Serotonin reuptake inhibitor-cognitive behavioural therapy-second generation antipsychotic combination for severe treatment-resistant obsessive-compulsive disorder. A prospective observational study.

IF 2.9 4区医学 Q2 PSYCHIATRY International Journal of Psychiatry in Clinical Practice Pub Date : 2022-11-01 Epub Date: 2022-03-24 DOI:10.1080/13651501.2022.2054351

Antonio Tundo, Loretta Salvati, Luca Cieri, Viviana Balestrini, Daniela Di Spigno, Floriana Orazi, Marica Iommi, Roberta Necci

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Abstract

Introduction: Six in ten patients with obsessive-compulsive disorder (OCD) do not respond to the first-line treatments with serotonin reuptake inhibitor (SRI) or cognitive behavioural therapy including exposure and response prevention (CBT/ERP), and several do not respond to second-line treatments, i.e., SRI-second generation antipsychotic (SGA) or SRI-CBT/ERP augmentation. Evidence on third-line treatments is inconsistent.

Objective: We investigated the 1-year response to SRI-CBT/ERP-SGA combination in patients with severe treatment-resistant OCD, who failed to respond to SRI and to SRI-SGA or SRI-CBT/ERP augmentation.

Methods: Twenty-eight patients were consecutively recruited and treated with SRI (drug(s) and doses previously administered), SGA (risperidone median dosage 1 mg/day in 14 cases, aripiprazole median dosage 3 mg/day in 14 cases) and CBT/ERP (median hours 32.5). Exclusion criteria: mental retardation and organic brain syndrome.

Results: The mean Y-BOCS total score reduction at 12 months was 28.2%, 60.7% of patients improved, 46.4% partially responded, 32.1% responded, and 28.6% remitted. Patients previously resistant to SRI-SGA and SRI-CBT/ERP did not significantly differ in the rates of improvement, partial response, response and remission.

Conclusions: This study suggests that SRI-SGA-CBT/ERP combination could be useful for severe treatment-resistant OCD. Small sample size is a limitation.Key pointsUp to 6 in 10 patients with OCD do not respond to first line treatments (CBT/ERP or SRIs) and several to second-line treatments (SRI-SGA or SRI CBT/ERP augmentation).In our study, patients with OCD resistant to the first and the second line treatment improved (61%), partially responded (46%), responded (32%), or remitted (29%) combining SRI, SGA and CBT/ERP.In our patients the SRI-SGA-CBT/ERP augmentation improved working/school, social and family impairment.SRI-SGA-CBT/ERP augmentation is easier to use than other treatments for severe treatment-resistant OCD.

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5 -羟色胺再摄取抑制剂-认知行为疗法-第二代抗精神病药物组合治疗严重难治性强迫症。一项前瞻性观察研究。

十分之六的强迫症(OCD)患者对血清素再摄取抑制剂(SRI)或包括暴露和反应预防(CBT/ERP)在内的认知行为疗法的一线治疗无效，一些患者对二线治疗无效，即SRI-第二代抗精神病药(SGA)或SRI-CBT/ERP增强。关于三线治疗的证据并不一致。目的:研究重度难治性强迫症患者对SRI、SRI- sga或SRI- cbt /ERP增强治疗无效的1年治疗反应。方法:连续招募28例患者，采用SRI(药物和剂量)、SGA(利培酮中位剂量1 mg/d 14例，阿立哌唑中位剂量3 mg/d 14例)和CBT/ERP(中位小时32.5)治疗。排除标准:智力低下和器质性脑综合征。结果:12个月时Y-BOCS总评分平均下降28.2%，60.7%的患者改善，46.4%的患者部分缓解，32.1%的患者缓解，28.6%的患者缓解。先前对SRI-SGA和SRI-CBT/ERP耐药的患者在改善率、部分缓解率、缓解率和缓解率方面没有显着差异。结论:本研究提示sri - sgi - cbt /ERP联合治疗可能对重度难治性强迫症有用。样本量小是一个限制。10名强迫症患者中有多达6名对一线治疗(CBT/ERP或SRIs)无效，几名对二线治疗(SRI- sga或SRI CBT/ERP增强)无效。在我们的研究中，对一线和二线治疗有抵抗的强迫症患者改善(61%)，部分缓解(46%)，缓解(32%)或缓解(29%)联合SRI, SGA和CBT/ERP。在我们的患者中，SRI-SGA-CBT/ERP增强改善了工作/学校、社会和家庭障碍。sri - saga - cbt /ERP增强比其他治疗方法更容易用于治疗严重的难治性强迫症。

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来源期刊

International Journal of Psychiatry in Clinical Practice 医学-精神病学

CiteScore

6.00

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： International Journal of Psychiatry in Clinical Practice provides an international forum for communication among health professionals with clinical, academic and research interests in psychiatry. The journal gives particular emphasis to papers that integrate the findings of academic research into realities of clinical practice. Focus on the practical aspects of managing and treating patients. Essential reading for the busy psychiatrist, trainee and interested physician. Includes original research papers, comprehensive review articles and short communications. Key words: Psychiatry, Neuropsychopharmacology, Mental health, Neuropsychiatry, Clinical Neurophysiology, Psychophysiology, Psychotherapy, Addiction, Schizophrenia, Depression, Bipolar Disorders and Anxiety.