Istituto di Psicopatologia, Rome, Italy.
Dipertimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.
Int J Psychiatry Clin Pract. 2022 Nov;26(4):395-400. doi: 10.1080/13651501.2022.2054351. Epub 2022 Mar 24.
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.
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.
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.
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.
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.
十分之六的强迫症（OCD）患者对一线治疗（包括暴露和反应预防（ERP）的选择性 5-羟色胺再摄取抑制剂（SRI）或认知行为疗法）没有反应，一些患者对二线治疗也没有反应，即 SRI-第二代抗精神病药（SGA）或 SRI-CBT/ERP 增效治疗。关于三线治疗的证据不一致。
我们调查了对 SRI-CBT/ERP-SGA 联合治疗反应不佳的严重治疗抵抗性 OCD 患者的一年反应，这些患者对 SRI 和 SRI-SGA 或 SRI-CBT/ERP 增效治疗均无反应。
连续招募了 28 例患者，并接受 SRI（以前使用的药物和剂量）、SGA（利培酮中位数剂量 1mg/天 14 例，阿立哌唑中位数剂量 3mg/天 14 例）和 CBT/ERP（中位数 32.5 小时）治疗。排除标准：智力障碍和器质性脑综合征。
在 12 个月时，Y-BOCS 总分的平均降低率为 28.2%，60.7%的患者改善，46.4%部分反应，32.1%反应，28.6%缓解。以前对 SRI-SGA 和 SRI-CBT/ERP 耐药的患者在改善、部分反应、反应和缓解的比例上没有显著差异。
这项研究表明，SRI-SGA-CBT/ERP 联合治疗可能对严重治疗抵抗性 OCD 有用。样本量小是一个限制。
多达十分之六的强迫症患者对一线治疗（CBT/ERP 或 SRI）和二线治疗（SRI-SGA 或 SRI CBT/ERP 增效治疗）无反应。
在我们的研究中，对一线和二线治疗均耐药的强迫症患者（61%）改善，部分反应（46%），反应（32%）或缓解（29%），联合 SRI、SGA 和 CBT/ERP。
在我们的患者中，SRI-SGA-CBT/ERP 增效治疗改善了工作/学校、社会和家庭功能障碍。
SRI-SGA-CBT/ERP 增效治疗比其他严重治疗抵抗性 OCD 的治疗方法更容易使用。
