Miodownik Chanoch, Bergman Joseph, Lerner Paul P, Kreinin Anatoly, Lerner Vladimir
*Be'er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva; †Mental Health Center Tirat Carmel, Bruce Rappaport Faculty of Medicine Technion, Haifa; and ‡Faculty of Medicine, Bar-Ilan University, Tsfat, Israel.
Clin Neuropharmacol. 2015 Jan-Feb;38(1):26-9. doi: 10.1097/WNF.0000000000000065.
Obsessive-compulsive disorder (OCD) is one of the most common and disabling psychiatric disorders. Treatment with selective serotonin reuptake inhibitors (SSRIs) shows significant improvement; however, residual symptoms remain in most patients despite continued treatment. For partial or nonresponding patients to multiple SSRIs, augmentation strategies are usually recommended. Here we present a consecutive sample of patients with resistant OCD treated with amisulpride augmentation to SSRIs.
We present 10 patients (5 males, 5 females) experiencing resistant OCD. Subjects were treated openly for 6 weeks with amisulpride 200 mg/d as add-on, excluding 1 patient who was treated with only 100 mg/d due to acute extrapyramidal adverse effect on a larger dose. Efficacy was assessed at baseline and after 6 weeks of treatment using the Yale-Brown Obsessive-Compulsive Scale, Clinical Global Impression-Severity, and Clinical Global Impression-Improvement.
The treatment was generally well tolerated without serious events. In all patients, average Yale-Brown Obsessive-Compulsive Scale scores diminished from 25.3 ± 5.96 points at baseline to 12.2 ± 5.98 at the sixth week (P < 0.0005). Of 10 patients, 7 had significant and partial improvement, and 3 patients did not demonstrate any improvement.
Treatment-resistant OCD patients positively responded and well tolerated amisulpride add-on to their ongoing regular pharmacotherapy. This case series demonstrates that amisulpride could be a promising optional therapy for patients who have resistant OCD. Further randomized controlled studies are necessary.
强迫症（OCD）是最常见且使人致残的精神疾病之一。选择性5-羟色胺再摄取抑制剂（SSRI）治疗显示出显著改善；然而，尽管持续治疗，大多数患者仍残留症状。对于对多种SSRI部分反应或无反应的患者，通常推荐增效策略。在此，我们展示了一组连续的难治性强迫症患者，他们接受了阿立哌唑增效SSRI治疗。
我们展示了10例（5男，5女）难治性强迫症患者。受试者以阿立哌唑200mg/d作为附加治疗进行6周的开放治疗，排除1例因较大剂量出现急性锥体外系不良反应而仅接受100mg/d治疗的患者。在基线和治疗6周后，使用耶鲁-布朗强迫症量表、临床总体印象-严重程度和临床总体印象-改善情况来评估疗效。
治疗总体耐受性良好，无严重事件发生。所有患者中，耶鲁-布朗强迫症量表平均得分从基线时的25.3±5.96分降至第6周时的12.2±5.98分（P<0.0005）。10例患者中，7例有显著且部分改善，3例患者未显示任何改善。
难治性强迫症患者对正在进行的常规药物治疗附加阿立哌唑有积极反应且耐受性良好。该病例系列表明，阿立哌唑可能是难治性强迫症患者一种有前景的可选治疗方法。需要进一步进行随机对照研究。
