Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review and meta-analysis

BMC Psychiatry

John Hodsoll²  Ben Goldacre³  Haben Ghezai²  Nicola Smallcombe⁴  Sarah Miles²  David Veale¹ 

[1] Centre for Anxiety Disorders and Trauma, The Maudsley Hospital, 99 Denmark Hill, London SE5 8AZ, UK;The Institute of Psychiatry, King’s College London and South London and Maudsley NHS Foundation Trust, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK;London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK;Kings College London Medical School, Denmark Hill, London SE5 9RS, UK

关键词: Selective serotonergic reuptake inhibitor;    Anti-psychotic;    Obsessive compulsive disorder;   

Others  :  1091943
DOI  :  10.1186/s12888-014-0317-5

 received in 2014-05-21, accepted in 2014-10-24,  发布年份 2014

【 摘 要 】

Background

In 2006, the National Institute of Clinical and Health Excellence (NICE) guidelines for Obsessive Compulsive Disorder (OCD) recommended anti-psychotics as a class for SSRI treatment resistant OCD. The article aims to systematically review and conduct a meta-analysis on the clinical effectiveness of atypical anti-psychotics augmenting an SSRI.

Methods

Studies that were double-blind randomized controlled trials of an atypical antipsychotic against a placebo, for a minimum of 4 weeks, in adults with OCD, were included. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores were the primary outcome measure. Inclusion criteria included Y-BOCS score of 16 or more and at least one adequate trial of a SSRI or clomipramine for at least 8 weeks prior to randomization. Data sources included Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews (CDSR), trial registries and pharmaceutical databases and manufacturers up to September 2013. Forest-plots were drawn to display differences between drug and placebo on the Y-BOCS.

Results

Two studies found aripiprazole to be effective in the short-term. There was a small effect-size for risperidone or anti-psychotics in general in the short-term. We found no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo.

Conclusions

Risperidone and aripiprazole can be used cautiously at a low dose as an augmentation agent in non-responders to SSRIs and CBT but should be monitored at 4 weeks to determine efficacy.

【 授权许可】

   
2014 Veale et al.; licensee BioMed Central Ltd.

【 图 表 】

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