Double Blinded, Placebo-Controlled Trial of Paliperidone Addition in SRI-Resistant Obsessive-Compulsive Disorder
Condition: Obsessive-Compulsive Disorder
MeSH terms: Compulsive Personality Disorder; Obsessive-Compulsive Disorder
Intervention: Paliperidone; Placebo
Intervention description: Paliperidone medication taken daily ranging from 3-9mg/day depending on tolerability and efficacy.; Pill placebo taken daily ranging from 3-9mg/day depending on tolerability and efficacy.
Intervention MeSH terms: Paliperidone Palmitate
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 34.0
Sex: All
Minimum age: 18 Years
Maximum age: 70 Years
Healthy volunteers: No
Keywords: Obsessive-Compulsive Disorder; Adults; Medication; Treatment

Summary:

      Obsessive-compulsive disorder (OCD) is a common, chronic, and oftentimes disabling disorder.
      The only established treatments for OCD are a specific form of Cognitive Behavioral Therapy
      (CBT) and the Serotonin Reuptake Inhibitor medications (SRIs). Few patients with OCD
      experience complete symptom resolution with either modality and even after two consecutive
      SRI trials, as many as 30%-40% of patients fail to derive a satisfactory response.
      Pharmacological options for these SRI-resistant cases include switching to a different
      antidepressant, increasing the dose of SRI, or augmentation with another agent.

      Previous studies showed that approximately 33-50% of OCD patients who have not had an
      adequate response to SRI medication had a positive response when an atypical antipsychotic
      medication was added. However, the problematic acute and long-term side effects of these
      medications are of concern and, at times, limit their use. Paliperidone has a number of
      advantages over these medications including fewer drug interactions and better tolerability.
      Thus, this study is designed to determine whether paliperidone augmentation of an existing
      medication is effective relative to taking a placebo and your existing medication.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Meets DSM-IV-TR criteria for a principal current diagnosis of OCD which is confirmed
             by both clinical evaluation and by structured interviews. OCD subjects with other
             comorbidities will be included provided OCD is judged to be the chief complaint.

          2. Subjects must continue to experience clinically significant symptoms of OCD (Y-BOCS
             score ≥19 and a rating of "moderate" or greater on the Clinical Global Impressions
             (CGI) scale) despite at least two adequate SRI monotherapy trials. One unsatisfactory
             trial can include the SRI currently being taken by the patient provided that the
             duration of treatment is 12 weeks or more and that the dose has been adequate.
             Subjects must be taking a clinically effective dose of a SRI (i.e., clomipramine,
             citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline) for at
             least 12 weeks. Subjects must be on their current dose for at least 12 weeks and must
             maintain their current dose throughout the study.

          3. Between the ages of 18-70 years of age.

          4. Only subjects with OC symptoms of at least one-year duration will be included.

          5. Eligible subjects must be in good physical health. Screening procedures will include
             detailed medical history, complete physical and neurological exams, routine blood
             studies (CBC, liver function tests, electrolytes), ECG, urine toxicology screen, and
             serum pregnancy test in women of child-bearing potential.

        Exclusion Criteria:

          1. Primary depression, schizophrenia or other psychotic disorders.

          2. Active bipolar disorder.

          3. Non-responder in the past to atypical antipsychotic augmentation. This criterion was
             chosen to prevent recruiting a sample of chronically refractory OCD cases that would
             otherwise be suited for more extreme interventions such as deep brain stimulation.

          4. Non-responder in the past to an adequate trial (> 20 hours) of cognitive-behavioral
             therapy that will be assessed by records review.

          5. Current clinically significant suicidality or individuals who have engaged in suicidal
             behaviors within 6 months will be excluded and referred for appropriate clinical
             intervention.

          6. Alcohol or other significant substance abuse within the last 6 months.

          7. History of neurosurgery, encephalitis or significant head trauma or a significant
             medical condition such as heart, liver, or renal disease.

          8. Nursing mothers or women of childbearing potential who do not use adequate
             contraception will be excluded.

          9. Subjects at an increased risk for seizures will also be excluded from this study
             (e.g., subjects with a history of seizures [other than childhood febrile seizures],
             subjects taking concomitant medications known to lower the seizure threshold).

         10. Estimated IQ < 80, mental retardation, dementia, brain damage, or other cognitive
             impairment that would interfere with the capacity to participate in the study and
             complete measures. If needed, the WASI will be used to assess this at screening.

         11. Concurrent use of benzodiazepines, other than for treatment of insomnia, will be
             prohibited during the trial. No other psychotropic medications will be permitted.