Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)

Casale, Antonio Del; Sorice, Serena; Padovano, Alessio; Simmaco, Maurizio; Ferracuti, Stefano; Lamis, Dorian A.; Rapinesi, Chiara; Sani, Gabriele; Girardi, Paolo; Kotzalidis, Georgios D.; Pompili, Maurizio

doi:10.2174/1570159x16666180813155017

Cited by 136 publications

(82 citation statements)

References 347 publications

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“…Neuroleptics are not the first-choice treatment for OCD, but it seems to be valid as adjuvant when treating resistant or refractory OCD (83), especially atypical neuroleptics, which have augmenting synergism with selective serotonin reuptake inhibitors (SSRIs) because they also have serotonergic action (83, 84). As the CTOC sample is predominantly composed of specialized and tertiary health services, the recruitment of more severe patients, nonresponders to conventional and complex treatments (with comorbidities with tics, for example), may have biased our results, leading to a greater prevalence of the use of these specific medications in these centers (39, 42, 85).…”

Section: Discussionmentioning

confidence: 99%

Level of Insight in Patients With Obsessive–Compulsive Disorder: An Exploratory Comparative Study Between Patients With “Good Insight” and “Poor Insight”

et al. 2019

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Introduction: Insight may be defined as the ability to perceive and evaluate external reality and to separate it from its subjective aspects. It also refers to the ability to self-assess difficulties and personal qualities. Insight may be a predictor of success in the treatment of obsessive–compulsive disorder (OCD), so that individuals with poor insight tend to become refractory to treatment. The objective of this study is to investigate factors associated with poor insight in individuals with OCD. Methods: This cross-sectional exploratory study used the Brown Belief Assessment Scale as a parameter for the creation of the comparison groups: individuals who obtained null scores (zero) composed the group with preserved or good insight ( n = 148), and those with scores above the 75% percentile composed the group with poor insight ( n = 124); those with intermediate scores were excluded. Sociodemographic characteristics and clinical and psychopathological aspects, intrinsic and extrinsic to the typical symptoms of OCD, were compared in a univariate analysis. A logistic regression was used to determine which factors associated with critical judgment remained significant. Results: Individuals in the poor insight group differed from those with good insight in regard to: more prevalent use of neuroleptics ( p = 0.05); higher untreated time interval ( p < 0.001); higher total Yale–Brown obsessive–compulsive scale score and the obsessions and compulsions factors (all factors with p < 0.001); higher dimensional Yale–Brown obsessive–compulsive scale total and dimensional scores ( p from 0.04 to 0.001); higher prevalence of contamination/cleaning ( p = 0.006) and hoarding ( p < 0.001) symptoms dimensions; more prevalent sensory phenomena ( p = 0.023); higher levels of depression ( p = 0.007); and more prevalent comorbidity with bipolar affective disorder ( p = 0.05) and post-traumatic stress disorder (PTSD) ( p = 0.04). After analyzing the logistic regression, we conclude that the most important factors associated with poor insight are: the presence of any sensory phenomena (OR: 2.24), use of neuroleptics (OR: 1.66), and hoarding symptoms (OR: 1.15). Conclusion: The variability of insight in patients with OCD seems to be an important psychopathological characteristic in the differentiation of possible subtypes of OCD, since the poor insight is associated with sensory phenomena and greater use of neuroleptics, which makes it possible to conjecture the role of dopaminergic neurocircuits in the neurobiology of this disorder. In addition, there is also an association with the symptoms of hoarding content, admittedly one of the symptomatic contents with less response to...

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Section: Discussionmentioning

confidence: 99%

Level of Insight in Patients With Obsessive–Compulsive Disorder: An Exploratory Comparative Study Between Patients With “Good Insight” and “Poor Insight”

et al. 2019

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“…The prevalence of OCD is estimated to be around 2% to 3% ( 2 – 4 ). Up to this date, the only treatments approved for alleviation of OCD are cognitive-behavioral therapy (CBT) and pharmacotherapy with (selective) serotonin reuptake inhibitors ((S)SRI) ( 5 ). However, about one third of patients does not benefit from these treatment strategies, experiences recurrent episodes, or does not tolerate treatment with SSRI ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Cannabis Improves Obsessive-Compulsive Disorder—Case Report and Review of the Literature

