fluvoxamine and Obsessive-Compulsive-Disorder

Although obsessive-compulsive personality disorder (OCPD) is one of the most prevalent personality disorders, it is one of the least studied. There is debate as to whether pharmacotherapy is efficacious for OCPD. We aimed to systematically evaluate the efficacy and tolerability of pharmacotherapy for OCPD.. This systematic review found two randomized controlled trials investigating pharmacotherapy of OCPD. In a study of major depression (n = 308) with comorbid OCPD (n = 71), citalopram was more effective for OCPD than sertraline with fewer drop-outs from treatment. In a small study of OCPD (n = 24), fluvoxamine was more effective than placebo, and there was a low drop-out rate. Risk of bias and quality assessment of these studies was not possible, and findings have very low levels of certainty.. Two studies provide preliminary evidence in support of citalopram and fluvoxamine for OCPD. Further randomized controlled trials are required before firm conclusions can be drawn regarding efficacy of pharmacotherapy for OCPD.

Topics: Citalopram; Compulsive Personality Disorder; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Randomized Controlled Trials as Topic

Autism spectrum disorders (ASD) are characterised by abnormalities in social interaction and communication skills, as well as stereotypic behaviours and restricted activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of conditions often comorbid with ASD such as depression, anxiety and obsessive-compulsive behaviours.. To determine if treatment with an SSRI:1. improves the core features of autism (social interaction, communication and behavioural problems);2. improves other non-core aspects of behaviour or function such as self-injurious behaviour;3. improves the quality of life of adults or children and their carers;4. has short- and long-term effects on outcome;5. causes harm.. We searched the following databases up until March 2013: CENTRAL, Ovid MEDLINE, Embase, CINAHL, PsycINFO, ERIC and Sociological Abstracts. We also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). This was supplemented by searching reference lists and contacting known experts in the field.. Randomised controlled trials (RCTs) of any dose of oral SSRI compared with placebo, in people with ASD.. Two authors independently selected studies for inclusion, extracted data and appraised each study's risk of bias.. Nine RCTs with a total of 320 participants were included. Four SSRIs were evaluated: fluoxetine (three studies), fluvoxamine (two studies), fenfluramine (two studies) and citalopram (two studies). Five studies included only children and four studies included only adults. Varying inclusion criteria were used with regard to diagnostic criteria and intelligence quotient of participants. Eighteen different outcome measures were reported. Although more than one study reported data for Clinical Global Impression (CGI) and obsessive-compulsive behaviour (OCB), different tool types or components of these outcomes were used in each study. As such, data were unsuitable for meta-analysis, except for one outcome (proportion improvement). One large, high-quality study in children showed no evidence of positive effect of citalopram. Three small studies in adults showed positive outcomes for CGI and OCB; one study showed improvements in aggression, and another in anxiety.. There is no evidence of effect of SSRIs in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear.

Topics: Adult; Age Factors; Autistic Disorder; Child; Child Development Disorders, Pervasive; Citalopram; Fenfluramine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors

Autism spectrum disorders (ASD) are characterised by abnormalities in social interaction and communication skills, as well as stereotypic behaviours and restricted activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of co-morbidity associated with ASD such as depression, anxiety and obsessive-compulsive behaviours.. To determine if treatment with an SSRI: 1. improves the core features of autism (social interaction, communication and behavioural problems); 2. improves other non-core aspects of behaviour or function such as self-injurious behaviour; 3. improves the quality of life of children and their carers; 4. has short and long term effects on outcome; 5. causes harms.. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 4), MEDLINE ( December 2009), EMBASE (December 2009), CINAHL (December 2009), PsycINFO (December 2009) and ERIC (December 2009), without language restrictions.. Randomised controlled trials (RCTs) of any dose of oral SSRI compared with placebo, in participants with autism spectrum disorders. Trials must have included at least one standardised outcome measure.. Two authors independently selected and appraised studies for inclusion and risk of bias. All data were continuous. Meta-analysis, where possible, used a random-effects model.. Seven RCTs with a total of 271 participants were included. Four SSRIs were evaluated: fluoxetine (two studies), fluvoxamine (two studies), fenfluramine (two studies) and citalopram (one study). Five studies included only children and two studies included only adults. Varying inclusion criteria were used with regard to diagnostic criteria and intelligence of participants. Seventeen different outcome measures were reported. Although more than one study reported data for Clinical Global Impression (CGI) and obsessive-compulsive behaviour (OCB), different tool types or components of these outcomes were used in each study. As such, data were unsuitable for meta-analysis. One large, high quality study in children showed no evidence of positive effect of citalopram. Two small studies in adults showed positive outcomes for CGI and OCB; one study showed improvements in aggression and another in anxiety.. There is no evidence of effect of SSRIs in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear.

Topics: Adult; Age Factors; Autistic Disorder; Child; Citalopram; Fenfluramine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors

Specific serotonin reuptake inhibitors are currently recommended as first-line treatments for obsessive-compulsive disorder (OCD) and social phobia or social anxiety disorder (SAD). Fluvoxamine has demonstrated efficacy in both these conditions and has recently been marketed in a controlled-release (CR) formulation in the United States for treatement of OCD and SAD. Three 12-week double-blind, multicenter, randomized, placebo-controlled studies were conducted with this formulation - two in SAD and one in OCD. All three studies showed a robust effect on the key symptoms of OCD and SAD and had broadly comparable efficacy to studies conducted with immediate-release (IR) fluvoxamine. The beneficial effects of fluvoxamine CR were maintained in a 12-week double-blind, randomized extension to one SAD trial. The CR formulation, when compared to its IR counterpart, offers less daily fluctuation in fluvoxamine levels and a more rapid titration schedule; in addition, a more rapid onset of effect may result from these features. Overall, the benefits of the CR formulation, among them the convenience of oncedaily dosing, were achieved without an increased adverse event burden versus the IR form.

Topics: Clinical Trials as Topic; Delayed-Action Preparations; Drug Interactions; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Phobic Disorders

The aim of the present paper was to critically examine evidence about the benefits of cognitive-behavioural therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) from controlled and single group studies, including its benefits relative to medication are critically reviewed. Selected studies were categorized by study type and by risk of bias classification. Standardized mean differences (Hedges' g or Cohen d) and, where appropriate, weighted mean difference (WMD) were calculated. All five comparison and 14 one-group studies showed a significant benefit for CBT within a wide range (ES = .78 to 4.38). Low risk of bias studies produced the lower adjusted effect sizes. The best available estimate of CBT efficacy relative to no treatment is about 1 standardized mean difference, equivalent to a treatment effect of 8 points on the Children's Yale-Brown Obsessive-Compulsive Scale. This represents a reduction in the risk of continuing to have OCD post-treatment of about 37% (95% CI 14% to 54%). Evidence from 3 studies indicates that the efficacy of CBT and medication do not differ significantly. CBT combined with medication is significantly more efficacious than non-active controls or medication alone but not relative to CBT alone. CBT should be regarded as a first line equivalent to anti-OCD medication with the potential to lead to better outcomes when combined with medication than medication alone can provide. Additional studies are needed to further clarify CBT's benefits and to investigate how it can be made more available as a treatment option for children and youth who suffer from OCD.

Topics: Adolescent; Anti-Anxiety Agents; Child; Clomipramine; Cognitive Behavioral Therapy; Combined Modality Therapy; Fluvoxamine; Follow-Up Studies; Humans; Obsessive-Compulsive Disorder; Randomized Controlled Trials as Topic; Sertraline; Treatment Outcome

This article reviews new developments of pharmacotherapy in obsessive-compulsive disorder (OCD) and OC spectrum disorders of the past five years. New developments primarily involved the ex-tension of evidence of efficacy of serotonin reuptake inhibitors(SRIs), the use of atypical antipsychotics in addition to SRIs for treatment refractory patients, the combination of pharmacotherapy with behavior therapy, and studies assessing predictors of response. Today, frontline pharmacological treatment of OCD still consists of drugs with potent serotonin reuptake inhibition proper-ties. In case of non-response, treatment options comprise adding another drug, increasing the dose, switching drugs, or changing the mode of delivery.

Topics: Brain; Clomipramine; Cognitive Behavioral Therapy; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Positron-Emission Tomography; Selective Serotonin Reuptake Inhibitors; Sertraline

Some behavioral side effects of selective serotonin reuptake inhibitor (SSRI) antidepressants have been known for a long time. Since the introduction of these drugs in the 1990s, publications have regularly reported behavioral side effects in children and adolescents, including excitation, motor restlessness, social disinhibition, and above all self-injurious ideation and behavior. Clinical trials provide only limited data. Although these data suggest that some self-injurious and suicidal behavior may indeed occur in children and adolescents receiving SSRIs, they are too disparate to specify the frequency of these acts. Clinical trials provide useful data about drug efficacy, but their methodology is inappropriate for determining the frequency of such side effects. SSRI and suicidality: the data are difficult to read. Although some epidemiologic data suggest that SSRIs may increase the risk of occurrence of self-injurious and suicidal behavior in children and adolescents, other epidemiologic data show that the rate of suicide mortality in children and adolescents has decreased since the introduction of SSRIs. No known mechanism explains how SSRIs might increase the risk of these behavioral side effects. It is clear, however, that these effects are not particular to children and adolescents but may also be observed among adults. SSRIs must be used rationally and carefully in children and adolescents. They should not be administered routinely in youth with obsessive-compulsive or depressive disorders. Their use should be reserved for severe disorders or when psychotherapy alone has been shown to be inadequate, and when they are used, efficacy and side effects must be monitored carefully and frequently.

Topics: Adolescent; Adult; Age Factors; Antidepressive Agents, Second-Generation; Case-Control Studies; Child, Preschool; Citalopram; Confidence Intervals; Depressive Disorder; Family Practice; Female; Fluoxetine; Fluvoxamine; History, Medieval; Humans; Male; Obsessive-Compulsive Disorder; Paroxetine; Placebos; Psychotherapy; Randomized Controlled Trials as Topic; Risk; Safety; Selective Serotonin Reuptake Inhibitors; Self-Injurious Behavior; Sertraline; Suicide; Suicide, Attempted

Fluvoxamine is the selective serotonin re-uptake inhibitor with the largest database in the treatment of obsessive-compulsive disorder, a severe, and often chronic, anxiety disorder associated with substantial impairment in functioning. The selective serotonin re-uptake inhibitors represent a first-line treatment in patients with obsessive-compulsive disorder. These agents work primarily by blocking the re-uptake of serotonin into the presynaptic nerve terminal, which is believed to be mediated by their effects on the serotonin transport system. In the last two decades, the anti-obsessional effect of fluvoxamine has been tested in several double-blind, placebo-controlled and active-comparison studies, demonstrating its superior efficacy over obsessions and compulsions compared with non-serotonergic antidepressants (i.e., desipramine) and equal efficacy to clomipramine (a tricyclic antidepressant with potent serotonin re-uptake inhibition) and other selective serotonin re-uptake inhibitors (paroxetine and citalopram). However, compared with clomipramine, the selective serotonin re-uptake inhibitor fluvoxamine showed fewer side effects and better tolerability. This reflects the poor affinity of this compound for adrenergic, muscarinic, cholinergic or histaminergic receptors.

