Delle Chiaie Roberto, Scarciglia Pierluigi, Pasquini Massimo, Caredda Maria, Biondi Massimo
Department of Psychiatry and Psychological Medicine, SAPIENZA University of Rome, Viale dell'Università, 30 - 00185 - Rome, Italy.
Clin Pract Epidemiol Ment Health. 2011;7:107-11. doi: 10.2174/1745017901107010107. Epub 2011 May 27.
Antipsychotic augmentation is an effective treatment intervention for Obsessive Compulsive Disorder (OCD) patients resistant to Selective Serotonin Reuptake Inhibitors (SSRI) agents. This pilot study was conducted to evaluate the effectiveness and tolerability of Aripiprazole for the augmentation of standard treatments in patients with resistant OCD.
Twenty patients diagnosed with OCD according to DSM-IV TR criteria and having a history of resistance to standard pharmacological treatment were included in the study. Aripiprazole was added to ongoing SSRI or clomipramine treatment with a starting dose of 5 mg/day and titrated up to a maximum of 20 mg/day (mean dose 12.62 mg ± 4.25). Efficacy was assessed with the Yale-Brown obsessive compulsive scale (Y-BOCS) and the Clinical Global Improvement-severity scale (CGI-S) at baseline and at week 12 of Aripiprazole augmentation. Side effects were monitored by the Udvalg for Kliniske Undersogelser (UKU) side effect rating scale.
All 20 subjects enrolled in our study completed the full 12-week course of treatment. A significant improvement over the 12-week study period was observed (paired t-test for mean Y-BOCS total score at week 12 as compared with baseline - all patients: t = 13.146, d.f. = 19, p= 0.0001). Aripiprazole was generally well tolerated and no changes were observed in vital signs. The most commonly observed side effects after the introduction of the augmenting agent included: akathysia, nausea/vomiting, hyperkinesia, tension/inner unrest, tremors, asthenia/lassitude/increased fatiguability.
Although results of this pilot study are preliminary and require confirmation in randomized controlled trials, our experience suggested that Aripiprazole is effective and well-tolerated as an augmenting agent in patients with treatment resistant OCD.
抗精神病药物增效治疗是对选择性5-羟色胺再摄取抑制剂（SSRI）耐药的强迫症（OCD）患者的一种有效治疗干预措施。本初步研究旨在评估阿立哌唑对难治性强迫症患者标准治疗进行增效的有效性和耐受性。
根据《精神疾病诊断与统计手册》第四版修订版（DSM-IV TR）标准诊断为强迫症且有标准药物治疗耐药史的20例患者纳入本研究。在正在进行的SSRI或氯米帕明治疗基础上加用阿立哌唑，起始剂量为5mg/天，滴定至最大剂量20mg/天（平均剂量12.62mg±4.25）。在基线及阿立哌唑增效治疗第12周时，采用耶鲁布朗强迫症量表（Y-BOCS）和临床总体改善-严重程度量表（CGI-S）评估疗效。采用临床不良反应评价量表（UKU）监测副作用。
本研究纳入的所有20例受试者均完成了为期12周的完整治疗疗程。在12周的研究期间观察到显著改善（与基线相比，第12周Y-BOCS总分的配对t检验 - 所有患者：t = 13.146，自由度 = 19，p = 0.0001）。阿立哌唑总体耐受性良好，生命体征未见变化。加用增效剂后最常观察到的副作用包括：静坐不能、恶心/呕吐、运动增多、紧张/内心不安、震颤、乏力/疲倦/易疲劳性增加。
尽管本初步研究结果是初步的，需要在随机对照试验中得到证实，但我们的经验表明，阿立哌唑作为难治性强迫症患者的增效剂是有效且耐受性良好的。
