Predictors of drug treatment response in obsessive-compulsive disorder. Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: a practical clinical trial. Amisulpiride augmentation in treatment resistant obsessive-compulsive disorder: an open trial. A long-term trial of the effectiveness and safety of atypical antipsychotic agents in augmenting SSRI-refractory obsessive-compulsive disorder. A placebo-controlled cross-over trial of adjunctive EPA in OCD. Impact of comorbidity on treatment response to paroxetine in pediatric obsessive-compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials? A Randomized Controlled Trial of Cognitive Therapy versus Intensive Behavior Therapy in Obsessive Compulsive Disorder Obsessive and compulsive symptoms in schizophrenia: a randomized controlled trial with fluvoxamine and neuroleptics. Quetiapine augmentation of serotonin reuptake inhibitors in obsessive-compulsive disorder Predictors of response to pharmacotherapy with citalopram in obsessive-compulsive disorder Quetiapine Addition to Serotonin Reuptake Inhibitors in Patients With Severe Obsessive-Compulsive Disorder: A Double-Blind, Randomized, Placebo-Controlled Study Long-term course and outcome of obsessive-compulsive patients after cognitive-behavioral therapy in combination with either fluvoxamine or placebo: a 7-year follow-up of a randomized double-blind trial. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder. Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder. Obsessive-Compulsive Symptom Dimensions as Predictors of Compliance with and Response to Behaviour Therapy: Results from a Controlled Trial Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: a 2-year follow-up of two randomized trials.
BACKGROUND Although a large body of evidence indicates the efficacy of pharmacotherapy in the treatment of obsessive-compulsive disorder ( OCD ) , a considerable percentage of these patients do not respond . Very few studies focus on factors related to treatment response of OCD . The purpose of this study was to investigate which clinical factors are related to drug treatment response in OCD . METHOD We examined 53 OCD patients treated with either clomipramine or fluoxetine for a period of 6 months , dividing the sample into " responders " and " nonresponders " to treatment . At admission , patients were evaluated using a semistructured clinical interview , the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) , the Hamilton Rating Scale for Depression , and the Hamilton Rating Scale for Anxiety . We then compared acute-phase patient characteristics and response to drug treatment . Response was defined as a decrease of at least 40 % in the Y-BOCS total score and a rating of " improved " or " very improved " on the Clinical Global Impressions scale within 16 weeks of treatment and maintained over three consecutive evaluations . RESULTS By the sixth month of treatment , 31 patients ( 58.5 % ) responded to either clomipramine or fluoxetine . Nonresponders had lower age at onset and longer duration of the disorder ; in addition , they showed higher frequency of compulsions , washing rituals , chronic course , concomitant schizotypal personality disorder , and previous hospitalizations . A worse response to drug treatment was predicted in a stepwise multiple regression by ( 1 ) concomitant schizotypal personality disorder , ( 2 ) presence of compulsions , and ( 3 ) longer illness length . CONCLUSION Our findings suggest that there are distinct types of OCD with respect to drug treatment response . They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities , which may be of value in the selection of patients for alternative treatments Clinical effectiveness of group cognitive-behavioral therapy ( GCBT ) versus fluoxetine in obsessive-compulsive disorder out patients that could present additional psychiatric comorbidities was assessed . Patients ( 18 - 65 years ; baseline Yale-Brown Obsessive-Compulsive-Scale [ Y-BOCS ] scores ≥ 16 ; potentially presenting additional psychiatric comorbidities ) were sequentially allocated for treatment with GCBT ( n=70 ) or fluoxetine ( n=88 ) . Mean Y-BOCS scores decreased by 23.13 % in the GCBT and 21.54 % in the SSRI groups ( p=0.875 ) . Patients presented a mean of 2.7 psychiatric comorbidities , and 81.4 % showed at least one additional disorder . A reduction of at least 35 % in baseline Y-BOCS scores and CGI ratings of 1 ( much better ) or 2 ( better ) was achieved by 33.3 % of GCBT patients and 27.7 % in the SSRI