Topics: Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Antipsychotic Agents; Behavior Therapy; Clomipramine; Drug Therapy, Combination; Fluvoxamine; Humans; Monoamine Oxidase Inhibitors; Obsessive-Compulsive Disorder; Paroxetine; Risperidone; Selective Serotonin Reuptake Inhibitors

Topics: Comorbidity; Feeding and Eating Disorders; Fluvoxamine; Humans; Nutritional Support; Obsessive-Compulsive Disorder; Paroxetine; Psychotherapy; Reference Standards; Selective Serotonin Reuptake Inhibitors; Serotonin

Topics: Antidepressive Agents; Clomipramine; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Randomized Controlled Trials as Topic; Treatment Outcome

Obsessive-compulsive disorder (OCD) is characterized by obsessions, compulsions, or both, which cause significant personal distress or social dysfunction. OCD is a common psychiatric illness with a prevalence of 1-2%. Because most people have regular contact with primary health care services, the patient with OCD is likely to see their general practitioner even though psychological problems may not be the main reason for consultation. Early recognition of the disorder facilitates early intervention. This reduces distress, disability and burden of illness. Pharmacological treatment with serotonin reuptake inhibitors (SRI) and cognitive-behavioral therapy have both been proven to be effective and are evidence based.

Topics: Adolescent; Adult; Anti-Anxiety Agents; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Citalopram; Clomipramine; Depression; Diagnosis, Differential; Eczema; Family Practice; Female; Fluoxetine; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Paroxetine; Psychotherapy; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Sertraline; Surveys and Questionnaires; Time Factors; Trichotillomania

Topics: Adolescent; Age of Onset; Antidepressive Agents, Tricyclic; Child; Clomipramine; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Sex Factors

Nonresponse to treatment in obsessive-compulsive disorder is common, associated with substantial impairment, and understudied. Little practical advice is available to clinicians on next-step treatment strategies for patients who have not responded well to 2 trials of selective serotonin reuptake inhibitors (SSRIs). Available options include continuation of SSRI treatment, switching to another SSRI or selective serotonin-norepinephrine reuptake inhibitor, augmenting with atypical neuroleptics or cognitive-behavioral therapy, or utilizing novel treatment approaches. The authors synthesize state-of-the-art treatment and give practical advice for clinicians.

Topics: Antipsychotic Agents; Benzodiazepines; Cognitive Behavioral Therapy; Combined Modality Therapy; Drug Therapy, Combination; Fluvoxamine; Humans; Morphine; Multicenter Studies as Topic; Neurotransmitter Uptake Inhibitors; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Practice Guidelines as Topic; Retrospective Studies; Review Literature as Topic; Selective Serotonin Reuptake Inhibitors; Sumatriptan; Treatment Outcome

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which may be used for the management of anxiety disorders in children and adolescents. Absorption of fluvoxamine was similar in adolescents to that in adults, which suggests that the maximum dosage of the drug for patients aged between 12 and 17 years can be as high as 300 mg/day. However, steady-state plasma fluvoxamine [corrected] concentrations were 2 to 3 times higher in children (aged between 6 and 11 years) than in adolescents; thus, the maximum fluvoxamine dosage recommended for children is 200 mg/day. Fluvoxamine (50 to 300 mg/day) for 8 to 16 weeks significantly reduced symptoms of obsessive-compulsive disorder (OCD) [measured across multiple assessment scales] compared with placebo in a well controlled trial in paediatric patients (n = 120) or from baseline in noncomparative trials in adolescent (n = 20) or paediatric (n = 16) patients. Improvements with fluvoxamine (up to 200 mg/day) were observed for up to 1 year in 98 patients with OCD in a noncomparative trial. The drug (up to 250 or 300 mg/day) also improved symptoms of anxiety compared with placebo in an 8-week well controlled trial in 128 paediatric patients with social phobia, separation anxiety disorder or generalised anxiety disorder (GAD). Fluvoxamine (50 to 300 mg/day) appears to be well tolerated in paediatric patients, with most adverse events with the drug (except abdominal discomfort, which occurred more often in patients receiving fluvoxamine) occurring with a similar incidence to those with placebo. The most common adverse events involved the central nervous system or gastrointestinal system. Most adverse events reported by paediatric patients with OCD were similar to those reported by adults. In conclusion, fluvoxamine is generally well tolerated and has demonstrated short-term efficacy compared with placebo in the treatment of OCD, and social phobia, separation anxiety disorder or GAD in well controlled trials in paediatric patients. Reductions in symptoms of anxiety with fluvoxamine have been observed for up to 1 year in children and adolescents with OCD. However, there are currently no comparative trials of fluvoxamine with other pharmacological agents. In the absence of such trials, current consensus opinion recommends that when pharmacotherapy is indicated, fluvoxamine, like other SSRIs, can be used as first-line treatment for anxiety disorders, particularly OCD, in paediatric patients. However, direct compari

Topics: Adolescent; Anti-Anxiety Agents; Anxiety, Separation; Child; Drug Interactions; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Phobic Disorders

To examine the efficacy and tolerability of clomipramine compared with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive-compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 failed SSRI trials.. The literature on the pharmacotherapy of OCD was critically examined.. The available research evidence is not conclusive but suggests that clomipramine possesses greater anti-obsessional efficacy than do the SSRIs. In addition, when clomipramine is presented to patients in a positive way, and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs.. Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research evidence. Both clomipramine and the SSRIs may be used as first-line treatments for OCD.

Topics: Clomipramine; Double-Blind Method; Expert Testimony; Fluoxetine; Fluvoxamine; Guidelines as Topic; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

Fluvoxamine (Depromel), a selective serotonin reuptake inhibitor (SSRI), was launched in May 1999 in Japan with more than 10 years' delay from the marketing in Europe and the United States. Fluvoxamine has been approved in about 80 countries as the indication to "depression" since 1983. As the indication to obsessive-compulsive disorder (OCD), fluvoxamine was first approved in the United States in 1994 and then in about 30 countries. Efficacy of the drug on "depression and depressed state" was found to be comparable to traditional tricyclic antidepressants (TCAs) by the clinical studies in Japan. Indication to OCD was first approved for fluvoxamine in Japan. The antidepressant and the anti-OCD action are considered the result of the serotonin reuptake inhibition at the serotonergic neurons. Fluvoxamine has little affinity for muscarinic, adrenergic alpha 1- and histamine H1-receptors, which TCAs have. Therefore, fluvoxamine possesses less side effects such as dry mouse, disuria, dizziness, orthostatic hypotension and drowsiness, etc.; and it is useful for elderly patients and long-term treatments for depression and OCD.

Topics: Animals; Depression; Disease Models, Animal; Drug Approval; Fluvoxamine; Humans; Japan; Mice; Obsessive-Compulsive Disorder; Receptors, Neurotransmitter; Selective Serotonin Reuptake Inhibitors; Time Factors

Fluvoxamine is a potent and selective serotonin reuptake inhibitor (SSRI) that has little or no effect on other monoamine reuptake mechanisms. Relative to other SSRIs, fluvoxamine is a weak inhibitor of cytochrome P450 (CYP) 2D6, a moderate inhibitor of CYP2C19 and CYP3A4 and a potent inhibitor of CYP1A2. In randomised, double-blind trials. fluvoxamine 100 to 300 mg/day for 6 to 10 weeks significantly reduced symptoms of obsessive-compulsive disorder (OCD) compared with placebo. Response rates of 38 to 52% have been reported with fluvoxamine, compared with response rates of 0 to 18% with placebo. In patients with OCD, fluvoxamine had similar efficacy to that of clomipramine and, in smaller trials, the SSRIs paroxetine and citalopram and was significantly more effective than desipramine. Maintenance therapy with fluvoxamine may reduce the likelihood of relapses in up to 67% of patients with OCD. Fluvoxamine < or = 300 mg/day for 6 to 8 weeks was as effective as imipramine in patients with panic disorder, and significantly more effective than placebo. In addition, treatment with fluvoxamine < or = 300 mg/day for > or = 8 weeks improved symptoms of social phobia (social anxiety disorder), post-traumatic stress disorder (PTSD), pathological gambling, compulsive buying, trichotillomania, kleptomania, body dysmorphic disorder, eating disorders and autistic disorder. Large trials comparing the efficacy of fluvoxamine and other SSRIs in patients with anxiety disorders are warranted. Fluvoxamine is generally well tolerated; in postmarketing studies, nausea was the only adverse event occurring in >10% of patients with less commonly reported events including somnolence, asthenia, headache, dry mouth and insomnia. Fluvoxamine is associated with a low risk of suicidal behaviour, sexual dysfunction and withdrawal syndrome. Fewer anticholinergic or cardiovascular events are associated with fluvoxamine than tricyclic antidepressants. Although comparative data are lacking, the tolerability profile of fluvoxamine appears to be broadly similar to those of other SSRIs.. Fluvoxamine has demonstrated short term efficacy in the treatment of OCD, panic disorder, social phobia, PTSD and in a range of obsessive-compulsive spectrum disorders. The drug is as effective as clomipramine in patients with OCD but appears to have a better tolerability profile. On the basis of current treatment guidelines, fluvoxamine, like other SSRIs, is recommended as first-line treatment for a number of anxiety disorders. It appears to offer some pharmacokinetic advantages and a different drug interaction profile to the other SSRIs with a broadly similar spectrum of adverse events. However, direct comparisons are required to assess the relative efficacy and tolerability of the different agents of this drug class.

