Risperidone Augmentation of Serotonin Reuptake Inhibitors in Obsessive-Compulsive and Related Disorders

Stein, Dan J.; Bouwer, Colin; Hawkridge, Susan; Emsley, Robin

doi:10.4088/jcp.v58n0306

Cited by 142 publications

(63 citation statements)

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“…Open-label studies of antipsychotic augmentation agents have yielded very promising results compared to the use of serotonin-enhancing agents. [29][30][31][32] This systematic review examines the efficacy and safety of antipsychotic agents as an augmentation strategy for treatment-refractory OCD in recently conducted, double-blind, randomized control clinical trials.…”

Section: Introductionmentioning

confidence: 99%

A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder

Bloch

Landeros-Weisenberger

et al. 2006

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As many as half of obsessive-compulsive disorder (OCD) patients treated with an adequate trial of serotonin reuptake inhibitors (SRIs) fail to fully respond to treatment and continue to exhibit significant symptoms. Many studies have assessed the effectiveness of antipsychotic augmentation in SRI-refractory OCD. In this systematic review, we evaluate the efficacy of antipsychotic augmentation in treatment-refractory OCD. The electronic databases of PubMed, PsychINFO (1967PsychINFO ( -2005, Embase (1974Embase ( -2000 and the Cochrane Central Register of Controlled Trials (CENTRAL, as of 2005, Issue 3) were searched for relevant double-blind trials using keywords 'antipsychotic agents' or 'neuroleptics' and 'obsessive-compulsive disorder'. Search results and analysis were limited to double-blind, randomized control trials involving the adult population. The proportion of subjects designated as treatment responders was defined by a greater than 35% reduction in Yale Brown Obsessive-Compulsive Scale (Y-BOCS) rating during the course of augmentation therapy. Nine studies involving 278 participants were included in the analysis. The meta-analysis of these studies demonstrated a significant absolute risk difference (ARD) in favor of antipsychotic augmentation of 0.22 (95% confidence interval (CI): 0.13, 0.31). The subgroup of OCD patients with comorbid tics have a particularly beneficial response to this intervention, ARD = 0.43 (95% CI: 0.19, 0.68). There was also evidence suggesting OCD patients should be treated with at least 3 months of maximaltolerated therapy of an SRI before initiating antipsychotic augmentation owing to the high rate of treatment response to continued SRI monotherapy (25.6%). Antipsychotic augmentation in SRI-refractory OCD is indicated in patients who have been treated for at least 3 months of maximal-tolerated therapy of an SRI. Unfortunately, only one-third of treatment-refractory OCD patients show a meaningful treatment response to antipsychotic augmentation. There is sufficient evidence in the published literature, demonstrating the efficacy of haloperidol and risperidone, and evidence regarding the efficacy of quetiapine and olanzapine is inconclusive. Patients with comorbid tics are likely to have a differential benefit to antipsychotic augmentation.

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Section: Introductionmentioning

confidence: 99%

A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder

Bloch

Landeros-Weisenberger

et al. 2006

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“…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.…”

Section: Other Medicationsmentioning

confidence: 99%

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

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

718

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, 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 randomized 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 randomized, 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 standard 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.

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“…For example, in patients with severe hoarding symptoms, should dopamine blockers or stimulants be included in a patient's treatment before defining non-response Black et al, 1998;Stein et al, 1997)? In reporting response rates, perhaps the response of cases of severe hoarding behavior, which have a poorer outcome following treatment with serotonin reuptake inhibitors, should be reported separately (Black et al, 1998;Mataix-Cols et al, 1999;Winsberg et al, 1999) from the rates of other non-responsive OCD patients.…”

Section: Subtypesmentioning

confidence: 99%

Treatment-refractory obsessive-compulsive disorder: Methodological issues, operational definitions and therapeutic lines

Pallanti

Quercioli

2006

Progress in Neuro-Psychopharmacology and Biological Psychiatry

337

190

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While controlled trials with SRIs have demonstrated a selective efficacy in obsessive-compulsive disorder (OCD), up to 40 -60% of patients do not have a satisfactory outcome. Non-response to treatment in OCD is associated with serious social disability. There are a large number of nonresponsive patients, and they are difficult to cluster due to ambiguities in diagnostic criteria, possibility of subtypes and a high rate of comorbidity. Moreover, the findings of current studies of ''so-called'' non-responsive cases are currently non-generalizable because of the lack of an operational definition of non-response. The result has been that a cumulative body of data on a reasonably homogeneous sample of non-responders has not been developed. The aims of the research in this area are to clarify some of the obstacles in defining stages of response and levels of non-response and, through a comprehensive analysis, to propose a systematic nosology for this rather common condition. Better characterization of which patients respond and do not respond to various treatments will enable more accurate clustering of patients, and help facilitate multisite data collection for future research trials. The authors reviewed also the more recent therapeutic pharmacological and psychological lines for the treatment of refractoriness in OCD. D

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Risperidone Augmentation of Serotonin Reuptake Inhibitors in Obsessive-Compulsive and Related Disorders

Cited by 142 publications

References 0 publications

A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder

A systematic review: antipsychotic augmentation with treatment 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

Treatment-refractory obsessive-compulsive disorder: Methodological issues, operational definitions and therapeutic lines

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