Paroxetine concentrations in obsessive-compulsive disorder: Support for a therapeutic interval

2017 ◽  
Vol 41 (S1) ◽  
pp. S322-S322
Author(s):  
M.B. Humble ◽  
M. Reis
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Clinical Symptoms ◽  
Global Evaluation ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Compulsive Disorder ◽  
Number Of Patients ◽  
The Mean ◽  
Competing Interest ◽  
L 13

IntroductionPrevious studies of concentrations of serotonin reuptake inhibitors (SRIs) versus therapeutic efficacy have yielded inconsistent results. Even if the relationships between the individual's serotonergic system and the clinical symptoms of obsessive-compulsive disorder (OCD) are poorly understood, the SRIs are consistently effective in OCD. However, studies on SRI concentrations in OCD treatment are rare.Objectives/aimsTo identify possible links between paroxetine concentrations and anti-obsessive response.MethodsIn a randomised, double-blind trial, comparing clomipramine, paroxetine and placebo in OCD treatment, serum paroxetine levels were measured after 1 week and after 4 weeks of treatment in 18 patients. Anti-obsessive response was assessed with Yale-Brown obsessive compulsive scale (Y-BOCS) and patients’ global evaluation (PGE), after 12 weeks of treatment.ResultsSerum paroxetine concentrations after 4 weeks suggested a therapeutic interval between 50 and 240 nmol/L (13–63 ng/mL). The mean Y-BOCS decrease was 54% inside versus 7% outside this interval (t = 3.96; P = 0.0011).ConclusionsParoxetine levels seemingly predicted clinical outcome. Studies with a greater number of patients are necessary in order to confirm this finding and to discern whether it is useful in clinical practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Duloxetine augmentation in resistant obsessive compulsive disorder: Surveying a new medication for challenges in treatment of OCD

2017 ◽  
Vol 41 (S1) ◽  
pp. S415-S415
Author(s):  
A. Mowla
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Primary Outcome Measure ◽  
Controlled Clinical Trial ◽  
Double Blind Study ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Compulsive Disorder ◽  
Significant Difference ◽  
Competing Interest ◽  
To Receive

IntroductionUp to 50% of patients with OCD have failed to respond in SSRI trials, so looking for pharmacological alternatives in treatment of obsessive compulsive disorder (OCD) seems necessary.ObjectivesSurveying duloxetine augmentation in treatment of resistant OCD.AimsStudy the effects of serotonin-norepinephrine enhancers for treatment of OCD.MethodsThis augmentation trial was designed as an 8-week randomized controlled, double blind study. Forty-six patients suffering from OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor (fluoxetine, citalopram or fluvoxamine) were randomly allocated to receive duloxetine or sertraline plus their current anti OCD treatment. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure.ResultsForty-six patients (24 of 30 in duloxetine group and 22 of 27 in sertraline group) completed the trial. Both groups showed improvement over the 8-week study period (mean Y-BOCS total score at week 8 as compared with baseline: P < 0.001 and P < 0.001) without significant difference (P = 0.861). Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0% in Y-BOCS score and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5% in Y-BOCS.ConclusionsOur double blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in resistant OCD patients. However, it needs to be noted that our study is preliminary and larger double blind placebo controlled studies are necessary to confirm the results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A double-blind comparison of sertraline and clomipramine in outpatients with obsessive-compulsive disorder

1997 ◽  
Vol 12 (2) ◽  
pp. 82-93 ◽  
Author(s):  
JC Bisserbe ◽  
RM Lane ◽  
MF Flament ◽  
Keyword(s):  
Adverse Events ◽  
Obsessive Compulsive Disorder ◽  
Depression Scale ◽  
Final Visit ◽  
Hamilton Depression Scale ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Compulsive Disorder ◽  
Number Of Patients ◽  
Intent To Treat