Topics: Adult; Aged; Drug Interactions; Feeding and Eating Disorders; Fluvoxamine; Humans; Intestinal Absorption; Metabolic Clearance Rate; Obsessive-Compulsive Disorder; Panic Disorder; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors; Stress Disorders, Post-Traumatic

The mainstay of the pharmacologic treatment of obsessive-compulsive disorder (OCD) is a 10- to 12-week trial of a potent serotonin reuptake inhibitor (SRI) at an adequate dose. Double-blind, placebo-controlled trials have established the anti-obsessive-compulsive (OC) efficacy of five different SRIs. One of the most thoroughly studied of these SRIs is fluvoxamine, the focus of this article. Fluvoxamine's pharmacologic and pharmacokinetic properties, its efficacy, and guidelines for its clinical use in OCD and related disorders are briefly reviewed. Potential drug-drug interactions are discussed and placed in clinical perspective. The management of common SRI-induced side effects is also addressed. Recent comparative studies suggest that fluvoxamine may be equivalent in efficacy to clomipramine, yet better tolerated. Fluvoxamine shows promise in the treatment of several so-called OC-spectrum disorders, but additional controlled trials are needed.

Topics: Adolescent; Child; Clinical Trials as Topic; Clomipramine; Compulsive Behavior; Disruptive, Impulse Control, and Conduct Disorders; Drug Administration Schedule; Drug Interactions; Fluvoxamine; Humans; Obsessive Behavior; Obsessive-Compulsive Disorder; Recurrence; Selective Serotonin Reuptake Inhibitors; Somatoform Disorders; Tourette Syndrome

The predominant hypothesis about obsessive-compulsive disorder (OCD) pathophysiology implicates abnormal serotonergic function regulation. Pharmacologic agents with potent serotonin reuptake-inhibiting properties have demonstrated effectiveness in treating OCD. In short-term clinical trials compared by meta-analysis, clomipramine and serotonin selective reuptake inhibitors (SSRIs) were found superior to placebo in improving symptoms of OCD. In one-to-one comparative studies, clomipramine has been found as efficacious as fluoxetine and fluvoxamine, and in a comparative trial of clomipramine with sertraline, there was a statistically superior response to sertraline after 16 weeks of treatment; moreover, discontinuation rate in patients taking clomipramine was more than twice that in patients taking sertraline (26% vs. 11%). In contrast to patients receiving clomipramine who showed poor tolerance in long-term use, patients maintained on fluoxetine for 24 weeks after an acute phase well tolerated the medication. In another study, patients responding to 12 weeks of sertraline treatment also showed improved tolerance during an additional 40-week period, with 75% completing the continuation phase. With long-term or even lifelong treatment appearing necessary for people with OCD, those agents that result in better tolerance will prove preferable.

Topics: 1-Naphthylamine; Adult; Antidepressive Agents; Clinical Trials as Topic; Clomipramine; Fluoxetine; Fluvoxamine; Humans; Meta-Analysis as Topic; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

Although obsessive-compulsive disorder (OCD) was once considered rare, recent epidemiologic data suggest a lifetime prevalence rate of 2% to 3%. The morbidity associated with OCD is quite high compared to other psychiatric conditions. This report reviews neurologic, neuropsychological, and psychosurgical findings relevant to the functional neuroanatomy of OCD. In addition, it describes more recent investigations of OCD using a variety of brain imaging techniques, including computed tomography, positron emission tomography, and single photon emission computed tomography (SPECT). Finally, it examines the results of an ongoing pilot study of high-resolution, full-volume, three-dimensional SPECT imaging in patients with OCD before and after treatment with fluvoxamine.

Topics: Adult; Brain; Cerebrovascular Circulation; Deoxyglucose; Female; Fluorodeoxyglucose F18; Fluvoxamine; Humans; Male; Middle Aged; Neuropsychological Tests; Obsessive-Compulsive Disorder; Organotechnetium Compounds; Oximes; Pilot Projects; Psychosurgery; Technetium Tc 99m Exametazime; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Xenon Radioisotopes

Pathological gambling is a disabling disorder that affects at least 2 1/2 million Americans and their families. Although pathological gambling has been characterized as an impulse control disorder, it has also been associated with compulsivity. Essential features of pathological gambling include constantly recurring gambling behavior that is maladaptive, in that personal, familial, and/or vocational endeavors are disrupted. Affective disorders and substance abuse often co-occur. Incidence of suicidality is extremely high. Despite the fact that this disorder is a widespread public health problem, few controlled studies of causes or treatment have been conducted. Preliminary neurobiological studies implicate serotonergic dysfunction in pathological gamblers. Treatment with serotonin reuptake inhibitors, such as clomipramine and fluvoxamine, may be effective in treating this disorder. Well-defined and controlled clinical trials in large samples of pathological gamblers are needed.

Topics: Adolescent; Adult; Comorbidity; Compulsive Behavior; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluvoxamine; Gambling; Humans; Lithium Carbonate; Male; Middle Aged; Mood Disorders; Obsessive-Compulsive Disorder; Placebo Effect; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Self-Help Groups; Serotonin; Substance-Related Disorders; Treatment Outcome

Established efficacy and tolerability in large multicentre controlled studies have made serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SRIs) the mainstay of monotherapy for adult obsessive-compulsive disorder (OCD). When compared with the selective serotonin reuptake inhibitors (SSRIs), the tricyclic compound clomipramine has a higher incidence of adverse effects but is well tolerated by most OCD patients and may confer the best overall antiobsessional effects. Consideration of specific adverse effect profiles, special patient population characteristics, drug interactions and relative cost of the various agents may direct clinicians in choosing the most appropriate first-line drug. Alternative agents as monotherapies have been explored, but none has consistently proven effective to date. Investigations of SRI augmentation with serotonin-enhancing agents have also failed to demonstrate substantial benefits for treatment-refractory OCD. Combination treatment with SRIs and dopamine receptor antagonist drugs appears to provide an improved response for the subpopulation of OCD patients who have comorbid 'tic-spectrum' disorders, though large-scale studies of the efficacy and tolerability of these regimens are not yet available.

Topics: 1-Naphthylamine; Adult; Aged; Antidepressive Agents; Buspirone; Child; Clomipramine; Clonazepam; Costs and Cost Analysis; Dopamine Antagonists; Drug Interactions; Drug Tolerance; Fenfluramine; Fluoxetine; Fluvoxamine; Humans; Lithium; Obsessive-Compulsive Disorder; Paroxetine; Risk Assessment; Selective Serotonin Reuptake Inhibitors; Sertraline; Tryptophan

A review of the efficacy of antidepressant drug treatment in patients with obsessive-compulsive disorder (OCD), using a meta-analytic approach.. Randomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica-Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive-compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms.. Clomipramine was superior to placebo in reducing both obsessive-compulsive symptoms considered together (g = 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% CI = 0.36 to 1.42) and compulsions (g = 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted mean g being respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive-compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y-BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties.. Antidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive-compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive-compulsive symptoms.

Topics: 1-Naphthylamine; Adolescent; Adult; Antidepressive Agents; Child; Clomipramine; Double-Blind Method; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Placebos; Sertraline; Treatment Outcome

Questions have been raised regarding the relative efficacy and tolerability of the different serotonin transport inhibitors in the treatment of obsessive-compulsive disorder. We compared the results from four large multicenter placebo-controlled trials of the serotonin transport inhibitors clomipramine hydrochloride (N = 520), fluoxetine hydrochloride (N = 355), fluvoxamine maleate (N = 320), and sertraline hydrochloride (N = 325) for the treatment of obsessive-compulsive disorder.. Effect size was calculated by subtracting the end-point drug treatment mean change from the end-point placebo mean change and dividing by the end-point pooled change standard deviation. A test for overall differences between effect sizes was conducted, followed by all possible pairwise comparisons. The Yale-Brown Obsessive Compulsive Scale was the primary outcome measure for all four studies.. All four agents were significantly more effective than placebo, with clomipramine significantly more effective than the other three treatments, which did not differ in effect size. A significantly greater percentage of patients treated with clomipramine were rated much or very much improved than were patients treated with fluoxetine, fluvoxamine, or sertraline.. While the results of this meta-analysis support the superiority of clomipramine, head-to-head, double-blind comparisons of these compounds would be the best test of comparative efficacy and tolerability.

Topics: 1-Naphthylamine; Adolescent; Adult; Clomipramine; Double-Blind Method; Female; Fluoxetine; Fluvoxamine; Humans; Male; Multicenter Studies as Topic; Obsessive-Compulsive Disorder; Patient Dropouts; Placebos; Psychiatric Status Rating Scales; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

Topics: Behavior Therapy; Clomipramine; Clonidine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Tourette Syndrome

Serotonin uptake inhibitors (SUIs) have been established as the first-line pharmacotherapy of obsessive compulsive disorder (OCD). However, approximately one half of patients who receive an adequate trial with these agents remain clinically unchanged. The addition of drugs that enhance serotonin (5-HT) neurotransmission, such as lithium and buspirone, to ongoing treatment in SUI-refractory patients has generally proved to be an ineffective strategy. The addition of dopamine antagonists to the regimens of SUI-resistant patients appears to be a useful approach for OCD patients with a comorbid chronic tic disorder (e.g., Tourette's syndrome) and possibly for those with concurrent psychotic spectrum disorders. These drug response data suggest that both the 5-HT and dopamine systems may be involved in the treatment, and possibly the pathophysiology, of specific subtypes of OCD.

Topics: Adult; Antipsychotic Agents; Clinical Trials as Topic; Clomipramine; Clozapine; Dopamine Antagonists; Drug Therapy, Combination; Female; Fluvoxamine; Haloperidol; Humans; Isoxazoles; Male; Obsessive-Compulsive Disorder; Piperidines; Risperidone; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Tic Disorders; Tourette Syndrome

Often obsessive compulsive disorder (OCD) patients are labeled as treatment refractory when some first-line options have not been fully explored. Most patients should be encouraged to participate in behavior therapy, even when pharmacotherapy alone has been partially successful. Antiobsessional agents such as clomipramine, fluoxetine, and fluvoxamine should be considered first-line drugs. Their prescription for a sufficient time and at therapeutic doses is imperative. Enhancement strategies for a selected group of OCD patients include low-dose high-potency neuroleptics. In addition, clonazepam can be helpful in augmenting the response to a first-line drug. Results from controlled studies with lithium and buspirone have been disappointing. If most of these pharmacologic alternatives fail, MAOIs appear to be the next best choice. Since in the future most referrals for treatment-refractory OCD patients will emanate from nonpsychiatrists, following a systemic strategy in their evaluation and pharmacologic management is most important.

