refractory to the SRI  and were r and omized in a double-blind manner to 6 weeks of risperidone ( n = 20 ) or placebo ( n = 16 ) addition . Behavioral ratings , including the Yale-Brown Obsessive Compulsive Scale , were obtained at baseline and throughout the trial . Placebo-treated patients subsequently received an identical open-label trial of risperidone addition . RESULTS For study completers , 9 ( 50 % ) of 18 risperidone-treated patients were responders ( mean daily dose , 2.2 + /-0.7 mg/d ) compared with 0 of 15 in the placebo addition group ( P<. 005 ) . Seven ( 50 % ) of 14 patients who received open-label risperidone addition responded . Risperidone addition was superior to placebo in reducing OCD ( P<.001 ) , depressive ( P<.001 ) , and anxiety ( P = .003 ) symptoms . There was no difference in response between OCD patients with and without comorbid diagnoses of chronic tic disorder or schizotypal personalty disorder . Other than mild , transient sedation , risperidone was well tolerated . CONCLUSION These results suggest that OCD patients with and without comorbid chronic tic disorders or schizotypal personality disorder may respond to the addition of low-dose risperidone to ongoing SRI therapy In this report , which is an up date of a guideline published in 2002 ( B and elow et al. 2002 , World J Biol Psychiatry 3:171 ) , recommendations for the pharmacological treatment of anxiety disorder , obsessive-compulsive disorder ( OCD ) and post-traumatic stress disorder ( PTSD ) are presented . Since the publication of the first version of this guideline , a substantial number of new r and omized controlled studies of anxiolytics have been published . In particular , more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs . The recommendations , developed by the World Federation of Societies of Biological Psychiatry ( WFSBP ) Task Force for the Pharmacological Treatment of Anxiety , Obsessive-Compulsive and Post-traumatic Stress Disorders , a consensus panel of 30 international experts , are now based on 510 published r and omized , placebo- or comparator-controlled clinical studies ( RCTs ) and 130 open studies and case reports . First-line treatments for these disorders are selective serotonin reuptake inhibitors ( SSRIs ) , serotonin-noradrenaline reuptake inhibitors ( SNRIs ) and the calcium channel modulator pregabalin . Tricyclic antidepressants ( TCAs ) are equally effective for some disorders , but many are less well tolerated than the SSRIs/SNRIs . In treatment-resistant cases , benzodiazepines may be used when the patient does not have a history of substance abuse disorders . Potential treatment options for patients unresponsive to st and ard treatments are described in this overview . Although these guidelines focus on medications , non-pharmacological were also considered . Cognitive behavioural therapy ( CBT ) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders , OCD , and PTSD to support them being recommended either alone or in combination with the above medicines 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 setting s 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 r and omly 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 ( Clinical Trials.gov ) Identifier NCT00854919 There is evidence of the clinical efficacy and safety of clomipramine and the newer selective serotonin reuptake inhibitors ( SSRIs ) for the treatment of obsessive-compulsive disorder ( OCD ) . In the present study , we have compared the efficacy and safety of 40 mg/day of fluoxetine and 150 mg/day of clomipramine in patients with OCD , diagnosed according to DSM-IIIR . A total of 55 patients entered this 8-week , double-blind controlled study . Efficacy for both drugs was comparable . The primary efficacy criterion , the Y-BOCS Total score , did not show any significant differences between treatment arms . Response rate was higher with clomipramine , using a 25 % decrease in Y-BOCS Total score as response threshold , but there were no significant differences between treatment arms using a 35 % threshold . Overall safety and tolerability were good for both drugs , being slightly better for fluoxetine This study aim ed to determine the efficacy and tolerability of adding quetiapine to a serotonin reuptake inhibitor in treatment-resistant obsessive – compulsive disorder ( OCD ) . Twenty-one adult treatment-resistant OCD patients were r and omized to 16 weeks of augmentation with either quetiapine ( n=11 ) or placebo ( n=10 ) . Patients with significant comorbidities , including tic-spectrum disorders , were not included . The treatment was well tolerated , with only one premature dropout in each treatment-group . The primary analysis showed that individuals in the quetiapine-treated group showed a 14 % mean improvement in baseline Yale – Brown Obsessive – Compulsive Scale scores at study endpoint compared with a 6 % improvement in those treated with placebo , but this difference did not reach statistical significance ( F<1 ) . Three patients treated with quetiapine met criteria for clinical response , compared to one patient who was treated with placebo . Larger studies are needed to explore the efficacy of second generation antipsychotics , such as quetiapine , when used as adjunct treatment in resistant OCD BACKGROUND Obsessive-compulsive disorder ( OCD ) often starts in childhood and adolescence and can be a chronic disorder with high persistence rates . There are few prospect i ve long-term follow-up studies . AIMS To follow up young people with OCD to clarify persistence rates and relevant predictors , presence of other psychiatric disorders , functional impairment , service utilisation and perceived treatment needs . METHOD All young people with OCD assessed over 9 years at the National and Specialist Paediatric OCD clinic , Maudsley Hospital , London , were included . Sixty-one per cent ( 142 of 222 ) of all contactable young people and parents completed computerised diagnostic interviews and question naires . RESULTS We found a persistence rate of OCD of 41 % ; 40 % of participants had a psychiatric diagnosis other than OCD at follow-up . The main predictor for persistent OCD was duration of illness at assessment . High levels of baseline psychopathology predicted other psychiatric disorders at follow-up . Functional impairment and quality of life were mildly to moderately affected . Approximately 50 % of participants were still receiving treatment and about 50 % felt a need for further treatment . CONCLUSIONS This study confirms that paediatric OCD can be a chronic condition that persists into adulthood . Early recognition and treatment might prevent chronicity . Important challenges for services are ensuring adequate treatment and a smooth transition from child to adult services The present study reports the results of an open-label trial on the use of the combination of olanzapine ( an atypical antipsychotic ) serotonin reuptake inhibitors ( SRIs ) in 26 resistant out patients affected by resistant obsessive-compulsive disorder ( OCD ) . All patients had been suffering from OCD , according to DSM IV criteria , for at least 2 years and had different comorbid disorders ; they had been treated with an  SRI  at adequate dosages for at least 6 months , or had tried different augmentation strategies with no or poor response . As a result , olanzapine was added and continued for 1 year . After 12 weeks of this regimen , most of the patients ( 17 ) had shown a reduction in OC symptoms , as assessed by a decrease in the Yale-Brown Obsessive Compulsive Scale total score , which continued throughout subsequent months . Only mild side-effects were recorded and no patient halted the treatment . The addition of olanzapine would appear to be a useful short- and long-term strategy for augmenting SRI effectiveness in resistant OCD patients , especially in those presenting comorbidity with bipolar disorders Abstract Objective . Anxiety disorders are frequently under-diagnosed conditions in primary care , although they can be managed effectively by general practitioners . Methods . This paper is a short and practical summary of the World Federation of Biological Psychiatry ( WFSBP ) guidelines for the pharmacological treatment of anxiety disorders , obsessive – compulsive disorder ( OCD ) and posttraumatic stress disorder ( PTSD ) for the treatment in primary care . The recommendations were developed by a task force of 30 international experts in the field and are based on r and omized controlled studies . Results . First-line pharmacological treatments for these disorders are  selective serotonin reuptake inhibitors  ( for