A Long-Term Trial of the Effectiveness and Safety of Atypical Antipsychotic Agents in Augmenting SSRI-Refractory Obsessive-Compulsive Disorder
A Long-Term Trial of the Effectiveness and Safety of Atypical Antipsychotic Agents in Augmenting SSRI-Refractory Obsessive-Compulsive Disorder
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DOI：
10.4088/jcp.08m04369
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发表时间：
2009-06-01
影响因子：
5.3
通讯作者：
Stein, Dan J.
中科院分区：
文献类型：
--
作者：
Matsunaga, Hisato;Nagata, Toshihiko;Stein, Dan J.
目的：虽然在短期试验中发现非典型抗精神病药物可有效增强5-羟色胺再摄取抑制剂（SRI）治疗难治性强迫症（OCD），但关于这些药物在长期临床环境中的有效性和安全性的数据很少。在最初的12周试验中对选择性SRI（SSRI）有反应的受试者（N = 46）继续接受SSRI单药治疗加认知行为治疗（CBT）1年。对SSRI无效的受试者（N = 44）被随机分配至3种非典型抗精神病药物（奥氮平、奎替鲁或利培酮）中的1种，并接受SSRI +非典型抗精神病药物联合CBT的连续治疗1年。本研究于2006年1月至2007年11月在大坂市立大学医学研究生院医院进行。结果：非典型抗精神病药物增强降低了SSRI难治性强迫症患者的平均+/- SD耶鲁-布朗强迫量表（YBOCS）总分（初始评估= 29.3 +/- 9.9）。1年后= 19.3 +/- 6.8）。然而，与SSRI应答者相比（初始评估= 25.8 +/- 11.4。后1年= 13.7 +/- 4.6），总YBOCS分数在那些谁需要非典型抗精神病药物增强最初较高，他们仍然在较高的水平比那些SRI反应后1年的treatment.Conclusions：我们的工作不足以支持的长期有效性的非典型抗精神病药物在增强SSRIs治疗顽固性强迫症患者。尽管这种方法似乎对某些类型的强迫症患者有用，例如具有对称性/有序性和囤积症状的患者，但这些数据强调了目前药物治疗难治性强迫症的局限性，并且它们的长期使用引起了一些安全性问题。
Objective: Although atypical antipsychotic agents have been found effective in the augmentation of serotonin reuptake inhibitors (SRIs) for treatment-resistant obsessive-compulsive disorder (OCD) in short-term trials, there are few data on the effectiveness and safety of these agents in clinical settings over the long term.Method: Subjects (N = 46) who responded to selective SRIs (SSRIs) in an initial 12-week trial were continued on SSRI monotherapy plus cognitive-behavioral therapy (CBT) for 1 year. Subjects (N = 44) who failed to respond to SSRIs were randomly assigned to 1 of 3 atypical antipsychotics-olanzapine, quetiapine, or risperidone-and were Consecutively treated using SSRI + atypical antipsychotics combined with CBT for 1 year. This study was conducted from January 2006 to November 2007 at Osaka City University Graduate School of Medicine Hospital, Japan.Results: Augmentation with atypical antipsychotics reduced mean +/- SD Yale-Brown Obsessive Compulsive Scale (YBOCS) total scores in SSRI-refractory OCD patients (at initial assessment = 29.3 +/- 9.9. after 1 year = 19.3 +/- 6.8). However, compared to SSRI responders (at initial assessment = 25.8 +/- 11.4. after 1 year = 13.7 +/- 4.6), total YBOCS scores in those who required atypical antipsychotic augmentation were initially higher, and they remained at higher levels than those of SRI responders after 1 year of the treatments.Conclusions: Our work does not sufficiently support the long-term effectiveness of the atypical antipsychotics in the augmentation of SSRIs for treatment-resistant OCD patients. Even though this approach seems useful for some types of OCD patients, such as those with symmetry/ordering and hoarding symptoms, these data emphasize the limitations of the current pharmacotherapeutic options in treatment-refractory OCD, and their chronic use raises a number of safety concerns.