The use of antipsychotics in obsessive compulsive disorder

Abstract

Obsessive‐compulsive disorder (OCD) is a chronic disease with a prevalence in the general population of around 2%–3%, generally accompanied by a severe impairment of functioning and quality of life. A consistent subgroup of patients may not achieve adequate symptom remission with first‐line treatments (i.e., cognitive behavioral therapy, selective serotonin reuptake inhibitors [SSRIs]). The most validated option for treatment‐resistant cases relies on the augmentative use of antipsychotics to SSRIs, preferably of the ‘second generation’. Indeed, dopamine appears to be crucially involved in OCD neuropathology due to its implication in systems relating to goal‐directed behaviour and maladaptive habits. Nevertheless, the mechanism of action of antipsychotics in OCD symptom improvement is still unclear. Risperidone, aripiprazole, and haloperidol seem to be the most useful medications, whereas ‘first generation’ antipsychotics may be indicated in case of comorbidity with tics and/or Tourette Syndrome. Antipsychotic augmentation may be also related to side‐effects, particularly in the long term (e.g., alteration in metabolic profile, sedation, extrapyramidal symptoms). The present mini‐review sought to provide the most updated evidence on augmentative antipsychotic use in treatment‐resistant patients with OCD, providing a road map for clinicians in daily practice and shedding light on avenues for further research.

Tic-Related Obsessive–Compulsive and Eating Disorders in Dandy–Walker Variant: A Case Report and Systematic Reappraisal of Psychiatric Profiles

“…It is worth mentioning that the use of antipsychotics (both as add-on therapy and as monotherapy) has always been intended to reduce difficult-to-treat obsessive-compulsive symptoms and tics [64,65]. This approach is particularly required when selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) have to be discontinued because of insufficient symptom management or unpleasant side effects.…”