[Obsessive-compulsive disorder, frontostriatal system and the effect of the serotonergic system]

Focal issues of recent research on obsessive-compulsive disorders have been the involvement of the frontostriatal system in the patho-physiology, as well as the manner of effect and efficacy of the serotonin reuptake inhibitors that unfold their specific efficacy in the frontostriatal system. The course of treatment among adolescent inpatients with obsessive-compulsive disorder was analyzed with regard to the medications used and their effects upon the course of treatment.

The data for all adolescents with obsessive-compulsive disorder admitted as inpatients to the Hospital for Child and Adolescent Psychiatry and Psychotherapy in Mannheim since 01.01.1990 were analyzed with regard to medication and the parameters for course and outcome.

Five patients dropped out of treatment, five patients received no medication, eight received sulpiride, ten were treated with clomipramine, and three with fluvoxamine. The average length of inpatient stay was longer for the groups treated with sulpiride and clomipramine than for the group that received no medication, but equivalent for these two medication groups. The success of treatment for obsessive-compulsive disorder was rated as higher in these two groups than in the group without medication. On sulpiride, patients gained weight and exhibited fatigue and increased levels of prolactin. On clomipramine, half of the patients exhibited cardiac side effects.

This small, nonrandomized medicated sample analyzed under non-double-blind conditions shows no difference in the efficacy of clomipramine and sulpiride under post hoc analysis. Rather, the side effects that occurred in patients on clomipramine indicate a more frequent use of SSRI to increase compliance as regards medication intake.