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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

Meta-analysis of risperidone treatment vs placebo for obsessive-compulsive disorder, measured as odds ratios.
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Fig8: Meta-analysis of risperidone treatment vs placebo for obsessive-compulsive disorder, measured as odds ratios.

Mentions: (a) Risperidone: Five studies were identified [12,14–17] with 77 participants in total taking risperidone and 89 receiving placebo. The overall difference was statistically significant with an overall mean reduction of 3.89 points on the Y-BOCS (95% CI = 1.43-5.48) and an effect size of D = 0.53 (Figure 2). The categorical analyses of responders in comparison to non-responders, on the Y-BOCS, indicated that overall those participants taking risperidone were 3.10 times more likely to respond to treatment (see Figure 8). The number needed to treat (NNT) for this ratio was 4.65.Figure 8


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)

Meta-analysis of risperidone treatment vs placebo for obsessive-compulsive disorder, measured as odds ratios.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig8: Meta-analysis of risperidone treatment vs placebo for obsessive-compulsive disorder, measured as odds ratios.
Mentions: (a) Risperidone: Five studies were identified [12,14–17] with 77 participants in total taking risperidone and 89 receiving placebo. The overall difference was statistically significant with an overall mean reduction of 3.89 points on the Y-BOCS (95% CI = 1.43-5.48) and an effect size of D = 0.53 (Figure 2). The categorical analyses of responders in comparison to non-responders, on the Y-BOCS, indicated that overall those participants taking risperidone were 3.10 times more likely to respond to treatment (see Figure 8). The number needed to treat (NNT) for this ratio was 4.65.Figure 8

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