Evidence-based pharmacotherapy of obsessive–compulsive disorder
Naomi A. Fineberg,Tim M. Gale +1 more
TL;DR: An updated literature review of the evidence supporting available strategies for the treatment of obsessive-compulsive disorder is presented, finding that selective serotonin reuptake inhibitors (SSRIs) remain the pharmacological treatment of choice for most patients and are associated with improved health-related quality of life.
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Abstract: Obsessive-compulsive disorder is a prevalent and disabling lifespan disorder. Clomipramine and the SSRIs have been found to be effective across the range of symptoms, both in acute and longer-term studies. Meta-analyses have reported a larger treatment effect for clomipramine relative to the SSRIs, but this is not supported by evidence from head-to-head comparator studies and, based on their superior safety and tolerability, SSRIs are the preferred option for long-term treatment in most cases. The treatment-effect is usually gradual and partial, and many patients fail to respond adequately to first-line treatment. Pharmacological options for refractory cases include switching SRI, increasing the dose, or augmenting with an antipsychotic agent. Novel strategies are under investigation for this highly morbid group. This paper reviews the key questions related to OCD pharmacotherapy, synthesizing evidence derived from randomized controlled trials, meta-analyses and consensus guidelines.
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Citations
The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers
Samuel R. Chamberlain,Andrew D. Blackwell,Naomi A. Fineberg,Trevor W. Robbins,Barbara J. Sahakian +4 more
TL;DR: It is proposed that neurocognitive indices of inhibitory functions may represent a useful heuristic in the search for endophenotypes in OCD, and that failures in cognitive and behavioural inhibitory processes appear to underlie many of the symptoms and neuroc cognitive findings.
833
Tricyclic antidepressant pharmacology and therapeutic drug interactions updated
TL;DR: New data on the pharmacology of tricyclic antidepressants, their affinities for human cloned CNS receptors and their cytochrome P450 enzyme inhibition profiles, allow improved deductions concerning their effects and interactions and indicate which of the TCAs are the most useful.
Probing compulsive and impulsive behaviors, from animal models to endophenotypes: a narrative review.
Naomi A. Fineberg,Naomi A. Fineberg,Naomi A. Fineberg,Marc N. Potenza,Samuel R. Chamberlain,Samuel R. Chamberlain,Heather A. Berlin,Lara Menzies,Antoine Bechara,Barbara J. Sahakian,Trevor W. Robbins,Edward T. Bullmore,Edward T. Bullmore,Eric Hollander +13 more
TL;DR: It is suggested that impulsivity and compulsivity each seem to be multidimensional, and Serotonin and dopamine interact across these circuits to modulate aspects of both impulsive and compulsive responding and as yet unidentified brain-based systems may also have important functions.
655
Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology
David S. Baldwin,Ian M. Anderson,David J. Nutt,Borwin Bandelow,Alyson J. Bond,Jonathan R. T. Davidson,J.A. den Boer,Naomi A. Fineberg,Martin Knapp,Jan Scott,Hans-Ulrich Wittchen +10 more
TL;DR: These British Association for Psychopharmacology guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.
Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology
David S. Baldwin,David S. Baldwin,Ian M. Anderson,David J. Nutt,Christer Allgulander,Borwin Bandelow,Johan A. den Boer,David M Christmas,Simon J. C. Davies,Naomi A. Fineberg,Nicky Lidbetter,Andrea Malizia,Paul McCrone,Daniel Nabarro,Catherine O'Neill,Jan Scott,Nic J.A. van der Wee,Hans-Ulrich Wittchen +17 more
TL;DR: This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions.
References
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Pierre Blier,Bergeron R +1 more
TL;DR: Addition of the 5-HT1A/β-adrcnergic antagonist pindolol did not alter OCD symptomatology but produced a rapid improvement of depressive symptoms, and Tryptophan was added to the SRI pINDolol regimen, producing a significant improvement after 4 weeks, with further amelioration after 6 weeks.
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Quetiapine versus clomipramine in the augmentation of selective serotonin reuptake inhibitors for the treatment of obsessive-compulsive disorder: a randomized, open-label trial.
Juliana Belo Diniz,Roseli Gedanki Shavitt,Carlos Eduardo Pereira,Ana Gabriela Hounie,I Pimentel,Lorrin M. Koran,S M Dainesi,E. C. Miguel +7 more
TL;DR: The results corroborate previous findings of quetiapine augmentation efficacy in obsessive-compulsive disorder (OCD) and show that higher target maximum dosages might have yielded different results.
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Venlafaxine in obsessive-compulsive disorder.
TL;DR: In this paper, the authors reported their limited experience with venlafaxine therapy in such patients and reported that the preliminary answer to this preliminary answer suggests that the partial solution may be missing in fluoxetine.
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Treatment benefit and the risk of suicidality in multicenter, randomized, controlled trials of sertraline in children and adolescents
TL;DR: A positive benefit-to-risk ratio for sertraline in adolescents with MDD and in patients of all ages with OCD is indicated, with the stipulation that doctor and patient preferences necessarily play a critical role in the choice of treatment.
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