SummaryThe aim of this study was to compare the efficacy, safety, and tolerability of sertraline and clomipramine in the treatment of obsessive-compulsive disorder (OCD). Outpatients with DSM-III-R defined OCD for 1 year or longer and scores of ≥ 20 on the YaleBrown Obsessive Compulsive Scale (Y-BOCS), ≥ 7 on the National Institute of Mental Health Global Obsessive-Compulsive Scale (NIMH-OC), ≥ 4 on the Clinical Global Impression Severity of Illness Scale (CGI-S) and ≤17 on the Hamilton Depression Scale (17 item HAMD) were randomized to sertraline (n = 86) or clomipramine (n = 82) once daily for 16 weeks. Initial daily doses of sertraline and clomipramine were 50 mg. After a minimum of 4 weeks, these doses could be increased by 50 mg increments every 2 weeks to a maximum of 200 mg daily if the response was thought inadequate. Efficacy was assessed at the end of 1, 2, 4, 6, 8, 12 and 16 weeks of therapy using the Y-BOCS, NIMH-OC, CGI-S, CGI Improvement Scale (CGI-I) and Clinical Anxiety Scale (CAS). One hundred sixty-eight patients were randomized and received at least one dose of double-blind medication; 86 received sertraline and 82 clomipramine. Mean final daily doses at final visit were clomipramine 90 mg (efficacy evaluable patients 101 mg, completers 110 mg), and sertraline 129 mg (efficacy evaluable patients 132 mg, completers 136 mg). Mean baseline Y-BOCS, NIMH-OC and CGI-S totals were 27.7, 10.1 and 5.5, respectively, for sertraline and 27.4, 9.9 and 5.5, respectively, for clomipramine. Sertraline demonstrated greater efficacy than clomipramine in the intent-to-treat patient group: mean baseline to final visit changes were 50.8% (Y-BOCS), 41.9% (NIMH-OC) and 37.7% (CGI-S) for sertraline and 42.9% (Y-BOCS), 33.8% (NIMH-OC) and 30.0% (CGI-S) for clomipramine (P < 0.05). The number of patients withdrawing because of adverse events was substantially greater for clomipramine (26%) than sertraline (11%) (P < 0.05). The most frequent adverse events for clomipramine were dry mouth (20%), anxiety (17%), constipation (16%), nausea (15%) and somnolence (11%), and for sertraline, diarrhea (12%) and nausea (12%). In this study, sertraline was more effective than clomipramine in the intent-to-treat analysis. The difference in efficacy between the treatments is almost wholly accounted for by a greater number of clomipramine withdrawals due to the poor patient acceptance of clomipramine. The superior tolerability of sertraline and the lower rate of premature treatment withdrawal relative to clomipramine may offer considerable quality of life and compliance benefits in the long-term management of a chronic disorder such as OCD.

scholarly journals Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a meta-analysis of double-blind, randomized, placebo-controlled trials

2013 ◽  
Vol 16 (3) ◽  
pp. 557-574 ◽  
Author(s):  
Markus Dold ◽  
Martin Aigner ◽  
Rupert Lanzenberger ◽  
Siegfried Kasper
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Serotonin Reuptake ◽  
Serotonin Reuptake Inhibitors ◽  
Controlled Trials ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Compulsive Disorder ◽  
Number Of Patients ◽  
First Choice

Abstract Because of the high number of patients with obsessive–compulsive disorder (OCD) not responding satisfactorily to initial monotherapy with serotonin reuptake inhibitors (SRIs), the evaluation of additional treatment options is highly relevant. To examine efficacy of add-on pharmacotherapy with antipsychotics, a systematic literature search was applied to identify all double-blind, randomized, placebo-controlled trials (DB-PC-RCTs) determining the efficacy of antipsychotic augmentation of SRIs in treatment-resistant OCD. The primary outcome of the pooled meta-analytic data analysis was response to the adjunctive antipsychotic treatment measured by both the rates of participants achieving response [defined as ⩾35% reduction in Yale–Brown Obsessive–Compulsive Scale (YBOCS)] and mean changes in YBOCS total score. Twelve DB-PC-RCTs investigating quetiapine (N = 5), risperidone (N = 3), olanzapine (N = 2), aripiprazole (N = 1) and haloperidol (N = 1) with a total of 394 subjects were included. Significantly more patients responded to augmentation with antipsychotics than with placebo [relative risk = 2.10, 95% confidence intervals (CI) 1.16–3.80]. Additionally, the mean reduction of the YBOCS total score revealed an efficacy in favour of the antipsychotic medication [standardized mean difference (SMD) = 0.54, 95% CI 0.15–0.93]. Significant efficacy was identifiable only for risperidone, but not for quetiapine and olanzapine. The results regarding aripiprazole and haloperidol were inconsistent. Overall, about one-third of SRI-resistant OCD patients benefited from an augmentation strategy with antipsychotics. Based on the favourable risk:benefit ratio, risperidone can be considered as the agent of first choice and should be preferred to quetiapine and olanzapine. Further trials, mainly with higher antipsychotic doses, are required to optimize pharmacological treatment recommendations for SRI-refractory OCD.