group ( p=0.463 ) . The Y-BOCS reduction was significantly lower in patients with one or more psychiatric comorbidities ( 21.15 % , and 18.73 % , respectively ) than in those with pure OCD ( 34.62 % ; p=0.034 ) . Being male , having comorbidity of Major Depression , Social Phobia , or Dysthymia predicted a worse response to both treatments . Response rates to both treatments were similar and lower than reported in the literature , probably due to the broad inclusion criteria and the result ing sample more similar to the real world population Despite the effectiveness of clomipramine and selective serotonin reuptake inhibitors ( SSRIs ) in the treatment of obsessive-compulsive disorder ( OCD ) , 40 % to 60 % of patients who receive an adequate treatment with these agents have significant persisting symptoms . Newer atypical antipsychotic drugs showed efficacy as augmenting agents in patients with OCD resistant to serotonin reuptake inhibitors ( SRIs ) . The objective of this study was to evaluate the efficacy and safety of amisulpiride augmentation in treatment resistant OCD . A total of 20 patients diagnosed with OCD according to DSM-IV criteria and having a history of resistance to treatment with SRIs were included in the study .  Amisulpiride 200 mg/day was added to ongoing SRI treatment and titrated up to 600 mg/day in flexible doses . The mean amisulpiride dose was 325 + /- 106 mg/day . The patients were assessed with the Yale-Brown obsessive-compulsive scale ( Y-BOCS ) at baseline and at week 12 of amisulpiride treatment . Side effects were monitored by the UKU side effect rating scale . The reduction in Y-BOCS scores between the baseline ( 26.7 + /- 6.3 ) and the end of the treatment ( 12.5 + /- 2.8 ) was statistically significant ( p=0.0001 ) . The most commonly observed side effects included weight gain ( 14 patients , 70 % ) , mild sedation ( 13 patients , 65 % ) and asthenia ( 7 patients , 35 % ) . This study has several limitations and , hence , the results are preliminary and require confirmation in a r and omized controlled trial . In conclusion , this study suggests that amisulpiride may be a promising option as an augmentation strategy in treatment resistant OCD OBJECTIVE Although atypical antipsychotic agents have been found effective in the augmentation of serotonin reuptake inhibitors ( SRIs ) for treatment-resistant obsessive-compulsive disorder ( OCD ) in short-term trials , there are few data on the effectiveness and safety of these agents in clinical setting s over the long term . METHOD Subjects ( N = 46 ) who responded to selective SRIs ( SSRIs ) in an initial 12-week trial were continued on SSRI monotherapy plus cognitive-behavioral therapy ( CBT ) for 1 year . Subjects ( N = 44 ) who failed to respond to SSRIs were r and omly assigned to 1 of 3 atypical antipsychotics -- olanzapine , quetiapine , or risperidone -- and were consecutively treated using SSRI + atypical antipsychotics combined with CBT for 1 year . This study was conducted from January 2006 to November 2007 at Osaka City University Graduate School of Medicine Hospital , Japan . RESULTS Augmentation with atypical antipsychotics reduced mean + /- SD Yale-Brown Obsessive Compulsive Scale ( YBOCS ) total scores in SSRI-refractory OCD patients ( at initial assessment = 29.3 + /- 9.9 , after 1 year = 19.3 + /- 6.8 ) . However , compared to SSRI responders ( at initial assessment = 25.8 + /- 11.4 , after 1 year = 13.7 + /- 4.6 ) , total YBOCS scores in those who required atypical antipsychotic augmentation were initially higher , and they remained at higher levels than those of SRI responders after 1 year of the treatments . CONCLUSIONS Our work does not sufficiently support the long-term effectiveness of the atypical antipsychotics in the augmentation of SSRIs for treatment-resistant OCD patients . Even though this approach seems useful for some types of OCD patients , such as those with symmetry/ordering and hoarding symptoms , these data emphasize the limitations of the current pharmacotherapeutic options in treatment-refractory OCD , and their chronic use raises a number of safety concerns . TRIAL REGISTRATION ( Clinical Trials.gov ) Identifier NCT00854919 Several clinical studies showed beneficial effects of omega-3 fatty acids in major affective disorders , including resistant depression . Some antidepressants are also effective , albeit less so , in obsessive-compulsive disorder ( OCD ) . We therefore undertook a preliminary placebo-controlled cross-over trial of