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BMC Psychiatry. 2014 Nov 29;14:317. doi: 10.1186/s12888-014-0317-5.

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

Author information

1
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.
2
Centre for Anxiety Disorders and Trauma, The Maudsley Hospital, 99 Denmark Hill, London, SE5 8AZ, UK. david.veale@kcl.ac.uk.
3
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. sarah.k.miles@kcl.ac.uk.
4
Kings College London Medical School, Denmark Hill, London, SE5 9RS, UK. nicola.smallcombe@kcl.ac.uk.
5
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. haben.ghezai@kcl.ac.uk.
6
London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. ben.goldacre@lshtm.ac.uk.
7
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. john.hodsoll@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.

PMID:
25432131
PMCID:
PMC4262998
DOI:
10.1186/s12888-014-0317-5
[Indexed for MEDLINE]
Free PMC Article

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