McDougle C J, Fleischmann R L, Epperson C N, Wasylink S, Leckman J F, Price L H
Department of Psychiatry, Yale University, New Haven, CT 06519, USA.
J Clin Psychiatry. 1995 Nov;56(11):526-8.
Forty percent to 60% of patients with obsessive-compulsive disorder (OCD) remain unimproved after adequate treatment with serotonin uptake inhibitors (SUIs). The addition of low-dose haloperidol and pimozide to ongoing SUI treatment has been shown to be effective in up to 65% of SUI-refractory OCD patients, particularly in those with comorbid chronic tic disorder. Because OCD patients typically require prolonged pharmacotherapy, they are subject to the development of tardive dyskinesia during neuroleptic treatment. Risperidone is a highly potent and selective serotonin2 and dopamine2 receptor antagonist with a side effect profile that appears to be much more tolerable and safer than that of typical neuroleptics.
We report our experience with three OCD patients who were unimproved after a minimum of 12 weeks of treatment with the potent and selective SUI fluvoxamine, in whom we added risperidone in an open-label manner.
All three patients showed significant improvement in their obsessive-compulsive symptoms as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) after risperidone 1 mg/day was added to ongoing fluvoxamine (250-300 mg/day). Within 4 weeks of adding risperidone, the three patients' Y-BOCS scores had decreased by 65%, 56%, and 43%, respectively. Other than mild or moderate sedation, no side effects were observed.
These results suggest that risperidone addition to ongoing SUIs may be an effective treatment strategy for refractory OCD.
40%至60%的强迫症（OCD）患者在接受5-羟色胺再摄取抑制剂（SUIs）充分治疗后仍未改善。在持续的SUIs治疗中添加低剂量氟哌啶醇和匹莫齐特已被证明对高达65%的SUIs难治性OCD患者有效，特别是那些合并慢性抽动障碍的患者。由于OCD患者通常需要长期药物治疗，他们在抗精神病药物治疗期间易发生迟发性运动障碍。利培酮是一种高效且选择性的5-羟色胺2和多巴胺2受体拮抗剂，其副作用似乎比典型抗精神病药物更易耐受且更安全。
我们报告了3例OCD患者的治疗经验，这些患者在接受强效选择性SUIs氟伏沙明至少12周的治疗后仍未改善，我们以开放标签的方式为他们添加了利培酮。
在持续的氟伏沙明（250 - 300毫克/天）治疗中添加利培酮1毫克/天后，所有3例患者根据耶鲁-布朗强迫症量表（Y-BOCS）测量的强迫症状均有显著改善。在添加利培酮的4周内，3例患者的Y-BOCS评分分别下降了65%、56%和43%。除了轻度或中度镇静外，未观察到其他副作用。
这些结果表明，在持续的SUIs治疗中添加利培酮可能是难治性OCD的一种有效治疗策略。