adjunctive eicosapentaenoic acid ( EPA ) in OCD . Eleven patients with current obsessive-compulsive disorder , who were on a stable maximally tolerated dose of SSRI with no further improvement over at least the last two months , were recruited . Subjects were r and omly allocated to begin 6 weeks of placebo ( 2 g liquid paraffin per day ) followed by 6 weeks of 2 g of EPA or EPA followed by placebo . Patients continued their prior SSRIs at the same dose . Assessment s were performed with the Yale-Brown Obsessive-Compulsive Scale ( YBOCS ) , and the Hamilton Rating Scales for depression ( HAM-D ) and anxiety ( HAM-A ) . There were no effects of order of treatment . Time had a main effect of YBOCS scores ; mean scores declined from 26.0 ( + /-5 ) to 17.6 ( + /-6 ) by week 6 on placebo and to 18.5 ( + /-4 ) on EPA . There were no effects on HAM-D and HAM-A. No clinical ly relevant side effects were reported . The results of this study suggest that adjunctive EPA is ineffective against OCD OBJECTIVE To examine the influence of psychiatric comorbidity on response and relapse rates in children and adolescents treated with paroxetine for obsessive-compulsive disorder ( OCD ) . METHODS Patients responding following 16 weeks of treatment ( phase I ) were r and omized to continued paroxetine or to placebo for 16 additional weeks ( phase II ) . OCD response ( phase I ) and relapse ( phase II ) criteria were based on the Clinical Global Impression-Improvement Scale and the Children 's Yale-Brown Obsessive Compulsive Scale . The presence of OCD and other psychiatric disorders was ascertained using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview . RESULTS At entry , 193 of 335 ( 57.6 % ) patients had at least one psychiatric disorder in addition to OCD , and 102 of 335 ( 30.4 % ) had multiple other disorders . Although the response rate to paroxetine in the overall population was high ( 71 % ) , the response rates in patients with comorbid attention deficit hyperactivity disorder , tic disorder , or oppositional defiant disorder ( 56 % , 53 % , and 39 % , respectively ) were significantly less than in patients with OCD only ( 75 % ) ( intent-to-treat population , last observation carried forward analysis , p < 0.05 ) . Psychiatric comorbidity was associated with a greater rate of relapse in the total patient population ( 46 % for one or more comorbid disorders [ p = 0.04 ] and 56 % for two or more comorbid disorders [ p < 0.05 ] vs. 32 % for no comorbidity ) . CONCLUSIONS The results of these post hoc analyses show that comorbid illness adversely impacted response to pharmacotherapy with paroxetine in pediatric OCD and significantly increased risk of relapse following withdrawal from treatment . Continued paroxetine treatment reduced the relapse rates in all groups compared with placebo , including those with comorbid illness . Because pediatric OCD is frequently comorbid with other psychiatric disorders , results of r and omized , controlled pediatric OCD trials that use multiple exclusion criteria may not generalize to more naturalistic OCD sample Background : The study was design ed to compare cognitive therapy ( CT ) with intensive behavior therapy ( BT ) in obsessive-compulsive disorder ( OCD ) and to study their change process . Methods : Sixty-five out patients with DSM-4 OCD were r and omized into 2 groups for 16 weeks of individual treatment in 3 centers . Group 1 received 20 sessions of CT . Group 2 received a BT program of 20 h in two phases : 4 weeks of intensive treatment ( 16 h ) , and 12 weeks of maintenance sessions ( 4 h ) . No medication was prescribed . Results : Sixty-two patients were evaluated at week 4 , 60 at week 16 ( post-test ) , 53 at week 26 and 48 at week 52 ( follow-up ) . The response rate was similar in the 2 groups . The Beck Depression Inventory ( BDI ) was significantly more improved by CT ( p = 0.001 ) at week 16 . The baseline BDI and Obsessive Thoughts Checklist scores predicted a therapeutic response in CT , while the baseline BDI score predicted a response in BT . At week 16 , only the changes in Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) and a scale measuring the interpretation of intrusive thoughts correlated in CT , while the changes in Y-BOCS , BDI , and interpretation of intrusive thoughts correlated in BT . Improvement was retained at follow-up without a between-group difference . The intent-to-treat analysis ( last observation carried forward ) found no between-group differences on obsessions , rituals