all disorders ) ,  serotonin-norepinephrine reuptake inhibitors  ( for some ) and  pregabalin  ( for generalized anxiety disorder only ) . A combination of  medication and cognitive behavior/exposure therapy  was shown to be a clinical ly desired treatment strategy . Conclusions . This short version of an evidence -based guideline may improve treatment of anxiety disorders , OCD , and PTSD in primary care BACKGROUND One of the few combination approaches to the treatment of obsessive-compulsive disorder ( OCD ) with encouraging support is the addition of an antipsychotic to a serotonin reuptake inhibitor . METHODS The study consisted of a 6-week , placebo-controlled addition of olanzapine 5 - 10 mg ( 6.1 + /- 2.1 mg , mean + /- SD ) to  fluoxetine  in OCD subjects who were partial or nonresponders to an 8-week , open-label fluoxetine trial ( 40 mg in 43 subjects , 20 mg in 1 subject ) . RESULTS Both the fluoxetine-plus-olanzapine ( n = 22 ) and fluoxetine-plus-placebo ( n = 22 ) groups improved significantly over 6 weeks [ F(3,113 ) = 11.64 , p < .0001 ] according to Yale-Brown Obsessive Compulsive Scale scores with repeated- measures analysis of variance ; however , the treatment x time interaction was not significant for olanzapine versus placebo addition to fluoxetine . CONCLUSIONS These findings indicate no additional advantage of adding olanzapine for 6 weeks in OCD patients who have not had a satisfactory response to fluoxetine for 8 weeks , compared with extending the monotherapy trial BACKGROUND Thalamic dysfunction has been implicated in obsessive-compulsive disorder ( OCD ) . While OCD frequently has its onset during childhood , to our knowledge , no prior study has measured neuroanatomical changes in the thalamus of patients with OCD near the onset of illness , and before and after treatment . METHODS Volumetric magnetic resonance imaging studies were conducted in 21 psychotropic drug-naive children , aged 8 to 17 years , with OCD and 21 case-matched healthy comparison subjects .  Magnetic resonance imaging studies were also conducted in 10 of the 21 patients with OCD after 12 weeks of monotherapy with the selective serotonin reuptake inhibitor , paroxetine hydrochloride . RESULTS Thalamic volumes were significantly greater in treatment-naive patients with OCD than in controls but declined significantly after paroxetine monotherapy to levels comparable with those of controls . Decrease in thalamic volume in patients with OCD was associated with reduction in OCD symptom severity . CONCLUSIONS Our findings provide new evidence of thalamic abnormalities in pediatric OCD and further suggest that paroxetine treatment may be paralleled by a reduction in thalamic volume . These reductions may , however , not be specific to paroxetine treatment and could be due to a more general treatment response , and /or spontaneous improvement in symptoms . Our findings are preliminary given the small sample size and our inability to measure discrete thalamic nuclei The augmentation of serotonin reuptake inhibitors ( SRIs ) with atypical antipsychotics for the management of  treatment-resistant obsessive-compulsive disorder ( OCD ) is gaining increasing acceptance . Quetiapine is a novel antipsychotic which is well tolerated , and which may therefore be particularly useful in this context . Charts of all patients treated in our OCD clinic with the combination of an SRI and quetiapine  were review ed . Demographic details and clinical symptoms on the Yale-Brown Obsessive-Compulsive Scale and the Clinical Global Impressions Scale ( CGI ) were tabulated before and after augmentation . Eight OCD patients who had proven resistance to treatment with SRIs  had received quetiapine augmentation . Four of these eight patients were responders ( CGI of 1 or 2 ) within 4 weeks . In the treatment-responders , the medication was well tolerated . Although limited by the retrospective design and lack of controls , these data are consistent with the growing literature suggesting that approximately one-half of OCD patients resistant to treatment with SRIs  may respond to augmentation with an atypical antipsychotic . Quetiapine , a relatively well tolerated agent , deserves further controlled study in this context Serotonin reuptake inhibitors appear to be uniquely effective treatments for