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Risperidone augmentation of SRI treatment for refractory obsessive-compulsive disorder
S Saxena1, D Wang, A Bystritsky
1Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA.
The Journal of Clinical Psychiatry
|July 1, 1996
Summary
Augmenting serotonin reuptake inhibitors (SRIs) with risperidone effectively treated refractory obsessive-compulsive disorder (OCD). Most patients tolerated the combination, showing significant symptom reduction, especially those with mental imagery.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Neuroscience
Background:
- Serotonin reuptake inhibitors (SRIs) are primary treatments for obsessive-compulsive disorder (OCD).
- A significant number of patients exhibit inadequate response to SRIs.
- Augmentation strategies are explored for SRI-refractory OCD.
Purpose of the Study:
- To evaluate the efficacy and tolerability of risperidone augmentation in patients with SRI-refractory OCD.
- To identify factors influencing treatment response in this patient population.
Main Methods:
- An open-label study involving 21 patients meeting DSM-IV criteria for OCD.
- Patients received adjunctive risperidone (mean dose 2.75 mg/day) alongside an SRI.
- All participants had previously failed at least one adequate SRI trial.
- Response was assessed via clinical judgment and standardized scales.
Main Results:
- 14 out of 16 (87%) patients who tolerated the combination showed substantial OCD symptom reduction within 3 weeks.
- Side effects, primarily akathisia, led to discontinuation in 5 (24%) patients.
- Patients with horrific mental imagery responded fastest; those with comorbid psychotic disorders improved gradually.
- Comorbid tic disorders were associated with poorer response and higher akathisia rates.
Conclusions:
- Risperidone augmentation appears effective and well-tolerated for SRI-refractory OCD.
- Treatment outcomes are influenced by OCD symptom subtypes and comorbid conditions.
- Further controlled trials are necessary to confirm risperidone's efficacy in refractory OCD.