Topics: Antipsychotic Agents; Behavior Therapy; Clomipramine; Clonazepam; Combined Modality Therapy; Controlled Clinical Trials as Topic; Drug Therapy, Combination; Electroconvulsive Therapy; Fluoxetine; Fluvoxamine; Humans; Monoamine Oxidase Inhibitors; Obsessive-Compulsive Disorder; Treatment Outcome

Potent inhibitors of 5-hydroxytryptamine (5-HT) reuptake have clearly been established as the first-line pharmacotherapy for treatment of obsessive-compulsive disorder (OCD). Although a variety of tricyclic antidepressants and monoamine oxidase inhibitors have similar efficacy in the treatment of depression and panic disorder, potent blockade of 5-HT transport appears to be a prerequisite for effective treatment of OCD. Adding agents that enhance 5-HT neurotransmission to ongoing treatment in patients whose OCD is refractory to 5-HT reuptake inhibitors has not yielded impressive results. However, the addition of low-dose dopamine (DA) antagonists to the regimens of treatment-resistant patients appears to be a potentially useful strategy for the specific subgroup of OCD patients with a comorbid chronic tic disorder such as Tourette's syndrome. Because of the toxicity associated with neuroleptics, a time-limited trial of those agents, with reassessment at regular intervals, is indicated. Pharmacologic studies suggest that both the 5-HT and DA systems may be critical to the treatment and possibly the pathophysiology of OCD.

Topics: 1-Naphthylamine; Buspirone; Clomipramine; Desipramine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Sertraline

Topics: Brain; Clomipramine; Dopamine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Serotonin; Tourette Syndrome

Topics: Brain; Clomipramine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Receptors, Serotonin; Serotonin

Topics: 1-Naphthylamine; Behavior Therapy; Clomipramine; Combined Modality Therapy; Depressive Disorder; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Serotonin Antagonists; Sertraline

The authors briefly review studies of the efficacy of potent serotonin reuptake inhibitors (SRIs) (e.g., clomipramine, fluvoxamine) in obsessive compulsive disorder (OCD) and compare the use of antidepressants in the treatment of depression and OCD. They propose an algorithm for those patients with OCD who fail to respond to an adequate trial with a potent SRI and discuss the promise and limitations of adding tryptophan, fenfluramine, lithium, buspirone, or a neuroleptic to ongoing SRI therapy. Other biological approaches (e.g., ECT, psychosurgery) are considered in terms of their narrowly defined roles in the treatment of patients with SRI-resistant OCD.

Topics: 1-Naphthylamine; Antidepressive Agents; Clomipramine; Depressive Disorder; Fluoxetine; Fluvoxamine; Humans; Neurotransmitter Uptake Inhibitors; Obsessive-Compulsive Disorder; Paroxetine; Piperidines; Serotonin; Sertraline

Within the past decade the field of psychiatry has rediscovered the neuropsychiatric syndrome of obsessive-compulsive disorder (OCD). Although excellently described over 150 years ago, for many years OCD was thought to be rare, untreatable, and to arise from hidden psychodynamic conflicts. All of these earlier ideas now appear to be wrong. Occurring in approximately 2% of adults, OCD consists of recurrent intrusive thoughts (obsessions) or senseless repetitive actions (compulsions). Although the aetiology of OCD remains unclear, recent neuro-imaging studies implicate the basal ganglia and frontal cortex as crucial structures in the pathogenesis of OCD. Genetic studies demonstrate a clear genetic component to OCD and an interesting link with chronic motor tics and the Gilles de la Tourette Syndrome. Although a true cure for the disorder remains elusive, most OCD symptoms respond well to treatment with 5HT reuptake inhibitors. The phenomenology and aetiology of OCD will be reviewed, with particular emphasis placed on the proper pharmacological treatment of this sometimes crippling disorder.

Topics: Clomipramine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder

Topics: Antidepressive Agents; Clinical Trials as Topic; Fluvoxamine; Humans; Meta-Analysis as Topic; Obsessive-Compulsive Disorder; Oximes; Research Design; Serotonin Antagonists

Topics: Antidepressive Agents; Brain; Depressive Disorder; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Panic Disorder; Receptors, Serotonin; Serotonin Antagonists

Ninety percent of obsessive compulsive patients can be helped by treatment with behavior therapy and drug treatment, used sequentially or concurrently. The effectiveness of these treatments has been demonstrated in controlled clinical trials and is superior to electroconvulsive therapy and dynamic or cognitive psychotherapies for this disorder. Potent serotonin uptake inhibiting drugs, from the class of heterocyclic antidepressants, are the most effective antiobsessional medications currently available. Although these drugs usually do not induce complete remission, they can reduce obsessive compulsive symptoms by 30% to 42%. Behavior therapy combines exposure and response prevention, which the patient first learns with the therapist and then practices independently. With behavior therapy, patients confront the triggers for their anxiety and then delay, diminish, or discontinue their rituals. Reduction in symptoms with behavior therapy averages 50% or greater. Behavior therapy is usually not effective in patients who are substantially depressed, are delusional, fail to comply, or undermine therapy with covert rituals or avoidance techniques. The rare patient with very severe obsessive compulsive disorder who does not respond to behavior or drug therapy may be a candidate for psychosurgery. Modern psychosurgical procedures are quite safe and can improve symptoms in the majority of otherwise unresponsive patients.

Topics: Antidepressive Agents; Behavior Therapy; Clinical Trials as Topic; Combined Modality Therapy; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Oximes; Psychosurgery; Serotonin Antagonists

Although obsessive compulsive disorder (OCD) traditionally has been considered a treatment-refractory syndrome, rigorous treatment studies over the past decade have demonstrated that most OCD patients respond to specific behavioral or pharmacologic therapies. In terms of the pharmacologic treatment of OCD, a relatively small group of antidepressant drugs (clomipramine, fluvoxamine, and fluoxetine) have been demonstrated to be antiobsessional. Several related antidepressants (desipramine, nortriptyline) appear to be ineffective for OCD. Clinical response requires prolonged treatment (greater than 6 weeks) with antiobsessional drugs and efficacy is not limited to depressed OCD patients. The few drugs that have been demonstrated to be antiobsessional share a high potency for the blockade of serotonin reuptake, suggesting a serotonergic mechanism for antiobsessional drug action. This suggestion has been further strengthened by studies demonstrating a high correlation between clinical response and changes in serotonergic markers with clomipramine treatment. Moreover, a serotonin antagonist, metergoline, appears to partly reverse the improvement observed following chronic clomipramine treatment. Overall, only about 50% of OCD patients appear to respond in any given pharmacologic treatment trial. Adjunctive treatments, such as lithium or L-tryptophan, have been reported to help in some cases. In addition, the use of neuroleptics either alone or in combination with antiobsessional drugs may be useful for OCD patients with psychotic features or tics. Pharmacologic treatments should be considered only one element of the therapeutic approach to be integrated with behavioral techniques as well as psychosocial interventions for the relief of this very intriguing syndrome.

Topics: Behavior Therapy; Clinical Trials as Topic; Clomipramine; Combined Modality Therapy; Fluoxetine; Fluvoxamine; Humans; Monoamine Oxidase Inhibitors; Obsessive-Compulsive Disorder; Oximes

Thirty-eight patients with primary obsessive-compulsive disorder participated in a 10-week, double-blind, placebo-controlled trial of the potent, selective serotonin reuptake inhibitor fluvoxamine. Fluvoxamine was significantly better than placebo on two of three measures of improvement in obsessive-compulsive symptoms. The authors also compared studies of the serotonergic agents fluvoxamine, sertraline, fluoxetine, and clomipramine and found that a greater effect size was associated with less serotonergic specificity and that some ability to affect other neurotransmitter systems may be a necessary but not sufficient requirement for antiobsessional activity. These data lend only partial support to a serotonin hypothesis of obsessive-compulsive disorder.

Topics: 1-Naphthylamine; Adult; Ambulatory Care; Clinical Trials as Topic; Clomipramine; Double-Blind Method; Female; Fluoxetine; Fluvoxamine; Humans; Male; Meta-Analysis as Topic; Obsessive-Compulsive Disorder; Oximes; Placebos; Psychiatric Status Rating Scales; Serotonin; Serotonin Antagonists; Sertraline

The studies reviewed here suggest that the potent and selective serotonin reuptake inhibitor fluvoxamine is an effective treatment for OCD. Response to the antiobsessional effects of fluvoxamine is independent of baseline levels of depression. Additional studies are currently underway to determine if fluvoxamine is actually more effective in OCD than less potent blockers of serotonin reuptake (e.g., desipramine) (Goodman et al. unpublished data). However, since the clinical response to potent serotonin reuptake blockers is often incomplete or, in as many as one-third of patients, absent, the precise relevance of the monoamine reuptake blocking properties of these medications to the pathogenesis of OCD remains unclear.

Topics: Antidepressive Agents; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Oximes

Recognized since the Middle Ages, and clearly described for more than 100 years, obsessive-compulsive disorder (OCD) continues to intrigue and challenge mental health professionals. Recent evidence has implicated dysfunctional serotonergic neurotransmission in OCD. This review summarizes the evidence favoring a serotonergic hypothesis for OCD followed by a more detailed discussion of the implications the hypothesis holds for treatment.

Topics: Behavior Therapy; Clomipramine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Oximes; Receptors, Serotonin; Serotonin Antagonists

The main aim of this study was to investigate the additional effects of L-theanine, an amino acid in tea and an analog of glutamate with neuroprotective and anti-depressant properties, on obsessive-compulsive disorder (OCD) symptoms in combination with fluvoxamine.. Patients from either sex aged between 18 and 60 years diagnosed with OCD, based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), who had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of more than 21 were enrolled in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either L-theanine (100 mg twice daily) and fluvoxamine (100 mg daily initially followed by 200 mg daily after week 5) or placebo and fluvoxamine. The primary outcome of interest in this study was the Y-BOCS total score decrease from baseline.. Findings in this study suggest L-theanine as a relatively safe and effective adjuvant therapy for moderate to severe OCD.

Topics: Adolescent; Adult; Double-Blind Method; Drug Therapy, Combination; Fluvoxamine; Glutamates; Humans; Middle Aged; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Young Adult

Obsessive-compulsive disorder (OCD) is a severe and debilitating neuropsychiatric condition. Although selective serotonin reuptake inhibitors, tricyclic antidepressants, and cognitive- behavioral therapy are the first-line medication and treatment for OCD, an estimated 30% of patients are treatment-resistant, and complete functional recovery is rare. Natural products as adjuvant or alternative therapies should be examined to find safer and more effective ways to manage OCD.. To investigate the potential benefits of a combined herbal drug based on Echium amoenum in treating OCD.. Design and Setting: In the psychiatric clinics of Mashhad University of Medical Sciences, 40 patients who met the criteria for the obsessive-compulsive disorder based on DSM-5 were studied in a parallel, double-blind, randomized clinical trial.. Subjects were randomly assigned to receive Echium amoenum-Melissa officinalis syrup and fluvoxamine or placebo syrup and fluvoxamine for 8 weeks.. The efficacy of treatment and recurrence of disease were surveyed and compared according to the Yale-Brown Obsessive Compulsive Scale at weeks 0, 4, and 8.. Evaluation at the 4th and 8th week showed no significant differences between the two groups (p-value = 0.11, p-value = 0.445, respectively). At the 8th week of treatment, patients in the intervention group showed a remarkable reduction in scores on the Yale-Brown Obsessive-Compulsive Scale questionnaire (p- value= 0.003), and patients in the control group didn't ((p- value= 0.180). This study showed that the E.amoneum-M.officinalis syrup was not significantly more efficacious than the fluvoxamine tablet, but the intervention group showed a significant improving trend (p-value= 0.001).. While monotherapy is usually the gold standard methodology, combination or augmentation therapy may also be of merit. Consequently, studies with larger sample sizes and the inclusion of para-clinical assessments such as serologic tests can further shed light on the mechanism of action of the E. amoneum- M. officinalis syrup and deepen our understanding of its effects.