and depression . Conclusions : CT and BT were equally effective on OCD , but at post-test CT had specific effects on depression which were stronger than those of BT . Pathways to improvement may be different in CT and BT . The outcomes are discussed in the light of an effect size analysis Obsessive-compulsive-related disorders are frequently comorbid with schizophrenia . The existence of obsessive and compulsive symptoms in patients with schizophrenia represents one of the most severe types of psychotic disorders and may predict a poor prognosis in most cases . Previous pilot studies and case reports have shown that the condition of some patients with schizophrenia did not exacerbate and even improved when serotonin reuptake inhibitors ( SSRIs ) were added to their st and ard neuroleptic regimen . The aim of this study was to evaluate the efficacy of a combination treatment of an SSRI ( fluvoxamine ) and st and ard neuroleptics for the treatment of obsessive-compulsive ( OC ) symptomatology in patients with schizophrenia compared with administration of neuroleptics only . Thirty in patients who met DSM-IV criteria for schizophrenia and also had prominent OC symptoms were r and omly divided into two groups . Fourteen patients were treated with conventional neuroleptics and fluvoxamine in doses of 100 to 200 mg/day for 8 weeks . Sixteen patients comprised a control group and received only their previous therapeutic neuroleptic therapy . The patients were assessed using the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) , the Positive and Negative Syndrome Scale ( PANSS ) , and the Clinical Global Impression Scale ( CGI ) at baseline and endpoint . Side effects were assessed weekly . The data were analyzed using an analysis of variance . A considerable reduction in PANSS ( 34.3 % ) and Y-BOCS ( 29.4 % ) scores was noted , and CGI scores decreased moderately in both groups . None of the patients showed an acute exacerbation at the end of the study . Side effects were mild and easily tolerated in most patients . This open , r and omized , controlled study reveals that coadministration of fluvoxamine , an SSRI , and neuroleptics in patients with schizophrenia and OC symptoms was associated with specific improvements of these symptoms . Thus , the use of an SSRI in treating a patient with schizophrenia and OC symptomatology may be warranted and safe . Other implication s of the findings , including general safety of the combined pharmacotherapy and the use of new antipsychotic medications , are also discussed The augmentation of serotonin reuptake inhibitors ( SRIs ) with atypical antipsychotics for the management of  treatment-resistant obsessive-compulsive disorder ( OCD ) is gaining increasing acceptance . Quetiapine is a novel antipsychotic which is well tolerated , and which may therefore be particularly useful in this context . Charts of all patients treated in our OCD clinic with the combination of an SRI and quetiapine  were review ed . Demographic details and clinical symptoms on the Yale-Brown Obsessive-Compulsive Scale and the Clinical Global Impressions Scale ( CGI ) were tabulated before and after augmentation . Eight OCD patients who had proven resistance to treatment with SRIs  had received quetiapine augmentation . Four of these eight patients were responders ( CGI of 1 or 2 ) within 4 weeks . In the treatment-responders , the medication was well tolerated . Although limited by the retrospective design and lack of controls , these data are consistent with the growing literature suggesting that approximately one-half of OCD patients resistant to treatment with SRIs  may respond to augmentation with an atypical antipsychotic . Quetiapine , a relatively well tolerated agent , deserves further controlled study in this context Although serotonin reuptake inhibitors ( SRIs ) are the medications of choice in the treatment of obsessive-compulsive disorder ( OCD ) , only 50 - 60 % of patients respond to a single trial of any of these agents . Improved knowledge of the predictors of response to treatment may have important clinical implication s. Data from a large r and omized placebo-controlled trial of citalopram in OCD was analysed using logistic regression to determine predictors of response . Demographic ( age , sex ) , clinical ( OCD severity and duration , depression severity , prior treatment ) and trial variables  ( citalopram dose , treatment duration ) were included . Subjects with longer duration of OCD , more severe OCD symptoms