obsessive-compulsive disorder ( OCD ) . This double-blind , placebo-controlled study was the first trial to assess the efficacy of the most selective of the serotonin reuptake inhibitors , citalopram , in OCD . A total of 401 patients were r and omized to receive citalopram 20 , 40 or 60 mg/day or placebo for 12 weeks . All three doses of citalopram were significantly more effective than placebo measured on the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) change score ( P < 0.01 ) . The highest response rate , defined as 25 % improvement in Y-BOCS entry score , was observed in the 60 mg group ( 65 % ) . This compared with 52 % and 57.4 % in the 40 mg and 20 mg groups . Response rate on placebo was 36.6 % ( P < 0.05 for all three doses of citalopram compared to placebo ) . There was no significant difference between the individual doses of citalopram . An advantage was seen for citalopram on the Sheehan Disability Scale compared with placebo ( P < 0.05 on all three citalopram groups versus placebo for both the work situation and the family life and home responsibilities and P < 0.05 on citalopram 60 mg and 20 mg versus placebo for the social life and home activities ) .  Citalopram was well tolerated ; only 4 to 6 patients in each dose group discontinued the study prematurely due to adverse events UNLABELLED Previous studies of serotonin transporter protein ( 5HTPR ) indexed in platelets by 3H-imipramine demonstrate reduction in children with comorbid obsessive-compulsive disorder ( OCD ) and Tourette 's syndrome ( TS ) . OBJECTIVE To use the 5HTPR selective lig and 3H-paroxetine and homogeneous diagnostic groups to reevaluate these findings . METHOD Platelet Kinetic binding parameters were evaluated using st and ard techniques from medication-free child and adolescent patients with OCD ( n = 18 ) , with TS ( n = 10 ) , and normal controls ( n = 19 ) . RESULTS Baseline binding capacity ( Bmax ) was significantly reduced in patients with OCD ( 1,342 + /- 952 fmol/mg ; protein p < .01 ) compared with normal controls ( 2,486 + /- 1309 fmol/mg ) and TS patients ( 2,420 + /- 1,069 fmol/mg ; p < .05 ) . Among OCD patients who were subsequently treated on an open-label basis with selective serotonin reuptake inhibitor ( SSRI ) , Bmax values at baseline differentiated between responders ( 1,718 + /- 1,041 fmol/mg ) and nonresponders ( 802 + /- 713 fmol/mg protein ; p < .05 ) . Response to SSRI was greatest in patients with a positive family history of OCD . Among responders ( n = 10 ) , baseline Yale-Brown Obsessive Compulsive Scale and Bmax were positively correlated ( r = .76 , p = .01 ) , as was Clinical Global Impression ( r = .67 , p = .03 ) . CONCLUSIONS Platelet 5HTPR capacity ( Bmax ) is reduced in children and adolescents with OCD , but not in those with TS . 5HTPR may be an indirect measure of basal serotonergic tone BACKGROUND Cognitive-behavioral therapy ( CBT ) is generally recommended for obsessive-compulsive disorder ( OCD ) patients who have failed to respond to approved medications . However , few studies of the efficacy of CBT have selected patients who did not respond to medications . METHOD We selected 20 adult OCD ( DSM-IV criteria ) patients with a history of inadequate response to adequate doses of multiple medications , as well as a high rate of comorbid disorders . After a 1-month wait-list period , patients received 15 sessions of outpatient CBT incorporating exposure and ritual prevention . RESULTS OCD severity ( as measured with the Yale-Brown Obsessive Compulsive Scale ) decreased significantly ( p < .05 ) after treatment , and gains appeared to have been maintained over a 6-month follow-up period . Analysis of clinical significance indicated that 53 % ( 8/15 ) of treatment completers met this criterion at posttreatment and 40 % ( 6/15 ) met the criterion at 6-month follow-up . The sample was characterized as having generally poor insight and putting low effort into CBT ; these factors significantly ( p < .05 ) predicted degree of improvement . CONCLUSION CBT is a useful treatment for OCD patients who have failed to respond adequately to multiple serotonin reuptake inhibitor medications . However , these results were attenuated compared with previous trials . Patients with a long history of poor response to medication may have poor insight and /or not put sufficient effort into treatment ; these factors are likely to diminish treatment outcome BACKGROUND Although serotonin reuptake inhibitors ( SRIs ) are the first-line treatment for obsessive-compulsive disorder ( OCD ) , approximately half of patients with OCD do not respond adequately to SRI monotherapy . Patients with predominant obsessions are common in OCD and are often difficult to treat , necessitating adjunctive treatment . METHOD This was a 9-week , double-blind , placebo-controlled , crossover study comparing the benefits of 2-week adjunctive treatments with risperidone , haloperidol , and placebo in patients with OCD ( DSM-IV criteria ) who continued to have severe symptoms despite taking a stable dose of an SRI . Eligible patients must have been receiving a therapeutic dose of an SRI for at least 12 weeks and at the screening visit had a score > or = 10 on items 1 - 5 ( obsession ) and a total score > or = 16 on the Yale-Brown Obsessive Compulsive Scale ( YBOCS ) . Data were collected from January 1999 through April 2002 . RESULTS Sixteen patients were enrolled and 12 completed the study . On the YBOCS , both risperidone and haloperidol significantly reduced obsession ( p < .05 ) when compared with placebo . There was a tendency that haloperidol , and to a lesser degree risperidone , also reduced the compulsion and the total YBOCS scores . These results were accompanied by a reduction in the Hopkins Symptom Checklist 90-revised ( SCL-90R ) anxiety scale score . According to the 17-item Hamilton Rating Scale for Depression , the SCL-90R depression scale , and the Profile of Mood States , risperidone , but not halo-peridol , also improved depressed mood . Neither risperidone nor haloperidol changed neurocogni-tive function during the 2-week treatment . All 12 patients completed the 2-week risperidone treatment , but 5 of the 12 terminated haloperidol treatment early owing to intolerable side effects . CONCLUSION Adjunctive risperidone improved obsessions and depressed mood and was well tolerated in patients with SRI-refractory OCD Objective : Although many patients with obsessive-compulsive disorder ( OCD ) benefit from treatment with serotonin reuptake inhibitors ( SRIs ) , it is estimated that 40 % to 60 % of them do not respond . The objective of the present study was to evaluate the efficacy of quetiapine added to baseline treatment with SRIs for the treatment of OCD in severely ill adult subjects . Method : Forty patients ( 21 men , 19 women ) with primary OCD according to Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria participated in a 12-week , double-blind , placebo-controlled trial . They were r and omly assigned to dosages of quetiapine titrated up to 400 mg/d ( n = 20 ) or to placebo ( n = 20 ) in addition to their SRI treatment . During the continuation phase ( weeks 6 - 12 ) , subjects received different dosages between 400 and 600 mg/d depending on clinical response . At entry , all patients were unresponsive to at least 1 course of at least 12 weeks of treatment with SRIs at defined doses . The total Yale-Brown Obsessive-Compulsive Scale score was the primary efficacy parameter . Results : Intention-to-treat , last-observation-carried-forward analysis demonstrated a mean ± SD decrease in Yale-Brown Obsessive-Compulsive Scale score of 5.2 ± 5.4 in the quetiapine group and 3.9 ± 4.9 in the placebo group . The analysis of treatment effects between the 2 groups showed no significant difference . There were no significant group differences in any of the other self-rating scales or clinician-administered rating scales . Conclusions : In this study , augmentation of SRI treatment with quetiapine in severe OCD had no additional effect Recently , atypical antipsychotics have been used for the management of the patients with refractory obsessive – compulsive disorder ( OCD ) . The aim of the present study was to evaluate the results of quetiapine augmentation to a serotonin reuptake inhibitor ( SRI ) in the patients with refractory OCD . Fifty-two patients with OCD according to DSM-IV entered 3 months of an open-label phase treatment with a SRI with or without concomitant adjunctive treatment regimen . Of them , 27 patients were refractory OCD . These patients were r and omly divided into two groups , SRI plus quetiapine and SRI plus