Topics: Adolescent; Double-Blind Method; Echium; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

On the basis of numerous previous studies, the serotonergic system plays a role in the pathogenesis of obsessive-compulsive disorder (OCD) and effective agents in this pathway, such as 5-hydroxytryptophan, can potentially contribute to treatment of patients with this disorder. Evaluating the efficacy of 5-hydroxytryptophan in treating OCD was the aim of the present randomized, double-blind, placebo-controlled 12-week trial. In a 12-week, randomized double-blind study, 60 patients with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of moderate to severe OCD and a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of >21 were randomly assigned to receive either fluoxetine plus placebo or fluoxetine plus 5-hydroxytryptophan (100 mg twice daily). All patients, regardless of their treatment group, received fluoxetine at 20 mg/day for the initial 4 weeks of the study followed by 60 mg/day of fluoxetine for the rest of the trial course. Symptoms were assessed using the Y-BOCS at baseline and weeks 4, 8 and 12. General linear model repeated measure showed significant effects for time × treatment interaction on total Y-BOCS (F = 12.07, df = 2.29, P-value <0.001), obsession (F = 8.25, df = 1.91, P-value = 0.001) and compulsion subscale scores (F = 6.64, df = 2.01, P-value = 0.002). 5-Hydroxytryptophan augmentation therapy demonstrated higher partial and complete treatment response rate (P = 0.032 and P = 0.001, respectively) according to the Y-BOCS total scores. The results of this study confirm that 5-hydroxytryptophan may be effective as an augmentative agent in treatment of moderate-to-severe OCD.

Topics: 5-Hydroxytryptophan; Adult; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Treatment Outcome; Young Adult

About 50% of obsessive-compulsive disorder patients still suffer significant symptoms even after the recommended first-line therapy. This demonstrates the necessity to investigate strategies to improve alleviation of symptoms.. The main objective of this study was to investigate the efficacy of a 5-hydroxytryptophan 3 receptor antagonist, tropisetron, as an adjuvant therapy to selective serotonin reuptake inhibitors, in ameliorating obsessive-compulsive disorder symptoms.. Men and women between the ages of 18-60 years diagnosed with obsessive-compulsive disorder, based on DSM5, who had a Yale-Brown obsessive compulsive scale score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either tropisetron (5 mg twice daily) and fluvoxamine (100 mg daily initially followed by 200 mg daily after week 4) or placebo and fluvoxamine. The primary outcome of interest in this study was the Yale-Brown obsessive compulsive scale total score decrease from baseline.. One hundred and eight participants were equally randomized into two groups; 48 participants in each group finished the trial. The Yale-Brown obsessive compulsive total score significantly dropped in both groups while the tropisetron group participants experienced a significantly higher decrease in their scores (Greenhouse-Geisser. This trial showed a significant efficacy for tropisetron over placebo in treatment of obsessive-compulsive disorder symptoms when added to fluvoxamine.

Topics: Adult; Double-Blind Method; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Serotonin 5-HT3 Receptor Antagonists; Tropisetron

The role of the glutamatergic system in the pathogenesis of obsessive-compulsive disorder (OCD) has been shown by numerous studies. The aim of the present randomized, double-blind, placebo-controlled, 12-week trial was to assess the efficacy and tolerability of amantadine as an adjuvant to fluvoxamine in the treatment of patients with moderate to severe OCD.. One hundred patients diagnosed with moderate to severe OCD were randomized into two parallel groups to receive fluvoxamine (100 mg twice a day) plus placebo or fluvoxamine (100 mg twice a day) plus amantadine (100 mg daily) for 12 weeks. All patients received 100 mg/day fluvoxamine for 28 days followed by 200 mg/day for the rest of the trial, regardless of their treatment groups. Patients were evaluated for response to treatment using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline and at Weeks 4, 10, and 12. The main outcome measure was to assess the efficacy of amantadine in improving the OCD symptoms.. Repeated-measure analysis of variance showed a significant effect for Time × Treatment interaction (Greenhouse-Geisser corrected: F = 3.84, d.f. = 1.50, P = 0.03) in the Y-BOCS total score and a significant effect for Time × Treatment interaction (Greenhouse-Geisser corrected: F = 5.67, d.f. = 1.48, P < 0.01) in the Y-BOCS Obsession subscale score between the two groups.. The results of this study suggest that amantadine may be effective as an augmentative agent in the treatment of moderate-to-severe OCD.

Topics: Adult; Amantadine; Double-Blind Method; Drug Synergism; Drug Therapy, Combination; Excitatory Amino Acid Antagonists; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Outcome Assessment, Health Care; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Young Adult

More effective, tolerable interventions for treatment-refractory obsessive-compulsive disorder (OCD) are needed. Preliminary findings encourage optimism that methylphenidate augmentation may be of benefit in the treatment of OCD. To test modulator methylphenidate (MPH) of extended-release formulations (MPH-ER) a safe and effective add-on therapy for refractory OCD, a pilot randomized, placebo-controlled, double-blind trial was conducted at an outpatient, single-center academic setting. Participants included 44 adults with serotonin reuptake inhibitor (SRI) treatment-refractory OCD and receiving a stable fluvoxamine pharmacotherapy with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores higher than 20. Data were analyzed in the intention-to-treat sample. All subjects were randomized into two parallel groups to receive fluvoxamine (250 mg daily) plus MPH-ER (36 mg daily) or fluvoxamine (250 mg daily) plus identical placebo tablets under double-blind conditions and followed for 8 weeks. Forty-four patients (29 [66%] men), with a mean (SD) age of 24.7 (6) years participated; with a mean (SD) duration of episode 5.7 (3) were randomized and forty-one finished the trial. In the intention-to-treat analysis, the improvement in the Y-BOCS total score and Y-BOCS obsession subscale score was more prominent in the fluvoxamine and MPH-ER group compared with those receiving placebo (P < .001). Additionally, cumulative response rates were higher in the MPH-ER vs placebo groups (59% vs 5%; P  < .001). MPH-ER was well tolerated; No subjects dropped out due to side effects. In summary, combined treatment with MPH-ER demonstrated an enhanced clinical rate of response compared to placebo. Further trials should examine MPH-ER efficacy in a larger sample.

Topics: Adult; Dopamine Uptake Inhibitors; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Methylphenidate; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Young Adult

Sudden gains are robust predictors of outcome in psychotherapy. However, previous attempts at predicting sudden gains have yielded inconclusive findings. The aim of the present study was to examine a novel, transdiagnostic, transtherapeutic predictor of sudden gains that would replicate in different settings and populations. Specifically, we examined intraindividual variability in symptoms.. We examined data from a randomized controlled trial (RCT) of prolonged exposure therapy for posttraumatic stress disorder (PTSD) in children and adolescents (n = 63), an RCT of cognitive and behavioral therapies for obsessive-compulsive disorder (OCD) in adults (n = 91), and psychodynamic therapy delivered under routine clinical conditions in a naturalistic setting for diverse disorders (n = 106). In all 3 data sets, we examined whether a measure of variability in symptoms occurring during the first sessions could predict sudden gains.. Variability in symptoms was found to be independent of total change during treatment. Variability in symptoms significantly predicted sudden gains in all 3 data sets and correctly classified 81.0%, 69.2%, and 76.9% of individuals to sudden gain or nonsudden gain status, respectively.. The present study represents the first examination of variability in symptoms as a predictor of sudden gains. Findings indicated that sudden gains are significantly predicted by intraindividual variability in symptoms, in diverse settings, contexts, and populations. Advantages of this predictor, as well as clinical and research implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Topics: Adaptation, Psychological; Adolescent; Adult; Child; Cognitive Behavioral Therapy; Combined Modality Therapy; Female; Fluvoxamine; Humans; Implosive Therapy; Individuality; Male; Middle Aged; Mood Disorders; Obsessive-Compulsive Disorder; Psychotherapy, Psychodynamic; Stress Disorders, Post-Traumatic; Treatment Outcome; Young Adult

To observe the clinical efficacy of dopamine modulator methylphenidate (MPH) of extended-release formulations (MPH-ER) augmentation of ongoing fluvoxamine treatment in refractory obsessive-compulsive disorder (OCD) and its effects on patient's anxiety and sleep quality.
 Methods: A pilot randomized, placebo-controlled, and double-blind trial was conducted at an outpatient, single-center academic setting. Participants included 44 adults with serotonin reuptake inhibitor treatment-refractory OCD and they received a stable fluvoxamine pharmacotherapy with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores higher than 20. The 44 patients were randomly assigned into a study group and a control group, with 22 patiencs in each group. Fluvoxamine and MPH-ER were given to the study group, while fluvoxamine and placebo were given to the control group, with 8 weeks of the treatment course. Y-BOCS, Hamilton Anxiety Scale (HAMA) were used to assess the efficacy, Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality, and Treatment Emergent Symptom Scale (TESS) was used to evaluate the side effects. Data were analyzed in the intention-to-treat sample.
 Results: The improvement in the Y-BOCS total score, Y-BOCS obsession subscale score and HAMA score were more prominent in the study group than those in the control group (P<0.001). There was no significant difference in PSQI score and TESS score between the two groups. MPH-ER was well tolerated.
 Conclusion: Fluvoxamine combined with MPH-ER is effective in the treatment of refractory obsessive-compulsive disorder. It can improve anxiety and has no adverse effect on sleep quality.. 目的：观察氟伏沙明联合长效哌甲酯治疗难治性强迫症的临床效果，探讨该治疗对患者焦虑情绪和睡眠质量的影响。方法：采取随机、双盲、安慰剂对照研究，将44例强迫症患者随机分成两组，每组22例，研究组服用氟伏沙明和长效哌甲酯缓释片，对照组服用氟伏沙明和安慰剂，随访时间均为8周。采用耶鲁-布朗强迫症状量表(Yale-Brown Obsessive Compulsive Scale，Y-BOCS)、汉密尔顿焦虑量表(Hamilton Anxiety Scale，HAMA)评定临床疗效，采用匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index，PSQI)评定睡眠质量，采用不良反应量表(Treatment Emergent Symptom Scale，TESS)评定不良反应。结果：研究组治疗总有效率高于对照组，差异有统计学意义(P<0.05)。治疗第8 周末两组 Y-BOCS，HAMA 评分比较差异有统计学意义(P<0.05)，两组 PSQI评分差异无统计学意义(P>0.05)。TESS评分在治疗第2，4，6，8周末差异均无统计学意义(P>0.05)。结论：氟伏沙明联合长效哌甲酯治疗难治性强迫症具有较好的疗效，可改善患者的焦虑情绪，对患者睡眠质量无影响，安全性较好，值得进一步在临床推广。.

