Aripiprazole Augmentation of Clomipramine-Refractory Obsessive-Compulsive Disorder

Abstract

Sir: Like many others, we have become concerned about the increasing use of more than 1 antipsychotic medication for the maintenance treatment of schizophrenic illness. In an effort to determine whether more than 1 medication was superior to 1 alone, we performed the following small pilot study. Method. The study was approved by the Massachusetts Mental Health Center Institutional Review Board and was conducted from August 2003 to June 2005. Ten patients with persistent serious but stable DSM-IV-defined schizophrenic illness who agreed to participate and gave written informed consent were enrolled; 3 patients served as controls and 7 as experimental subjects. No subject was in crisis or relapse. All were taking at least 2 antipsychotic medications. Two patients were taking 3 antipsychotics: 1 was taking olanzapine with quetiapine and perphenazine, and 1 was taking olanzapine with risperidone and fluphenazine. Four more patients were taking olanzapine (1 each with ziprasidone, risperidone, fluphenazine, and haloperidol decanoate). Two were taking quetiapine with risperidone, and 1 was taking ziprasidone with fluphenazine. One subject was taking clozapine and risperidone. After a baseline psychiatric interview to exclude those with concurrent substance abuse, unstable medical illness, or suicidal preoccupation, the subjects had 1 of their antipsychotic medications discontinued. An initial dose-finding phase substituted 15 mg/day of aripiprazole after a first antipsychotic was discontinued. Three of 4 subjects who withdrew from the study did so because of severe agitation. The study was then restarted using a lower starting dose of aripiprazole. As the first antipsychotic drug was tapered and discontinued, either 2.5 or 5 mg/day of aripiprazole was begun. The dose of aripiprazole was increased according to clinician decision as the second antipsychotic medication was tapered and discontinued. Control subjects continued to take their multiple antipsychotic medications as originally prescribed. All subjects were followed over the remaining period until the total study duration of 12 weeks was reached. Subjects were rated pretreatment and posttreatment with the Clinical Global Impressions scale, 1 Brief Psychiatric Rating Scale (BPRS), 2 and Positive and Negative Syndrome Scale (PANSS). 3 Results. All subjects showed a modest decrease in total BPRS scores with no meaningful difference between those who were maintained on treatment with multiple antipsychotics and those who had aripiprazole substituted for both antipsychotics. The 3 control subjects showed a reduction in total scores (mean change =-3.7), and 6 of 7 of the switched patients showed a reduction (mean change =-2.8); the seventh subject did not have baseline ratings performed. On the PANSS total score, all 3 control subjects showed a reduction in symptoms (mean change =-7.4); 6 of the 7 switched patients showed a reduction (mean change =-9.4). Global scores of psychopathology did not change in either group, although 2 switched patients were rated as improved...

The Efficacy of Aripiprazole versus Risperidone as Augmentation Therapy in the Treatment of the Resistant Obsessive-Compulsive Disorder: A Double-Blind Clinical Trial

“…Another open-label study in 2005 by Connor et al on 18 OCD patients treated with a daily dose of 10-30 mg Aripiprazole for eight weeks showed 43% of patients had at least 30% decrease in their Y-BOCS score at the end of the study (29). Similar findings have been reported in other studies (30)(31)(32)(33)(34)(35)(36)(37)(38).…”

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…In long-term and relapse prevention studies, escitalopram, fluoxetine, paroxetine, sertraline and clomipramine were superior to placebo (see above for references). Within the limits of the acute treatment phase, response to treatment with SSRIs is characteristi- SSRI Pallanti et al 1999 Yes (C1) Addition of an SSRI to clomipramine Ravizza et al 1996 Yes (C1) Adding lithium to clomipramine * Rasmussen 1984 Yes (C1) Addition of buspirone to an* SSRI Jenike et al 1991b;Markovitz et al 1990 Yes (C1) Addition of topiramate to an SSRI Hollander and Dell'Osso, 2006;Van Ameringen et al 2006 Yes (C1) Addition of N-acetylcysteine to an SSRI Lafleur et al 2006 Yes (C2) Addition of atypical antipsychotics Á aripiprazole Á olanzapine, Á perospirone, Á quetiapine, or Á risperidone, to an SSRI or clomipramine Agid and Lerer 1999; Atmaca et al 2002;Bogan et al 2005;Bogetto et al 2000;da Rocha and Correa 2007;Dell'Osso et al 2006;Francobandiera, 2001;Friedman et al 2007b;Kawahara et al 2000;Koran et al 2000;Marazziti and Pallanti 1999;Marazziti et al 2005;Mohr et al 2002;Otsuka et al 2007;Pfanner et al 2000;Ravizza et al 1996;Saxena et al 1996;Stein et al 1997;Storch et al 2008;Weiss et al 1999;Yoshimura et al 2006 Yes (C1) cally partial. Between 30 and 60% cases in acute phase DBPC studies reached a clinically relevant level of improvement.…”

Combination of Aripiprazole and Other Psychopharmacological Treatments in Resistant and Multi-Resistant Patients

“…Aripiprazole has been successfully combined with clomipramine as an adjunctive agent in the treatment of resistant Obsessive-Compulsive Disorder [14]. Aripiprazole has been successfully combined with clomipramine as an adjunctive agent in the treatment of resistant Obsessive-Compulsive Disorder [14].…”