or previous selective SRI use were less likely to be responders in the citalopram trial . In contrast , subjects who received adequate medication doses for sufficient periods of time in the citalopram trial were more likely to be responders . Despite greater awareness of OCD in recent years , there is evidence that the disorder continues to be underdiagnosed and undertreated . The data here emphasize the crucial importance of early diagnosis and treatment of OCD , and of pharmacotherapy with appropriate dose and duration Objective : Although many patients with obsessive-compulsive disorder ( OCD ) benefit from treatment with serotonin reuptake inhibitors ( SRIs ) , it is estimated that 40 % to 60 % of them do not respond . The objective of the present study was to evaluate the efficacy of quetiapine added to baseline treatment with SRIs for the treatment of OCD in severely ill adult subjects . Method : Forty patients ( 21 men , 19 women ) with primary OCD according to Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria participated in a 12-week , double-blind , placebo-controlled trial . They were r and omly assigned to dosages of quetiapine titrated up to 400 mg/d ( n = 20 ) or to placebo ( n = 20 ) in addition to their SRI treatment . During the continuation phase ( weeks 6 - 12 ) , subjects received different dosages between 400 and 600 mg/d depending on clinical response . At entry , all patients were unresponsive to at least 1 course of at least 12 weeks of treatment with SRIs at defined doses . The total Yale-Brown Obsessive-Compulsive Scale score was the primary efficacy parameter . Results : Intention-to-treat , last-observation-carried-forward analysis demonstrated a mean ± SD decrease in Yale-Brown Obsessive-Compulsive Scale score of 5.2 ± 5.4 in the quetiapine group and 3.9 ± 4.9 in the placebo group . The analysis of treatment effects between the 2 groups showed no significant difference . There were no significant group differences in any of the other self-rating scales or clinician-administered rating scales . Conclusions : In this study , augmentation of SRI treatment with quetiapine in severe OCD had no additional effect Longitudinal studies with very long follow-up periods of patients with obsessive-compulsive disorder ( OCD ) who have received adequate treatment are rare . In the current study , 30 of 37 in patients ( 81 % ) with severe OCD were followed up 6 - 8 years after treatment with cognitive-behavioral therapy ( CBT ) in combination with either fluvoxamine or placebo in a r and omized design . The significant improvements ( with large effectsizes ) in obsessive-compulsive symptoms from pre- to post-treatment ( 41 % reduction on the Y-BOCS ) remained stable at follow-up ( 45 % ) . Responder rates , defined as > or = 35 % reduction on the Y-BOCS , were 67 % and 60 % , respectively . Depressive symptoms decreased significantly not only from pre- to post-treatment but also during follow-up . Re-hospitalization , which occurred in 11 patients ( 37 % ) , was associated with more severe depressive symptoms at pre-treatment and living without a partner . Full symptom remission at follow-up , defined as both Y-BOCS total score < or = 7 and no longer meeting diagnostic criteria for OCD , was achieved by 8 patients ( 27 % ) . Patients without full remission at follow-up had a significantly longer history of OCD , assessed at pretreatment , compared to remitted patients . The shortterm treatment outcome had no predictive value for the long-term course . Throughout the naturalistic follow-up , nearly all patients ( 29 patients ) received additional  psychotherapy  and /or medication . This might indicate that such chronic OCD patients usually need additional therapeutic support after effective inpatient treatment to maintain their improvements over long periods CONTEXT Second-generation ( atypical ) antipsychotics ( SGAs ) are more expensive than first-generation ( typical ) antipsychotics ( FGAs ) but are perceived to be more effective , with fewer adverse effects , and preferable to patients . Most evidence comes from short-term efficacy trials of symptoms . OBJECTIVE To test the hypothesis that in people with schizophrenia requiring a change in treatment , SGAs other than clozapine are associated with improved quality of life across 1 year compared with FGAs . DESIGN A noncommercially funded , pragmatic , multisite , r and omized controlled trial of antipsychotic drug classes , with blind assessment s at 12 , 26 , and 56 weeks using