Topics: Adult; Double-Blind Method; Drug Therapy, Combination; Fluvoxamine; Humans; Methylphenidate; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Treatment Outcome

Dysregulation of glutamate is implicated in the pathogenesis of obsessive-compulsive disorder (OCD). Consistently, glutamate-modulating agents, such as riluzole and memantine have been used in OCD treatment. Previous research has identified some neuroprotective role for L-carnosine potentially via its modulatory effect on glutamate. Here, we assessed the efficacy of L-carnosine as adjuvant to fluvoxamine in OCD treatment.. Forty-four patients diagnosed with moderate to severe OCD were recruited in a randomized double-blind trial. Patients received either L-carnosine or placebo as adjuvant to fluvoxamine for 10 weeks. The Yale- Brown Obsessive Compulsive Scale (Y-BOCS) was used for assessing the severity of symptoms at baseline and at weeks 4, 8, and 10.. General linear model repeated measure showed significant effects for Time × Treatment interaction on total Y-BOCS [F (2.10, 88.42) = 8.66, p < 0.001], obsession [F (1.88, 79.34) = 4.96, p = 0.01] and compulsion [F (1.88, 79.11) = 4.57, p = 0.01]. At week 10, the change from baseline in Y-BOCS scores was 8.86 ± 2.89 (mean ± SD) in the L-carnosine group compared to 5.86 ± 2.88 in the placebo group.. L-carnosine results in significant reduction of obsessive-compulsive symptoms when used as an adjuvant to fluvoxamine.

Topics: Adult; Carnosine; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Linear Models; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Psychotropic Drugs; Treatment Outcome

The efficacy of selective serotonin reuptake inhibitors (SRIs) in psychiatric disorders may be "augmented" through the addition of atypical antipsychotic drugs. A synergistic increase in dopamine (DA) release in the prefrontal cortex has been suggested to underlie this augmentation effect, though the mechanism of action is not clear yet. We used in vivo microdialysis in rats to study DA release following the administration of combinations of fluvoxamine (10 mg/kg) and quetiapine (10 mg/kg) with various monoamine-related drugs. The results confirmed that the selective 5-HT1A antagonist WAY-100635 (0.05 mg/kg) partially blocked the fluvoxamine-quetiapine synergistic effect (maximum DA increase dropped from 325% to 214%). A novel finding is that the α1-adrenergic blocker prazosin (1 mg/kg), combined with fluvoxamine, partially mimicked the effect of augmentation (maximum DA increase 205%; area-under-the-curve 163%). As this suggested that prazosin augmentation might be tested in a clinical study, we performed an open clinical trial of prazosin 20 mg addition to SRI in therapy-resistant patients with obsessive-compulsive disorder applying for neurosurgery. A small, non-significant reduction in Yale Brown Obsessive Compulsive Scale (Y-BOCS) scores was observed in 10 patients and one patient was classified as a responder with a reduction in Y-BOCS scores of more than 25%. We suggest that future clinical studies augmenting SRIs with an α1-adrenergic blocker in less treatment resistant cases should be considered. The clinical trial "Prazosin in combination with a serotonin reuptake inhibitor for patients with Obsessive Compulsive disorder: an open label study" was registered at 24/05/2011 under trial number ISRCTN61562706: http://www.controlled-trials.com/ISRCTN61562706.

Topics: Adrenergic alpha-1 Receptor Antagonists; Adult; Animals; Antidepressive Agents; Area Under Curve; Disease Models, Animal; Dopamine; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Drug Synergism; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Piperazines; Prazosin; Pyridines; Rats; Rats, Wistar; Serotonin; Serotonin Antagonists; Young Adult

N-acetylcysteine (NAC) has been proposed as a potential therapy for obsessive-compulsive disorder (OCD) as it may regulate the exchange of glutamate and prevent its pre-oxidant effects. The aim of the present double-blind, placebo-controlled trial was to assess the efficacy and tolerability of NAC augmentation in moderate-to-severe (OCD) treatment.. In this randomized, double-blind, two-centre, placebo-controlled, 10-week trial, patients with moderate-to-severe OCD were enrolled. Patients were randomized into two parallel groups to receive fluvoxamine (200 mg daily) plus placebo or fluvoxamine (200 mg daily) plus NAC (2000 mg daily). A total of 44 patients (22 in each group) were visited to evaluate response to therapy using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at baseline, and at weeks 4, 8 and 10. Side effects were recorded using predesigned checklists upon each visit.. Repeated-measures ANOVA showed a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 5·14, d.f. = 1·64, P = 0·012) in the Y-BOCS total score and a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 5·44, d.f. = 1·54, P = 0·011) in the Y-BOCS obsession subscale between the two groups.. Our results showed that NAC might be effective as an augmentative agent in the treatment of moderate-to-severe OCD.. Iranian Registry of Clinical Trials (www.irct.ir): IRCT201405271556N60.

Topics: Acetylcysteine; Adult; Double-Blind Method; Drug Interactions; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Iran; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

The aim of the present randomized, double-blind, placebo-controlled, 8-week trial was to assess the efficacy and tolerability of riluzole augmentation of fluvoxamine in treatment of patients with moderate to severe obsessive-compulsive disorder.. Patients were randomized into two parallel groups to receive fluvoxamine plus placebo or fluvoxamine plus riluzole (50 mg twice daily). All patients, regardless of their treatment group, received fluvoxamine at 100 mg/day for the initial 4 weeks of the study followed by 200 mg/day of fluvoxamine for the rest of the trial course. A total of 50 patients (25 in each group) were evaluated for response to treatment using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline and at weeks 4, 8 and 10. Side-effects were recorded using predesigned checklists in each visit. Repeated-measure analysis of variance showed a significant effect for time × treatment interaction in the Y-BOCS total score and a significant effect for time × treatment interaction in the Y-BOCS Compulsive subscale score between the two groups.. Repeated-measure analysis of variance showed a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.07, d.f. = 1.22, P = 0.04) in the Y-BOCS total score and a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.45, d.f. = 1.33, P = 0.028) in the Y-BOCS Compulsive subscale score between the two groups. Riluzole augmentation therapy demonstrated higher, partial or complete treatment response according to the Y-BOCS total scores.. Riluzole may be of clinical use as an adjuvant agent to fluvoxamine in treatment of moderate to severe obsessive-compulsive disorder.

Topics: Adult; Double-Blind Method; Drug Synergism; Drug Therapy, Combination; Excitatory Amino Acid Antagonists; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Outcome Assessment, Health Care; Riluzole; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index

Several lines of evidence implicate glutamatergic dysfunction in the pathophysiology of obsessive-compulsive disorder (OCD), presenting this neurotransmitter as a target for the development of novel pharmacotherapy. The objective of this study was to assess the efficacy of minocycline as an augmentative agent to fluvoxamine in the treatment of patients with OCD.. One hundred and two patients with the diagnosis of moderate-to-severe OCD were recruited to this study. A randomized double-blind trial was designed and patients received either L-carnosine or placebo as adjuvant to fluvoxamine for 10 weeks. The patients randomly received either minocycline 100 mg twice per day or placebo for 10 weeks. All patients received fluvoxamine (100 mg/day) for the first 4 weeks, followed by 200 mg/day for the rest of the trial, regardless of their treatment groups. Participants were evaluated using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The main outcome measure was to assess the efficacy of minocycline in improving the OCD symptoms.. General linear model repeated measures demonstrated significant effect for time × treatment interaction on the Y-BOCS total scores, F(1.49, 137.93) = 7.1, P  = 0.003, and Y-BOCS Obsession subscale score, F(1.54, 141.94) = 9.72, P = 0.001, and near significant effect for the Y-BOCS Compulsion subscale score, F(1.27, 117.47) = 2.92, P  = 0.08. A significantly greater rate of partial and complete response was observed in the minocycline group (P < 0.001). The frequency of side-effects was not significantly different between the treatment arms.. The results of this study suggest that minocycline could be a tolerable and effective adjuvant in the management of patients with OCD.

Topics: Adult; Anti-Bacterial Agents; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Minocycline; Neuroprotective Agents; Obsessive-Compulsive Disorder; Outcome Assessment, Health Care; Selective Serotonin Reuptake Inhibitors

The effectiveness of Fluvoxamine was compared to that of Cognitive Therapy (CT) in a 12-week randomized controlled trial (RCT) in 48 patients with obsessive-compulsive disorder (OCD), who were treatment-resistant to a previous behavior therapy (BT). A considerable amount of patients did not comply with the assigned treatment and switched treatments. The aim of this study was to identify patient characteristics predictive of assignment compliance and to study whether these characteristics were related to outcome. A logistic model, based on psychological and social patient characteristics, in addition to or in interaction with the assignment, was used for the explanation of compliance with treatment assignment. Especially patients who have a higher score on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) tend to comply with the effective Fluvoxamine treatment. The same set of variables was related to both compliance and outcome of therapy received. Therefore, the logistic model of compliance could be used to reduce the positive bias of As-Treated analysis (AT). The difference between the results of Fluvoxamine and Cognitive Therapy remained statistically significant after correcting for the positive bias as the result of assignment refusal and after applying the assumption that two drop-out patients needed imputation of lesser results.

