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

Veale D, Miles S, Smallcombe N, Ghezai H, Goldacre B, Hodsoll J - BMC Psychiatry (2014)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: 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. david.veale@kcl.ac.uk.

ABSTRACT

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.

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Related in: MedlinePlus

Flow diagram of study selection for meta-analysis.
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Fig6: Flow diagram of study selection for meta-analysis.

Mentions: FigureĀ 6 provides a flowchart of the search and the number of studies that were screened for eligibility and subsequently excluded or included in the review. Our search of trial registries found one published study of risperidone or placebo with a SSRI in a non-indexed journal which showed no benefit from adding risperidone [31]. However this did not meet our inclusion criteria as participants were not resistant to a SSRI. No unpublished studies were found from trial registries or received from manufacturers.Figure 6


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

Veale D, Miles S, Smallcombe N, Ghezai H, Goldacre B, Hodsoll J - BMC Psychiatry (2014)

Flow diagram of study selection for meta-analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4262998&req=5

Fig6: Flow diagram of study selection for meta-analysis.
Mentions: FigureĀ 6 provides a flowchart of the search and the number of studies that were screened for eligibility and subsequently excluded or included in the review. Our search of trial registries found one published study of risperidone or placebo with a SSRI in a non-indexed journal which showed no benefit from adding risperidone [31]. However this did not meet our inclusion criteria as participants were not resistant to a SSRI. No unpublished studies were found from trial registries or received from manufacturers.Figure 6

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: 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. david.veale@kcl.ac.uk.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus