Augmentation strategy with olanzapine in resistant obsessive compulsive disorder: an Italian long-term open-label study

Abstract

The present study reports the results of an open-label trial on the use of the combination of olanzapine (an atypical antipsychotic) serotonin reuptake inhibitors (SRIs) in 26 resistant outpatients affected by resistant obsessive-compulsive disorder (OCD).

All patients had been suffering from OCD, according to DSM IV criteria, for at least 2 years and had different comorbid disorders; they had been treated with an SRI at adequate dosages for at least 6 months, or had tried different augmentation strategies with no or poor response. As a result, olanzapine was added and continued for 1 year.

After 12 weeks of this regimen, most of the patients (17) had shown a reduction in OC symptoms, as assessed by a decrease in the Yale-Brown Obsessive Compulsive Scale total score, which continued throughout subsequent months. Only mild side-effects were recorded and no patient halted the treatment.

The addition of olanzapine would appear to be a useful short- and long-term strategy for augmenting SRI effectiveness in resistant OCD patients, especially in those presenting comorbidity with bipolar disorders.

Keywords

obsessive-compulsive disorder serotonin re-uptake inhibitors augmentation strategies atypical neuroleptics olanzapine

References

Amador X F , Strauss D H , Yale S A , Flaum M M , Endicott J , Gorman J M (1994) Assessment of insight in psychosis . Am J Psychiatry 150(6): 873-879

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn(DSM-IV). American Psychiatric Press, Washington, DC

Atmaca M , Kuloglu M , Tezcan E , Gecici O (2002) Quetiapine augmentation in patients with treatment-resistant obsessive-compulsive disorder: a single-blind, placebo-controlled study . Int Clin Psychopharmacol 17: 115-119

Bystrisky A , Ackerman D L , Rosen R M , Vapnik T , Gorbis E , Maidment K M , Saxena S (2004) Augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder . J Clin Psychiatry 65: 565-568

D’Amico G , Cedro C , Muscatello M R , Pandolfo G , Di Rosa A E , Zoccali R , La Torre D , D’Arrigo C , Spina E (2003) Olanzapine augmentation of paroxetine-refractory obsessive-compulsive disorder . Prog Neuropsychopharmacol Biol Psychiatry 27: 619-623

Finiberg N , Marazziti D , Stein D J (2001) Obsessive-Compulsive Disorder: a Practical Guide. Martin Dunitz, London

First M B , Spitzer R L , Gibbon M , Williams J B W (1997) Structured Clinical Interview for DSM-IV Axis I Disorders - Patient Edition (SCID-I/P, Version 2.0, 4/97 revision), Biometrics Research Department, New York State Psychiatric Institute, New York, NY

Goodman W K , Price L H , Mazure C , Delgado P L , Palumbo S , Krystal J H , Nagy L M , Rasmussen, S A , Heninger G R , Charney D S (1989) The Yale-Brown Obsessive Compulsive Scale, I: development, use and reliability . Arch Gen Psychiatry 46: 1006-1011

Guy W (1976) ECDEU Assessment Manual for Psychopharmacology, US Dept Health, Education, and Welfare publication (ADM) 223-244, Government Printing Office, Washington, DC

10.

Koran L M , Ringold A L , Elliott M A (2000) Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder . J Clin Psychiatry 61(7): 514-517

11.

McDougle C J (1997) Update on pharmacologic management of OCD: agents and augmentation . J Clin Psychiatry 58 (Suppl. 12): 11-17

12.

McDougle C J , Goodman W K Price L H (1994) Dopamine antagonists in tic-related and psychotic spectrum obsessive compulsive disorders . J Clin Psychiatry 55 (Suppl. 11): 24-31

13.

Montgomery S A , Asberg M (1979) A new depression scale designed to be sensitive to change . Br J Psychiatry 134: 382-389

14.

Pfanner C , Marazziti D , Dell’Osso L , Presta S , Gemignani A , Milanfranchi A , Cassano G B (2000) Risperidone augmentation in refractory obsessive-compulsive disorder: an open-label study . Int Clin Psychopharmacol 15(5): 297-301

15.

Potenza M N , Wasylink S , Longhurst J G , Epperson C N , McDougle C J (1998) Olanzapine augmentation of fluoxetine in the treatment of refractory obsessive-compulsive disorder . J Clin Psychopharmacol 18(5): 423-424

16.

Shapira N A , Wrd H E , Mandoki M M , Murphy T K , Yang M C K , Blier P , Goodman W K (2004) A double-blind placebo controlled trial of olanzapine addition in fluoxetine-refractory obsessive-compulsive disorder . Biol Psychiatry 55: 553-555

17.

Stein D J , Hollander E (1992) Low-dose pimozide augmentation of serotonin reuptake blockers in the treatment of trichotillomania . J Clin Psychiatry 53: 123-126

18.

Weiss E L , Potenza M N , McDougle C J , Epperson C N (1999) Olanzapine addition in obsessive-compulsive disorder refractory to selective serotonin reuptake inhibitors: an open-label case series . J Clin Psychiatry 60(8): 524-527