Topics: Adult; Cognitive Behavioral Therapy; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Outcome Assessment, Health Care; Patient Compliance; Patient Dropouts; Selective Serotonin Reuptake Inhibitors

A growing body of evidence implicates inflammatory cascades in the pathophysiology of obsessive-compulsive disorder (OCD), making this pathway a target for development of novel treatments.. 50 outpatients with moderate to severe OCD participated in the trial, and underwent 10 weeks of treatment with either celecoxib (200 mg twice daily) or placebo as an adjuvant to fluvoxamine. Participants were investigated using Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The main outcome measure was to assess the efficacy of celecoxib in improving the OCD symptoms.. General linear model repeated measures demonstrated significant effect for time × treatment interaction on the Y-BOCS total scores [F (1.38, 66.34)=6.91, p=0.005]. Kaplan-Meier estimation with log-rank test demonstrated significantly more rapid response in the celecoxib group than the placebo group (p<0.001). There was no significant difference in adverse event frequencies between the groups.. The results of the current study suggest that celecoxib could be a tolerable and effective adjunctive treatment for more rapid and more satisfying improvements in OCD symptoms.

Topics: Adolescent; Adult; Antidepressive Agents; Celecoxib; Cyclooxygenase 2 Inhibitors; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Severity of Illness Index; Young Adult

The aim of this study was to investigate the efficacy and safety of ondansetron as an augmentative agent to fluvoxamine in the treatment of patients with obsessive-compulsive disorder (OCD). Forty-six men and women, aged 18-60 years, who fulfilled the diagnostic criteria of OCD on the basis of the DSM-IV-TR and had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of at least 21 were recruited into the study. The patients randomly received either ondansetron (8 mg/day) or placebo for 8 weeks. All patients received fluvoxamine (100 mg/day) for the first 4 weeks, followed by 200 mg/day for the rest of the trial. The patients were assessed using the Y-BOCS and the adverse event checklists at baseline, and the second, fourth, sixth, and eighth week. Forty-four patients completed the study. The Y-BOCS total score as well as the Y-BOCS obsession subscale score and compulsion subscale score showed significantly greater reduction in the ondansetron group than in the placebo group. There was no significant difference in adverse events between the two groups. In this 8-week double-blind randomized-controlled trial, ondansetron showed significant beneficial effect as an augmentative agent with fluvoxamine in patients with moderate to severe OCD and it was generally well tolerated.

Topics: Adolescent; Adult; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Ondansetron; Placebos; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Treatment Outcome; Young Adult

There is a growing body of evidence for the efficacy of memantine augmentation in patients with obsessive-compulsive disorder (OCD). However, to date, no double-blind study has addressed this issue. The objective of the present randomized double-blind placebo-controlled study was to evaluate efficacy and tolerability of memantine add-on treatment in patients with moderate to severe OCD. Forty-two patients with the diagnosis of OCD based on DSM-IV-TR who had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of ≥21 were randomly assigned to memantine (10 mg/day for the first week, and 20 mg/day for the rest of the trial) or placebo in addition to fluvoxamine for eight weeks. Patients were assessed using Y-BOCS every two weeks. Thirty-eight patients completed the study. Repeated measure ANOVA showed significant effect for time × treatment interaction in total scale [F (2.096, 75.470) = 5.280, P = 0.006] and obsession [F (2.340, 94.547) = 5.716, P = 0.002] and near significant effect for compulsion subscales [F (2.005, 79.179) = 2.841, P = 0.065]. By week eight, all patients in the memantine group and six (32%) patients in the placebo group [P value of Fisher's exact test <0.001] met the criteria for partial and complete response. At the end of the trial, 17 (89%) patients in the memantine group compared with six (32%) patients in the placebo group achieved remission (χ(2)(1) = 13.328, P < 0.001). Frequency of side-effects was not significantly different between the two groups. In summary, we showed that memantine add-on to fluvoxamine significantly improved short-term outcomes in patients with moderate to severe OCD.

Topics: Adolescent; Adult; Analysis of Variance; Antidepressive Agents, Second-Generation; Antiparkinson Agents; Double-Blind Method; Drug Synergism; Female; Fluvoxamine; Humans; Male; Memantine; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Time Factors; Young Adult

The present study examined sudden gains during treatment for obsessive-compulsive disorder (OCD) and their relationship to short- and long-term outcome.. Ninety-one individuals (age 19-64) completed either cognitive treatment, exposure treatment, or their combination with fluvoxamine for OCD. Participants' obsessive-compulsive symptoms were assessed before each weekly treatment session. In addition, obsessive-compulsive and depressive symptoms were assessed pre treatment and post treatment as well as 12 months following treatment termination.. Sudden gains were found among 34.1% of participants and constituted 65.5% of the total reduction in obsessive-compulsive symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of OCD symptoms post treatment, and this was maintained during follow-up.. Sudden gains are common in treatments for OCD and are predictive of treatment outcome and follow-up. Sudden gains mark a distinct trajectory of response to treatment for OCD. Individuals with sudden gains greatly improve during treatment and maintain their gains during follow-up, whereas individuals without sudden gains improve to a significantly lesser extent. Thus, treatment planning and development can benefit from considering sudden gains and the intra-individual course of improvement.

Topics: Adult; Analysis of Variance; Cognitive Behavioral Therapy; Combined Modality Therapy; Depression; Female; Fluvoxamine; Follow-Up Studies; Humans; Implosive Therapy; Male; Middle Aged; Obsessive-Compulsive Disorder; Outcome Assessment, Health Care; Psychiatric Status Rating Scales; Regression Analysis; Selective Serotonin Reuptake Inhibitors; Time Factors; Young Adult

In this study, we explored the possible relationships between plasma fluvoxamine levels and clinical features and/or response in adult obsessive-compulsive disorder (OCD) patients treated with this drug for 6 months.. Twenty OCD outpatients of both sexes who were already taking fluvoxamine (mean dose ± SD: 216.7 ± 86.2) for at least 4 weeks were included in the study. The severity of OCD was assessed by means of the Yale-Brown obsessive-compulsive scale (Y-BOCS). The fluvoxamine plasma levels were measured by high-performance liquid chromatography analysis. All evaluations were performed after 4 weeks (t1) and 6 months (t2) of fluvoxamine intake.. The plasma levels of fluvoxamine remained stable at the two assessment times, with no sex-related differences. Sixteen (80%) patients responded to treatment as shown by the significant (>35%) decrease of the Y-BOCS total score. Men's compulsions improved more than those of women. Significant and positive correlations were detected between fluvoxamine plasma levels at t1 and t2 and the difference (delta) of the Y-BOCS total and compulsion subscale scores between t1 and t2. Another significant, albeit negative, correlation was measured between the difference of the compulsion subscale score and the difference of fluvoxamine levels at t1 and t2.. These findings underline the potential importance of evaluating fluvoxamine plasma levels in OCD and their relationships with the clinical response that may be gender-related on specific symptoms.

Topics: Adult; Chromatography, High Pressure Liquid; Female; Fluvoxamine; Follow-Up Studies; Humans; Male; Obsessive-Compulsive Disorder; Outpatients; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Sex Factors; Time Factors; Treatment Outcome; Young Adult

Several small studies have shown beneficial effects of ondansetron, a serotonin 5-HT(3) receptor antagonist, in the treatment of obsessive-compulsive disorder (OCD). The efficacy of other 5-HT(3) receptor antagonists in patients with OCD is still unclear. Granisetron does not alter cytochrome P450 activity and might have a lower risk of drug interactions, a longer duration of action and a better tolerability profile than other 5-HT(3) receptor antagonists.. The objective of this study was to assess the efficacy and tolerability of granisetron augmentation of fluvoxamine in patients with OCD.. This was a two-centre, randomized, double-blind, placebo-controlled, parallel-group study conducted from November 2011 to March 2012.. The study setting was outpatient clinics of two large referral centres.. Study participants were men and women, aged 18-60 years, who met the diagnostic criteria of OCD based on the DSM-IV-TR and who had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of at least 21.. Participants were randomly assigned to granisetron (Kytril(®); SmithKline Beecham, Philadelphia, PA, USA) 1 mg every 12 hours or placebo every 12 hours in addition to fluvoxamine for 8 weeks.. Patients were assessed using the Y-BOCS at baseline, second, fourth, sixth and eighth weeks. The primary outcome measure was the difference in the score change of Y-BOCS total score from baseline to week 8 between the two groups. We also compared changes in the obsession and compulsion subscales of the Y-BOCS, and frequencies of partial response (≥25% reduction in Y-BOCS score), complete response (≥35% reduction in Y-BOCS score) and remission (Y-BOCS score ≤16) between the two groups.. Of the 42 included patients, 39 (20 in the placebo group, 19 in the granisetron group) completed the study. Significant time X treatment interaction was observed for total Y-BOCS (F [2.097, 79.678] = 4.941, p = 0.009), obsession (F [2.337, 88.799] = 4.938, p = 0.006) and compulsion (F [2.050, 77.899] = 4.674, p = 0.012) subscales. By week 8, complete response and remission were achieved by 20 (100%) and 18 (90%) patients in the granisetron group and by 7 (35%) patients in the placebo group (p-value of Fisher's exact test <0.001, risk ratio (RR) [95% CI] = 3.857 [2.039, 7.297]). There was no significant difference in the tolerability between the two regimens.. Granisetron is an efficacious adjunct for the short-term treatment of patients with moderate to severe OCD and is well tolerated.. IRCT201202041556N32.

Topics: Adult; Double-Blind Method; Drug Synergism; Female; Fluvoxamine; Granisetron; Humans; Male; Obsessive-Compulsive Disorder; Outcome Assessment, Health Care; Serotonin 5-HT3 Receptor Antagonists

To compare the effectiveness of second-step treatment with cognitive therapy (CT) versus fluvoxamine in patients with obsessive-compulsive disorder (OCD) who are nonresponsive to exposure in vivo with response prevention (ERP).. A 12-week randomized controlled trial at an outpatient clinic in the Netherlands comparing CT with fluvoxamine in OCD. Of 118 subjects with OCD treated with 12 weeks of ERP, 48 appeared to be nonresponders (Y-BOCS improvement score of less than one third). These nonresponders were randomized to CT (n = 22) or fluvoxamine (n = 26). The main outcome measure was the Y-BOCS severity scale. Statistical analyses were conducted in the intention-to-treat sample (n = 45) on an 'as randomized basis' and in the per-protocol sample (n = 30). Due to selective dropout in the fluvoxamine group, two additional sensitivity analyses were performed.. Complete data could be obtained from 45 subjects (94%) after 12 weeks. Fifty percent of the patients refused fluvoxamine after randomization compared to 13% who refused CT [χ(2)(1) = 7.10; p = 0.01]. CT as a second-step treatment did not appear to be effective in this sample of nonresponders. Fluvoxamine was significantly superior to CT in the intention-to-treat sample, in the per-protocol sample and in the two separately defined samples in which the sensitivity analyses were performed.. OCD patients who are nonresponsive to ERP may benefit more from a switch to treatment with an antidepressant instead of switching to CT. In clinical practice, it may be important to motivate this subgroup of patients to undergo psychopharmacological treatment, as this may improve their outcome considerably.