Prevalence and clinical correlates of sensory phenomena in obsessive compulsive disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S323-S323 ◽  
Author(s):  
S. Rayappa ◽  
A. Hegde ◽  
J.C. Narayanaswamy ◽  
S.S. Arumugham ◽  
S. Bada Math ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Age Of Onset ◽  
Repetitive Behavior ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Clinical Correlates ◽  
Number Of Patients ◽  
Competing Interest ◽  
The University ◽  
Just Right

IntroductionA substantial number of patients suffering from obsessive compulsive disorder (OCD) report a subjective distressing experience prior to the repetitive behavior, known as sensory phenomena(SP).ObjectivesNeed to systematically evaluate SP and the clinical correlates in OCD.AimsAssess prevalence of SP and clinical correlates in OCD.MethodsSubjects (n = 71) fulfilling the criteria for DSM IV-TR OCD were recruited consecutively from a specialty OCD clinic in Southern India and were assessed using the Yale brown obsessive and compulsive scale (YBOCS), dimensional Yale-Brown obsessive compulsive scale (D-YBOCS) and the University of São Paulo Sensory Phenomena Scale (USP-SPS).ResultsThe prevalence of the SP was found to be 50.7%. Prevalence of SP is significantly greater in the patients with early age of onset (P = 0.47). In subtypes of SP, Tactile was 12.7%, “just right” for look was 26.8%, “just right” for sound was 9.9%, “just right” for feeling was 16.9%, feeling of incompleteness leading to repetitive behavior was 22.5%, “energy release” sensation leading to repetitive behavior was 4.2% and “urge only” leading to repetitive behavior was 11.3%. SP was found to have significant correlation with symmetry/ordering/arranging/counting dimension (P = 0.003). Significant positive correlation existed between SP severity and the severity of the compulsions (P = 0.02).ConclusionConsidering its high prevalence in OCD, it might be useful to incorporate SP assessment during the routine clinical assessment of OCD. It might warrant a place in the phenomenological and nosological description of OCD. Additionally, the neurobiological correlates of SP need to be explored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Paroxetine versus Clomipramine in the Treatment of Obsessive–Compulsive Disorder

1996 ◽  
Vol 169 (4) ◽  
pp. 468-474 ◽  
Author(s):  
Joseph Zohar ◽  
Rajinder Judge ◽  
Keyword(s):  
Adverse Events ◽  
Obsessive Compulsive Disorder ◽  
Rating Scale ◽  
Comparable Efficacy ◽  
Global Evaluation ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Randomised Study ◽  
Compulsive Disorder ◽  
Efficacy Measures

BackgroundThe aim was to assess the effect of a flexible dose of paroxetine, compared with clomipramine and placebo, in obsessive-compulsive disorder (OCD).MethodIn a multinational randomised study, 406 subjects with OCD of at least six months duration received double-blind mediation for up to 12 weeks. Doses were adjusted according to therapeutic effect and side-effects. Primary efficacy measures were the Yale–Brown Obsessive–Compulsive Scale and the National Institute of Mental Health Obsessive–Compulsive Scale. Secondary efficacy measures were the Montgomery–åsberg Depression Rating Scale, Symptom Check-List (90), Clinical Global Impression, and Patients' Global Evaluation.ResultsParoxetine was significantly more effective than placebo, and of comparable efficacy to clomipramine. Paroxetine had significantly superior tolerability to clomipramine on three measures: CGI efficacy index, anticholinergic adverse events, and adverse events leading to withdrawal.ConclusionParoxetine is as effective as clomipramine in the treatment of OCD. The comparable efficacy and better tolerability of paroxetine suggest that it would be an appropriate treatment for OCD.

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