Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails?

Franz, Adelar Pedro; Paim, Mariana; Araújo, Rafael Moreno de; Rosa, Virgínia de Oliveira; Barbosa, Ísis Mendes; Blaya, Carolina; Ferrão, Ygor Arzeno

doi:10.1590/s2237-60892013000100004

Cited by 13 publications

(6 citation statements)

References 101 publications

(51 reference statements)

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“…Franz et al (29) in their study searched for the most efficient therapeutic approach for OCD, refractory cases in particular, and found that the use of clonidine in combination with SSRIs for two weeks could alleviate OCD symptoms; however, these effects remained uncertain and limited to some cases, necessitating further evaluations.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Clonidine Augmentation Therapy for Obsessive-Compulsive Disorder Treatment; a Randomized Clinical Trial

Akouchakian

Tarrahi

Mohebati

2021

Iran J Psychiatry Behav Sci

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Background: Obsessive-compulsive disorder (OCD) is a common neuropsychiatric disorder worldwide. Inadequate response of OCD patients to a usual agent makes this disorder a great challenge, and recent studies have recommended augmentation therapy as a new choice. Objectives: As traces of noradrenergic dysfunction have been noted in OCD pathophysiology, the current study aimed to assess the efficacy of clonidine augmentation therapy for treating OCD. Methods: This was a randomized clinical trial conducted on 57 OCD patients divided into the two groups of 1-mg clonidine augmentation therapy (n = 28) and placebo group (n = 29). The medication was administered for 12 weeks. Patients’ primary treatment, including SSRIs or clomipramine, continued by receiving the same dose used before participation in this study. The Yale-Brown Obsessive-Compulsive scale (Y-BOCS) and Clinical Global Impression-Severity scale (CGI-S) were used to assess the patients at the start of the study and then at four-week intervals. Drug-related adverse effects and global improvement were assessed and compared between the two groups. Results: The initial CGI scores were 3.89 ± 1.57 and 4.10 ± 1.61 at the baseline and 2.29 ± 1.18 and 3.07 ± 1.51 at the end of the study in the intervention and control groups, respectively. Both groups revealed a significant improvement (P-value = 0.001) with no significant difference between them (P-value = 0.22). The primary Y-BOCS score in the clonidine-treated group was 27.61 ± 8.08 versus 28.69 ± 7.44 in the control group at the baseline, which declined to 20.25 ± 6.08 versus 25.45 ± 7.35 at the end of the study, respectively. Both groups revealed a significant improvement (P-value = 0.001), but there was no statistically significant difference between them (P-value = 0.06). Drug-related complications were not statistically different between the two groups (P-value > 0.05); however, the clonidine-treated patients presented more adverse effects than control subjects. Conclusions: Although the use of clonidine posed no remarkable drug-related adverse effects, it was not superior to placebo considering symptom relief.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Clonidine Augmentation Therapy for Obsessive-Compulsive Disorder Treatment; a Randomized Clinical Trial

Akouchakian

Tarrahi

Mohebati

2021

Iran J Psychiatry Behav Sci

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“…The most common and effective evidence-based treatment for OCD includes selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy with exposure and response prevention (Abramowitz & Arch, 2014;Franz et al, 2013;Pauls et al, 2014). Limitations in the development and promotion of treatment for the minority population and the lack of professional cultural competence emphasizes the need for research that includes ethnic considerations (Williams et al, 2010;Zane et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Conditioned Fear Extinction, Neuropsychological, and Psychological Aspects of OCD in Latinos

Santiago-Mejías¹,

Martínez²

2020

Rev Cari Psicol

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Background: Although culture can affect emotional and behavioral reactions, there is little research on the manifestations of obsessive-compulsive disorder (OCD) among Latinos. Previous studies using a fear extinction model with a non-Latino population showed that individuals with OCD have difficulty maintaining safety memories. Their neuropsychological performance has shown inconsistent findings. We compared Puerto Ricans with OCD and healthy controls on fear extinction retention, neuropsychological performance, and psychological self-reports. Methods: 17 healthy and 11 Puerto Rican adults with OCD underwent a fear conditioning and extinction paradigm using neutral visual cues that were paired or unpaired with an electric stimulus to elicit skin conductance responses. Neuropsychological tests (WCST,EST,MSIT) and psychological self-reports (BAI,BDI,STAI,PANAS,EDS)were administered. Results: OCD subjects did not show impaired extinction recall. However, they showed higher reaction times towards neutral than threat-related words on the EST, compared to healthy controls. No differences on neuropsychological tests that lacked emotional content were observed. OCD subjects showed increased symptoms of anxiety, trait anxiety, depression, negative affect, and emotional dysregulation. Conclusions: Puerto Ricans with OCD may have physiological and neuropsychological characteristics that are similar to healthy subjects, but a different psychological profile, which can be used to tailor cultural adaptations of evidence-based treatments for OCD.

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“…However, due to the growing trend of aripiprazole seems that soon this antipsychotic agent replaced the use of quetiapine in the treatment of refractory OCD. As the treatment of refractory OCD generally requires high doses of SSRIs, this higher dose increases the side effects, especially loss of sexual drive [133].…”

Section: Discussionmentioning

confidence: 99%

Comparing the Effect of Second-Generation Antipsychotics Versus Selective Serotonin Reuptake Inhibitors in Refractory Obsessive-Compulsive Disorder: a Systematic Review of the Past, Present, and Future Clinical Trials

Sayah¹,

Rahim²

2016

Asian J Pharm Clin Res

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Objective: In this concise and systematic review, the trend of using major medication modalities prescribed for refractory obsessive-compulsive disorder (OCD), including serotonin-specific reuptake inhibitors (SSRIs) and second-generation antipsychotics (SGAs) are discussed. Methods:We systematically searched PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) systematically using Mesh terms. OCD is extremely disabling and associated with considerable depression and other serious psychiatric illnesses.Results: Through databases, we found 78 randomized clinical trials (RCTs), which included selective SSRI compared with routine drug therapy or placebo. Out of these 78 studies, 62 studies were conducted on adult patients with OCD, comprising 7920 cases. While only 16 RCTs were performed on children and adolescents with OCD, including 1313 people. We found 24 clinical trial studies related to SGAs, of which were conducted on adult patients with OCD, including 992 cases. Conclusion:As our data showed among the SSRIs, fluvoxamine has been particularly well studied and used in RCTs in both children and adolescents with OCD. According to the summary of our review, it will be better when therapists use SGAs in the early treatment programs of refractory OCD. Thus, considering our reviewed, it seems that the first choice of early treatment programs of refractory OCD is fluvoxamine in combination with quetiapine or aripiprazole.

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Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails?

Cited by 13 publications

References 101 publications

Evaluation of Clonidine Augmentation Therapy for Obsessive-Compulsive Disorder Treatment; a Randomized Clinical Trial

Evaluation of Clonidine Augmentation Therapy for Obsessive-Compulsive Disorder Treatment; a Randomized Clinical Trial

Conditioned Fear Extinction, Neuropsychological, and Psychological Aspects of OCD in Latinos

Comparing the Effect of Second-Generation Antipsychotics Versus Selective Serotonin Reuptake Inhibitors in Refractory Obsessive-Compulsive Disorder: a Systematic Review of the Past, Present, and Future Clinical Trials

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