The assessment of drugs in obsessional states.

Obsessive-compulsive disorder (OCD) is a common heterogeneous psychiatric disorder manifesting with obsessions and compulsions. Obsessions are intrusive, recurrent, and persistent unwanted thoughts. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to the obsessions. The heterogeneity of OCD includes themes of obsessions, types of rituals, presence or absence of tics, etiology, genetics, and response to pharmacotherapy. Complications of OCD include interpersonal difficulties, unemployment, substance abuse, criminal justice issues, and physical injuries. Areas of the brain involved in the pathophysiology include the orbitofrontal cortex, anterior cingulate gyrus, and basal ganglia. Overall, OCD may be due to a malfunction in the cortico-striato-thalamo-cortical circuit in the brain. Neurotransmitters implicated in OCD include serotonin, dopamine, and glutamate. Numerous drugs such as atypical antipsychotics and dopaminergic agents can cause or exacerbate OCD symptoms. The etiology includes genetics and neurological insults. Treatment of OCD includes psychotherapy, pharmacotherapy, electroconvulsive therapy, transcranial magnetic simulation, and in extreme cases surgery. Exposure and response prevention is the most effective form of psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacotherapy. Higher doses than listed in the package insert and a longer trial are often needed for SSRIs than compared to other psychiatric disorders. Alternatives to SSRIs include clomipramine and serotonin/norepinephrine reuptake inhibitors. Treatment of resistant cases includes augmentation with atypical antipsychotics, pindolol, buspirone, and glutamate-blocking agents.

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“…116 The first open-label study of clomipramine was done in the 1960s. 117 Clomipramine did not receive FDA approval for OCD until 1989.…”

Section: Clomipraminementioning

confidence: 99%

Obsessive–Compulsive Disorder

Bokor

Anderson²

2014

Journal of Pharmacy Practice

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“…It is a tricyclic antidepressant (TCA) with a potent ability to inhibit serotonin reuptake; it also inhibits the reuptake of norepinephrine, and has dopamine-blocking effects ( Bokor and Anderson, 2014 ). The first open-label study of clomipramine was done in the 1960s ( Philpott, 1976 ). Clomipramine did not receive FDA approval for OCD until 1989.…”

Section: Introductionmentioning

confidence: 99%

Intravenous Clomipramine for Treatment-Resistant Obsessive-Compulsive Disorder

Karameh

Khani

2015

IJNPPY

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Background:This open trial was conducted to evaluate the effectiveness of intravenous clomipramine (CMI) in refractory obsessive-compulsive disorder (OCD).Methods:Thirty OCD poor responders to previous multiple trials of anti-obsessive medications were selected and admitted to the hospital. Severity of the illness and response to treatment were primarily assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). CMI was gradually administered intravenously for one week. All patients were thereafter switched to oral CMI with a maximum dose of 225mg/day.Results:The Y-BOCS total score mean at admission was in the severe range (24–31), and dropped on discharge and follow-ups to the moderate range (16–23). At discharge, 23 patients (76.7%) had a decrease in Y-BOCS ≥25% and were considered responders, while only 18 (60%) were still responders at 24 weeks. No relevant persistent side effects were reported.Conclusion:Intravenous clomipramine could be of benefit for severe OCD cases that have not adequately responded to several therapies, including oral clomipramine.

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“…Monotherapy with Serotonin Reuptake Inhibitors. One of the seminal serendipitous discoveries in psychiatry was the incidental observation by Spanish psychiatrists (Fernández Córdoba and López-Ibor Aliño, 1967) that the tricyclic antidepressant (TCA), clomipramine, provided relief also for "obsessional" symptoms in patients with depression (Yaryura-Tobias and Neziroglu, 1975;Philpott, 1976;Ananth, 1986). This clinical impression contradicted the hitherto widely held belief that OCD is refractory to pharmacotherapy (Goodman et al, 2014), sparking extensive and fruitful investigations of pharmacotherapy not only for OCD comorbid with depression but also for OCD in patients without this comorbid psychiatric diagnosis.…”

Section: A Current Understanding Of Whatmentioning

confidence: 99%

The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap

et al. 2019

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Servier and has received research funding from Servier and Lundbeck. Except for income from the primary employer and research funding to B.H.H. from the above-mentioned organizations and agencies, no financial support or compensation has been received from any individual or corporate entity over the past 3 years for research or professional services, and there are no personal financial holdings that could be perceived as constituting a potential conflict of interest.

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The assessment of drugs in obsessional states.

Cited by 10 publications

References 39 publications

Obsessive–Compulsive Disorder

Obsessive–Compulsive Disorder

Intravenous Clomipramine for Treatment-Resistant Obsessive-Compulsive Disorder

The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap

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