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Augmentation with cognitive behavioural therapy has superior efficacy to augmentation with risperidone for treating adults with treatment resistant OCD
  1. Joseph O'Neill
  1. Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neurosciences, University of California, Los Angeles, California, USA; joneill@mednet.ucla.edu

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What is already known on this topic?

For adult patients with obsessive-compulsive disorder (OCD) resistant to serotonin reuptake inhibitors (SRIs), American Psychological Association practice guidelines1 recommend adding either behavioural therapy based on exposure and response prevention (EX/RP) or a second-generation antipsychotic. Factors mentioned in the guidelines1 that might lead patients and clinicians to prefer the antipsychotic option includes local availability of properly trained cognitive-behavioural therapy (CBT) therapists, treatment costs and the patient's ability to comply with CBT (willingness to do the time-intensive and emotionally challenging work of CBT over several weeks). Among antipsychotics, risperidone has been most effective in small trials.2–4

What this paper adds?

  • This first large-scale (100 patients) comparison of the two augmentation strategies yielded far superior efficacy in symptom reduction, remission and other metrics for EX/RP than for risperidone.

  • Risperidone was only slightly (but not significantly) more effective than placebo.

  • Adverse effects of 12-week SRI treatment were also observed in overall 37% of patients at baseline, which is more than expected.

Limitations

  • Successful augmentation (EX/RP) produced a small (25%) improvement in 80% of patients, however, only 43% achieved ‘minimal’ symptoms, meaning most patients were still partial responders even after augmentation.

  • Maximum permitted dose of risperidone was 4 mg/day, …

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