intention-to-treat analysis . SETTING Fourteen community psychiatric services in the English National Health Service . PARTICIPANTS Two hundred twenty-seven people aged 18 to 65 years with DSM-IV schizophrenia and related disorders assessed for medication review because of inadequate response or adverse effects . INTERVENTIONS R and omized prescription of either FGAs or SGAs ( other than clozapine ) , with the choice of individual drug made by the managing psychiatrist . MAIN OUTCOME MEASURES Quality of Life Scale scores , symptoms , adverse effects , participant satisfaction , and costs of care . RESULTS The primary hypothesis of significant improvement in Quality of Life Scale scores during the year after commencement of SGAs vs FGAs was excluded . Participants in the FGA arm showed a trend toward greater improvements in Quality of Life Scale and symptom scores . Participants reported no clear preference for either drug group ; costs were similar . CONCLUSIONS In people with schizophrenia whose medication is changed for clinical reasons , there is no disadvantage across 1 year in terms of quality of life , symptoms , or associated costs of care in using FGAs rather than nonclozapine SGAs . Neither inadequate power nor patterns of drug discontinuation accounted for the result The purpose of this treatment package design study was to investigate the differential efficacy of cognitive therapy or exposure in vivo with response prevention for obsessive compulsive disorder ( OCD ) versus the sequential combination with fluvoxamine .  Patients with OCD ( N = 117 ) were r and omized to one of the following five conditions : a ) cognitive therapy for weeks 1 to 16 , b ) exposure in vivo with response prevention for weeks 1 to 16 , c ) fluvoxamine for weeks 1 to 16 plus cognitive therapy in weeks 9 to 16 , d ) fluvoxamine for weeks 1 to 16 plus exposure in vivo with response prevention in weeks 9 to 16 , or e ) waiting list control condition for weeks 1 to 8 only . Assessment s took place before treatment ( pretest ) and after 8 ( midtest ) , and 16 weeks ( posttest ) . In the first 8 weeks , six treatment sessions were delivered . During weeks 9 to 16 , another 10 sessions were given . Thirty-one patients dropped out . Outcome was assessed by patient- , therapist- and assessor-ratings of the Anxiety Discomfort Scale , the Yale-Brown Obsessive Compulsive Scale , and the Padua Inventory-Revised . In contrast with the four treatments , after 8 weeks the waiting list control condition did not result in a significant decrease of symptoms . After 16 weeks of treatment , all four treatment packages were effective on these OCD ratings , but they did not differ among each other in effectiveness . In OCD , the sequential combination of fluvoxamine with cognitive therapy or exposure in vivo with response prevention is not superior to either cognitive therapy or exposure in vivo alone BACKGROUND Adding the atypical neuroleptic risperidone to a serotonin reuptake inhibitor ( SRI ) has benefited patients with treatment-refractory obsessive-compulsive disorder ( OCD ) . Since olanzapine and risperidone have similar serotonergic and dopaminergic receptor binding profiles , we tested the hypothesis that olanzapine augmentation would be beneficial in treatment-unresponsive OCD . METHOD For this 8-week trial , we recruited 10 adult OCD patients ( DSM-IV criteria ) unresponsive to fluoxetine ( > or = 60 mg/day ) for > or = 10 weeks , which was continued throughout the trial . Other psychotropic medications were discontinued . Subjects had OCD for > or = 1 year , a Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) score of > or = 18 , and no organic , psychotic , or other primary Axis I disorder . Two weeks after olanzapine , 2.5 mg/day , was added , and in the absence of responder status ( Y-BOCS score decrease > or = 25 % ) and limiting side effects , we increased the dose to 5 mg/day , and after 2 more weeks , to 10 mg/day for 4 weeks . RESULTS The subjects had failed a mean of 3.3 SRI trials ( range , 1 - 5 ) and had a mean + /- SD baseline Y-BOCS score of 29.0 + /- 4.9 . Nine patients completed the trial . The subjects ' mean + /- SD endpoint Y-BOCS score was 24.4 + /- 8.0 ( a 16 % decrease ) . The 3 responders ' Y-BOCS scores dropped 68 % , 30 % , and 29 % , but only 1 patient was rated " much improved . " He maintained this improvement during a 6-month follow-up period taking olanzapine , 5 mg/day . Improvement in OCD was independent of improvement in mood symptoms . Six