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Review
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Atypical Antipsychotic Augmentation in SSRI Treatment Refractory Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis

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Review

Atypical Antipsychotic Augmentation in SSRI Treatment Refractory Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis

David Veale et al. BMC Psychiatry.

Abstract

Background: In 2006, the National Institute of Clinical and Health Excellence (NICE) guidelines for Obsessive Compulsive Disorder (OCD) recommended anti-psychotics as a class for SSRI treatment resistant OCD. The article aims to systematically review and conduct a meta-analysis on the clinical effectiveness of atypical anti-psychotics augmenting an SSRI.

Methods: Studies that were double-blind randomized controlled trials of an atypical antipsychotic against a placebo, for a minimum of 4 weeks, in adults with OCD, were included. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores were the primary outcome measure. Inclusion criteria included Y-BOCS score of 16 or more and at least one adequate trial of a SSRI or clomipramine for at least 8 weeks prior to randomization. Data sources included Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews (CDSR), trial registries and pharmaceutical databases and manufacturers up to September 2013. Forest-plots were drawn to display differences between drug and placebo on the Y-BOCS.

Results: Two studies found aripiprazole to be effective in the short-term. There was a small effect-size for risperidone or anti-psychotics in general in the short-term. We found no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo.

Conclusions: Risperidone and aripiprazole can be used cautiously at a low dose as an augmentation agent in non-responders to SSRIs and CBT but should be monitored at 4 weeks to determine efficacy.

Figures

Figure 1
Figure 1
Meta-analysis of all anti-psychotics for obsessive-compulsive disorder.
Figure 2
Figure 2
Meta-analysis of risperidone treatment vs placebo for obsessive-compulsive disorder.
Figure 3
Figure 3
Meta-analysis of olanzapine treatment vs placebo for obsessive-compulsive disorder.
Figure 4
Figure 4
Meta-analysis of quetiapine treatment vs placebo for obsessive-compulsive disorder.
Figure 5
Figure 5
Meta-analysis of aripiprazole treatment vs placebo for obsessive-compulsive disorder.
Figure 6
Figure 6
Flow diagram of study selection for meta-analysis.
Figure 7
Figure 7
Funnel plot for all studies.
Figure 8
Figure 8
Meta-analysis of risperidone treatment vs placebo for obsessive-compulsive disorder, measured as odds ratios.

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