Clinical practice guidelines for Obsessive-Compulsive Disorder

Reddy, YC Janardhan; Sundar, A Shyam; Narayanaswamy, Janardhanan C.; Math, Suresh Bada

doi:10.4103/0019-5545.196976

Cited by 102 publications

(68 citation statements)

References 48 publications

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“…The expert group reviewed the evidence and recommended the following dosage (with strength of recommendation) in the Indian population. These doses are slightly lower than the recommendations in the recently published meta-analysis[45] [Table 1].…”

Section: Meta-analysesmentioning

confidence: 66%

Antipsychotic augmentation in the treatment of obsessive-compulsive disorder

Thamby

Jaisoorya

2019

Indian J Psychiatry

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Most studies suggest that obsessive-compulsive disorder runs a chronic course. Only 40%–70% of patients respond to first-line treatment with selective serotonin reuptake inhibitors (SSRIs). The most common pharmacological strategy used in clinical practice for partial responders to SSRIs is augmentation with an atypical antipsychotic. This article aims to review the efficacy, tolerability, and comparative efficacy of antipsychotics as augmenting agents in patients who showed inadequate response to SSRIs. In addition to case reports and case series, 15 randomized controls trials, 6 meta-analyses, and 3 expert guidelines have been examined. The findings suggest that one in three SSRI nonresponders improve with antipsychotic augmentation. The presence of comorbid tics and/or schizotypal disorder may predict a better response to antipsychotic augmentation. Among antipsychotics, risperidone, and aripiprazole have the best evidence, with haloperidol being considered second in-line owing to its unfavorable side effect profile. Guidelines recommend that antipsychotics be administered at a low-to-medium dosage for a duration not exceeding 3 months, with mandatory discontinuation if there is no response. Larger studies and head-to-head trials are needed to further explore this treatment strategy.

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Section: Meta-analysesmentioning

confidence: 66%

Antipsychotic augmentation in the treatment of obsessive-compulsive disorder

Thamby

Jaisoorya

2019

Indian J Psychiatry

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“…Further evidence for a role of (altered) peripheral insulin signaling in OCD etiology is suggested by the fact that selective serotonin reuptake inhibitors (SSRIs), the first-line pharmacological treatment for OCD, positively affect diabetic parameters when used to treat depressive symptoms in T2D (i.e. decreasing HbA1c levels and insulin requirement, and increasing insulin sensitivity) (45). Interestingly, SSRIs are particularly effective for treating harm-related obsessions, which are a part of ‘aggressive taboo thoughts’ (46).…”

Section: Discussionmentioning

confidence: 99%

Shared genetic etiology between obsessive-compulsive disorder, obsessive-compulsive symptoms in the population, and insulin signaling

Bralten

Widomska

Witte

et al. 2019

Preprint

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AbstractObjectiveObsessive-compulsive symptoms (OCS) in the population have been linked to obsessive-compulsive disorder (OCD) in genetic and epidemiological studies. Insulin signaling has been implicated in OCD. We extend previous work by assessing genetic overlap between OCD, population-based OCS, and central nervous system (CNS) and peripheral insulin signaling.MethodsWe conducted genome-wide association studies (GWASs) in the population-based Philadelphia Neurodevelopmental Cohort (PNC, 650 children and adolescents) of the total OCS score and six OCS factors from an exploratory factor analysis of 22 questions. Subsequently, we performed polygenic risk score (PRS) analysis to assess shared genetic etiologies between clinical OCD (using GWAS data from the Psychiatric Genomics Consortium), the total OCS score and OCS factors. We then performed gene-set analyses with a set of OCD-linked genes centered around CNS insulin-regulated synaptic function and PRS analyses for five peripheral insulin signaling-related traits. For validation purposes, we explored data from the independent Spit for Science population cohort (5047 children and adolescents).ResultsIn the PNC, we found a shared genetic etiology between OCD and ‘impairment’, ‘contamination/cleaning’ and ‘guilty taboo thoughts’. In the Spit for Science cohort, we were able to validate the finding for ‘contamination/cleaning’, and additionally observed genetic sharing between OCD and ‘symmetry/counting/ordering’. The CNS insulin-linked gene-set associated with ‘symmetry/counting/ordering’. We also identified genetic sharing between peripheral insulin signaling-related traits (type 2 diabetes and the blood levels of HbA1C, fasting insulin and 2 hour glucose) and OCD as well as certain OCS.ConclusionsOCD, OCS in the population and insulin-related traits share genetic risk factors, indicating a common etiological mechanism underlying somatic and psychiatric disorders.

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“…Noninvasive brain stimulation techniques are experimental strategies for OCD. [ 1 2 ] Here, we present a case of resistant OCD, where electroconvulsive therapy (ECT) was the only successful treatment option.…”

mentioning

confidence: 99%

“…Next line of treatment in OCD is somatic treatment such as ECT, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation but evidence regarding the effect of ECT are sparse. [ 2 ] A recent systematic review published in 2015 showed that the role of ECT in the routine treatment of OCD is not significant, but it proposed the beneficial effects of ECT in OCD under special circumstances. [ 1 ] Most of the cases who improved on ECT were benign.…”

mentioning

confidence: 99%