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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

Funnel plot for all studies.
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Fig7: Funnel plot for all studies.

Mentions: A Funnel plot for all the studies was drawn (FigureĀ 7). There is some suggestion of asymmetry in the funnel plot, however as all studies included in the analysis were small it is difficult to draw a firm conclusion in terms of small study bias. Asymmetries in funnel plots can also be due heterogeneity within the sample and over-estimation of treatment in some studies. Given this, we would advise caution in any conclusion of publication bias.Figure 7


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)

Funnel plot for all studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig7: Funnel plot for all studies.
Mentions: A Funnel plot for all the studies was drawn (FigureĀ 7). There is some suggestion of asymmetry in the funnel plot, however as all studies included in the analysis were small it is difficult to draw a firm conclusion in terms of small study bias. Asymmetries in funnel plots can also be due heterogeneity within the sample and over-estimation of treatment in some studies. Given this, we would advise caution in any conclusion of publication bias.Figure 7

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