placebo , for an 8-week single-blind phase . The course of OCD was evaluated by Yale – Brown Obsession – Compulsion ( Y-BOCS ) and Clinical Global Impression – Severity of Illness and Improvement ( CGI-SI and I ) Scales every other week for 8 weeks . Of the 14 patients in group I , nine ( 64.4 % ) showed significant improvement with 60 % or greater improvement on the Y-BOCS and one ( 7.1 % ) partial improvement with 30 % or greater improvement on the Y-BOCS , whereas no improvement was observed in group II . The addition of quetiapine to ongoing SRI therapy has been found to be effective and well-tolerated approach in patients with refractory OCD Although serotonin reuptake inhibitors ( SRIs ) are the medications of choice in the treatment of obsessive-compulsive disorder ( OCD ) , only 50 - 60 % of patients respond to a single trial of any of these agents . Improved knowledge of the predictors of response to treatment may have important clinical implication s. Data from a large r and omized placebo-controlled trial of citalopram in OCD was analysed using logistic regression to determine predictors of response . Demographic ( age , sex ) , clinical ( OCD severity and duration , depression severity , prior treatment ) and trial variables  ( citalopram dose , treatment duration ) were included . Subjects with longer duration of OCD , more severe OCD symptoms or previous selective SRI use were less likely to be responders in the citalopram trial . In contrast , subjects who received adequate medication doses for sufficient periods of time in the citalopram trial were more likely to be responders . Despite greater awareness of OCD in recent years , there is evidence that the disorder continues to be underdiagnosed and undertreated . The data here emphasize the crucial importance of early diagnosis and treatment of OCD , and of pharmacotherapy with appropriate dose and duration Some meta-analyses have suggested that the selective serotonin reuptake inhibitors ( SSRIs ) are less effective than clomipramine in the treatment of obsessive-compulsive disorder ( OCD ) . The aim of this double-blind , r and omised , multicentre study was to directly compare the efficacy and safety of fluvoxamine and clomipramine in patients with OCD . A total of 227 patients were r and omised to flexible doses of fluvoxamine or clomipramine ( both 150 - 300 mg/day ) for 10 weeks . Fluvoxamine and clomipramine were both clinical ly effective and there were no statistically significant differences between the two treatment groups , at any visit , on the National Institute of Mental Health Obsessive-Compulsive global rating scale , the Yale-Brown Obsessive-Compulsive scale ( total score and obsession and compulsion subscores ) , the Clinical Global Impression severity of illness and global improvement subscales , the Clinical Anxiety Scale and the 17-item Hamilton Depression Rating Scale . However , there were differences in safety between the two treatments . Compared with fluvoxamine-treated patients , those treated with clomipramine had more anticholinergic side effects ( dry mouth , constipation and tremor ) and premature withdrawals due to adverse events ( 18 versus 9 ) . The results from this controlled study indicate that fluvoxamine is as effective as clomipramine in the treatment of OCD but has a better tolerability profile . Copyright 2001 John Wiley & Sons ,
Two trials examined olanzapine and found no difference in the primary outcome ( response to treatment ) and most other efficacy-related outcomes but it was associated with more weight gain than monotherapy with antidepressants .
There were also some beneficial effects of quetiapine in terms of anxiety or depressive symptoms .
BACKGROUND Obsessive compulsive disorder ( OCD ) is a psychiatric disorder which has been shown to affect 2 to 3.5 % of people during their lifetimes .
Inadequate response occurs in 40 % to 60 % of people that are prescribed first line pharmaceutical treatments ( selective serotonin reuptake inhibitors ( SSRIs ) ) .
To date not much is known about the efficacy and adverse effects of second-generation antipsychotic drugs ( SGAs ) in people suffering from OCD .
OBJECTIVES To evaluate the effects of SGAs ( monotherapy or add on ) compared with placebo or other forms of pharmaceutical treatment for people with OCD .