2020

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Although several lines of evidence support the hypothesis of a dysregulation of serotoninergic neurotransmission in the pathophysiology of obsessive-compulsive disorder (OCD), there is also evidence for an involvement of other pathways such as the GABAergic, glutamatergic, and dopaminergic systems. Only recently, data obtained from a small number of animal studies alternatively suggested an involvement of the endocannabinoid system in the pathophysiology of OCD reporting beneficial effects in OCD-like behavior after use of substances that stimulate the endocannabinoid system. In humans, until today, only two case reports are available reporting successful treatment with dronabinol (tetrahydrocannabinol, THC), an agonist at central cannabinoid CB1 receptors, in patients with otherwise treatment refractory OCD. In addition, data obtained from a small open uncontrolled trial using the THC analogue nabilone suggest that the combination of nabilone plus exposure-based psychotherapy is more effective than each treatment alone. These reports are in line with data from a limited number of case studies and small controlled trials in patients with Tourette syndrome (TS), a chronic motor and vocal tic disorder often associated with comorbid obsessive compulsive behavior (OCB), reporting not only an improvement of tics, but also of comorbid OCB after use of different kinds of cannabis-based medicines including THC, cannabis extracts, and flowers. Here we present the case of a 22-year-old male patient, who suffered from severe OCD since childhood and significantly improved after treatment with medicinal cannabis with markedly reduced OCD and depression resulting in a considerable improvement of quality of life. In addition, we give a review of current literature on the effects of cannabinoids in animal models and patients with OCD and suggest a cannabinoid hypothesis of OCD.

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“…The second generation antipsychotic drugs (also known as the "atypical" antipsychotics, to differentiate them from the original first generation, "typical, " antipsychotics) represent the most effective pharmacological treatment for chronic psychotic illnesses, which include the schizophrenia spectrum disorders (1). This class of drugs is also increasingly being used to treat additional psychiatric indications, such as bipolar disorder, mood, and anxiety disorders (2)(3)(4)(5)(6)(7). The widespread preference for the use of the second over the first generation antipsychotics is largely driven by the lower incidence of neurological side-effects in the former, which include extrapyramidal symptoms and tardive dyskinesia (8), as well as lower rates of neuroendocrine abnormalities such as hyperprolactinemia (9,10).…”

Section: Introductionmentioning

confidence: 99%

Differential Effects of Acute Treatment With Antipsychotic Drugs on Peripheral Catecholamines

Boyda

Tse

et al. 2020

Front. Psychiatry

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Antipsychotic drugs represent the most effective treatment for chronic psychotic disorders. The newer second generation drugs offer the advantage of fewer neurological side-effects compared to prior drugs, but many cause serious metabolic side-effects. The underlying physiology of these side-effects is not well-understood, but evidence exists to indicate that the sympathetic nervous system may play an important role. In order to examine this possibility further, we treated separate groups of adult female rats acutely with either the first generation antipsychotic drug haloperidol (0.1 or 1 mg/kg) or the second generation drugs risperidone (0.25 or 2.5 mg/kg), clozapine (2 or 20 mg/kg), olanzapine (3 or 15 mg/kg) or vehicle by intraperitoneal injection. Blood samples were collected prior to drug and then 30, 60, 120, and 180 mins after treatment. Plasma samples were assayed by HPLC-ED for levels of norepinephrine, epinephrine, and dopamine. Results confirmed that all antipsychotics increased peripheral catecholamines, although this was drug and dose dependent. For norepinephrine, haloperidol caused the smallest maximum increase (+158%], followed by risperidone (+793%), olanzapine (+952%) and clozapine (+1,684%). A similar pattern was observed for increases in epinephrine levels by haloperidol (+143%], olanzapine (+529%), risperidone (+617%) then clozapine (+806%). Dopamine levels increased moderately with olanzapine [+174%], risperidone [+271%], and clozapine [+430%]. Interestingly, levels of the catecholamines did not correlate strongly with each other prior to treatment at baseline, but were increasingly correlated after treatment as time proceeded. The results demonstrate antipsychotics can potently regulate peripheral catecholamines, in a manner consistent with their metabolic liability.

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Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)

Abstract: SSRI/clomipramine in combination with CBT/ERP is associated with the optimal response compared to each treatment alone or to other treatments. New strategies for refractory OCD are needed. The role of pharmacogenomics could become preponderant in the coming years.

Cited by 136 publications

References 347 publications

Level of Insight in Patients With Obsessive–Compulsive Disorder: An Exploratory Comparative Study Between Patients With “Good Insight” and “Poor Insight”

Level of Insight in Patients With Obsessive–Compulsive Disorder: An Exploratory Comparative Study Between Patients With “Good Insight” and “Poor Insight”

Cannabis Improves Obsessive-Compulsive Disorder—Case Report and Review of the Literature

Differential Effects of Acute Treatment With Antipsychotic Drugs on Peripheral Catecholamines

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