patients ( 60 % ) experienced significant weight gain . CONCLUSION Olanzapine augmentation may benefit treatment-unresponsive OCD . Double-blind , placebo-controlled trials are warranted along with trials comparing risperidone and olanzapine augmentation Background : Recent factor-analytic studies in obsessive-compulsive disorder ( OCD ) identified consistent symptom dimensions . Support for the validity of these dimensions comes from studies of psychiatric comorbidity , functional brain imaging , genetic transmission , and treatment response to medications . This study examined whether previously identified OCD symptom dimensions are associated with treatment compliance and response to behaviour therapy ( BT ) for OCD . Methods : One hundred and fifty-three OCD out patients who participated in a multi-centre r and omised controlled trial of computer- versus clinician-guided BT for OCD were included in the study . Logistic and multiple regression models tested for significant predictors of compliance with and response to BT and relaxation . Results : The patients studied were phenomenologically comparable ( including the presence of ‘ pure ’ obsessions and mental rituals ) to those in previous serotonin reuptake inhibitor ( SRI ) trials and those in clinical epidemiology studies . High scorers on the ‘ hoarding ’ dimension were more likely to drop out prematurely from the study and tended to improve less . For those completing treatment , the strongest predictor of outcome was pre-treatment severity . Initial depression scores were unrelated to outcome . After controlling for symptom severity , higher scores on the ‘ sexual/religious obsessions ’ factor predicted poorer outcome with BT , especially when computer-guided . Conclusions : BT is especially indicated for OCD patients with aggressive/checking , contamination/cleaning and symmetry/ordering symptoms .  Previous accounts of unsuccessful  BT  in patients with hoarding symptoms may be due in part to their propensity to drop out earlier from treatment . Patients with sexual/religious obsessions , but not those with mental rituals , might respond less well to traditional BT techniques . Existing treatments need to be refined and /or new treatments developed to improve these patients ’ adherence and response to treatment Relatively little is known about the long-term durability of group treatments for obsessive-compulsive disorder ( OCD ) and contemporary cognitive treatments . The current study investigated the 2-year follow-up results for participants who completed r and omized trials of group or individual treatment  and received either cognitive therapy ( CT ) or exposure plus response prevention ( ERP ) .  Yale-Brown Obsessive Compulsive Scale ( YBOCS ) scores for individual ERP and CT were not significantly different over 2 years . However , YBOCS scores were consistently lower over time for group ERP participants than for group CT participants . With a single exception in the group treatment study , secondary cognitive and depression scores were stable , indicating that gains achieved during acute treatment were maintained over 2 years . Less than 10 % of treatment completers relapsed in each of the treatment trials . Approximately 50 % of the completer sample was rated as recovered at 2 years . Additionally , a tentative cross- study comparison suggests that CT was better tolerated and result ed in less dropout than did ERP . Despite the overall positive results , efficacy of OCD treatments has reached a plateau and may require a fresh perspective to move forward
Two trials examined olanzapine and found no difference in the primary outcome ( response to treatment ) and most other efficacy-related outcomes but it was associated with more weight gain than monotherapy with antidepressants .
There were also some beneficial effects of quetiapine in terms of anxiety or depressive symptoms .
BACKGROUND Obsessive compulsive disorder ( OCD ) is a psychiatric disorder which has been shown to affect 2 to 3.5 % of people during their lifetimes .
Inadequate response occurs in 40 % to 60 % of people that are prescribed first line pharmaceutical treatments ( selective serotonin reuptake inhibitors ( SSRIs ) ) .
To date not much is known about the efficacy and adverse effects of second-generation antipsychotic drugs ( SGAs ) in people suffering from OCD .
OBJECTIVES To evaluate the effects of SGAs ( monotherapy or add on ) compared with placebo or other forms of pharmaceutical treatment for people with OCD .