Topics: Adult; Behavior Therapy; Cognitive Behavioral Therapy; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Treatment Failure; Treatment Outcome

Many OCD patients present with comorbid conditions, and major depression is one of the most frequent comorbidities observed. OCD patients with comorbid depression exhibit functional disability and poor quality of life. However, it is unclear whether depressive symptoms are predictive of treatment response, and debate remains whether they should be targeted in the treatment of comorbid patients. The current study aimed at assessing the predictive value of depression and OCD symptoms in the long term outcome of OCD treatment.. In the current study, relations between OCD and depressive symptoms were systematically investigated in a group of 121 OCD patients who received 16 sessions of behavior or cognitive therapy either alone or with fluvoxamine.. Depression (either as a continuous or categorical variable) was not predictive of treatment response in any of the treatment modalities for up to 5 years of follow-up. Changes in OCD symptoms largely predicted changes in depressive symptoms but not vice versa.. Subsequent to participation in the RCT, almost two-thirds of the participants received some form of additional treatment (either pharmacological or psychological), and as a result, it is impossible to determine interaction effects with additional treatment received after the trial.. Treatment of OCD with comorbid depression should focus on amelioration of OCD symptoms. When OCD treatment is successful, depressive symptoms are likely to ameliorate as well.

Topics: Adult; Cognitive Behavioral Therapy; Comorbidity; Depression; Depressive Disorder; Depressive Disorder, Major; Female; Fluvoxamine; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Obsessive-Compulsive Disorder; Predictive Value of Tests; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Young Adult

Recent neuroimaging studies suggest that the pathophysiology of obsessive-compulsive disorder (OCD) may involve more widely distributed large-scale brain systems, including the parietal, occipital, and cerebellar areas, rather than the conventional orbitofronto-striatal model. We hypothesized that not only orbitofrontal cortex and caudate nucleus activities but also posterior brain regions might be associated with subsequent treatment response to serotonin reuptake inhibitors in OCD. The participants were 17 patients with OCD. Each patient was required to undergo fluvoxamine pharmacotherapy for 12 weeks. Before treatment, fMRI images of the subjects were obtained in the context of a symptom-provocation paradigm. The percentage changes in total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, from pre- to post-treatment, served as the index of treatment response. Statistical Parametric Mapping was used to identify brain loci where pre-treatment brain activation significantly correlated with the subsequent treatment response. Fifteen of 17 patients completed the 12-week treatment. During the symptom provocation task, patients showed brain activation in the left superior temporal gyrus (STG), left precuneus, left frontal cortices, right cerebellum, and right frontal cortices. We found that pre-treatment activation in the right cerebellum (Z-score=5.10, x,y,z=22,-84,-18) and the left STG (Z-score=4.95, x,y,z=-62,-22,0) was positively correlated with the improvement in the Y-BOCS score. Our results suggest that pre-treatment activation in the right cerebellum and in the left STG predict subsequent reduction in OCD symptom severity. There is every possibility that fMRI can be used as a tool to predict treatment response.

Topics: Adult; Brain; Brain Mapping; Female; Fluvoxamine; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Obsessive-Compulsive Disorder; Oxygen; Predictive Value of Tests; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors

Compulsive hoarding has been studied primarily in Western countries. Here we sought to examine compulsive hoarding in Japanese patients with obsessive-compulsive disorder (OCD). The heterogeneous nature of hoarding was also investigated.. One hundred and sixty-eight OCD outpatients were initially assessed to determine the presence or absence of compulsive hoarding, and whether hoarding was primary or secondary to another symptom dimension for which they had received treatment for 1 year.. Of the participants, 54 patients were found to have compulsive hoarding. Hoarders were significantly more likely than non-hoarding patients to have more severe psychopathology including elevated severity of OCD symptoms, poorer insight, higher prevalence of comorbid schizotypal or obsessive-compulsive personality disorder, closer association with symmetry dimension, and poorer treatment outcome. Comparisons of subjects with primary and secondary hoarding found that the former group had more severe clinical features, while the latter group hoarded a wider variety of items, including apparently bizarre ones.. The prevalence and clinical characteristics of compulsive hoarding in OCD subjects was similar to those reported in Western countries, supporting its trans-cultural consistency. The distinction between primary and secondary hoarding in OCD is clinically useful, and may contribute to the debate about whether hoarding should be a separate diagnostic entity.

Topics: Adult; Antidepressive Agents, Second-Generation; Cognitive Behavioral Therapy; Compulsive Behavior; Female; Fluvoxamine; Humans; Japan; Male; Obsessive-Compulsive Disorder; Paroxetine; Prevalence; Psychiatric Status Rating Scales; Psychometrics; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Young Adult

Until now no studies have investigated the benefits of adding brief dynamic therapy (BDT) to medication in obsessive-compulsive disorder (OCD), while a number of recent investigations have demonstrated the efficacy of supplemental BDT among patients with major depressive disorders (MDD). The objective of the present study was to explore the efficacy of BDT combined with pharmacotherapy in comparison with pharmacotherapy alone in the treatment of OCD with concurrent MDD.. A 12-month randomized clinical trial compared a standard selective serotonin reuptake inhibitor treatment with (n = 27) or without (n = 30) supplemental BDT in patients with OCD and concurrent MDD. Supplemental BDT was added during the first 16-week trial; all patients continued to be treated with only pharmacotherapy in the following continuation phase. The primary efficacy assessments were the Yale-Brown Obsessive Compulsive Scale and the 17-item Hamilton Rating Scale for Depression; the secondary efficacy measures included the Clinical Global Impression scale and the Global Assessment of Functioning. The data analysis was conducted on the 'intent-to-treat (ITT) efficacy patient sample'.. Fifty patients completed the study. No difference between the 2 treatment groups was found at any point by any assessment method in the ITT study sample.. Supplemental BDT in the treatment of patients with OCD with concurrent MDD who are receiving effective medication has no significant clinical effect on both obsessive and depressive symptoms.

Topics: Adult; Combined Modality Therapy; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Psychotherapy, Brief; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

Although atypical antipsychotic agents have been found effective in the augmentation of serotonin reuptake inhibitors (SRIs) for treatment-resistant obsessive-compulsive disorder (OCD) in short-term trials, there are few data on the effectiveness and safety of these agents in clinical settings over the long term.. Subjects (N = 46) who responded to selective SRIs (SSRIs) in an initial 12-week trial were continued on SSRI monotherapy plus cognitive-behavioral therapy (CBT) for 1 year. Subjects (N = 44) who failed to respond to SSRIs were randomly assigned to 1 of 3 atypical antipsychotics -- olanzapine, quetiapine, or risperidone -- and were consecutively treated using SSRI + atypical antipsychotics combined with CBT for 1 year. This study was conducted from January 2006 to November 2007 at Osaka City University Graduate School of Medicine Hospital, Japan.. Augmentation with atypical antipsychotics reduced mean +/- SD Yale-Brown Obsessive Compulsive Scale (YBOCS) total scores in SSRI-refractory OCD patients (at initial assessment = 29.3 +/- 9.9, after 1 year = 19.3 +/- 6.8). However, compared to SSRI responders (at initial assessment = 25.8 +/- 11.4, after 1 year = 13.7 +/- 4.6), total YBOCS scores in those who required atypical antipsychotic augmentation were initially higher, and they remained at higher levels than those of SRI responders after 1 year of the treatments.. Our work does not sufficiently support the long-term effectiveness of the atypical antipsychotics in the augmentation of SSRIs for treatment-resistant OCD patients. Even though this approach seems useful for some types of OCD patients, such as those with symmetry/ordering and hoarding symptoms, these data emphasize the limitations of the current pharmacotherapeutic options in treatment-refractory OCD, and their chronic use raises a number of safety concerns.. (ClinicalTrials.gov) Identifier NCT00854919.

Topics: Adult; Ambulatory Care; Antipsychotic Agents; Benzodiazepines; Body Mass Index; Cognitive Behavioral Therapy; Combined Modality Therapy; Dibenzothiazepines; Drug Resistance; Drug Therapy, Combination; Female; Fluvoxamine; Follow-Up Studies; Humans; Long-Term Care; Male; Obsessive-Compulsive Disorder; Olanzapine; Paroxetine; Quetiapine Fumarate; Risperidone; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Young Adult

Topics: Adult; Behavior Therapy; Combined Modality Therapy; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Young Adult

Changes in D(2) receptors during antidepressant therapy have been reported in patients with major depressive disorder using PET/SPET. The aim of this study was to evaluate modifications in D(2) receptors that might occur in patients affected by obsessive-compulsive disorder (OCD) during serotonin reuptake sites inhibitors (SSRIs). To this purpose, we measured the in vivo binding of [(11)C]raclopride ([(11)C]Rac)in the brain of a group of OCD naïve patients before and after the repeated administration of the inhibitor SSRI fluvoxamine. Eight patients with a Diagnostic and Statistical Manual of Mental Disorders IVth edition diagnosis of OCD completed the study undergoing a PET scan and a complete clinical evaluation before and during treatment with fluvoxamine. Patients have been compared also with a group of nine age-matched normal volunteers. Fluvoxamine treatment significantly improved clinical symptoms and increased [(11)C]Rac binding potential (BP) in the basal ganglia of OCD patients (7.5+/-5.2, 6.9+/-6.9, and 9.9+/-9.3% in dorsal caudate, dorsal putamen, and ventral basal ganglia, respectively; p<0.01) to values closer to those observed in the group of normal subjects. Chronic treatment with fluvoxamine induces a slight but significant increase in striatal [(11)C]Rac BP of previously drug-naïve OCD patients. The modifications in D(2) receptor availability might be secondary to fluvoxamine effects on serotoninergic activity.

Topics: Adult; Basal Ganglia; Brain Mapping; Carbon Isotopes; Dopamine Antagonists; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Positron-Emission Tomography; Protein Binding; Raclopride; Receptors, Dopamine D2; Selective Serotonin Reuptake Inhibitors; Tissue Distribution

According to previous data, the addition of risperidone in obsessive-compulsive patients refractory to serotonin reuptake inhibitors (SRIs) is shown to be a safe and effective treatment strategy. The aims of our study were to evaluate the efficacy of risperidone addition, in comparison to placebo, in fluvoxamine-refractory obsessive-compulsive patients and to investigate whether risperidone could boost the efficacy of fluvoxamine in fluvoxamine-responder patients. Subjects were 45 obsessive-compulsive inpatients, consecutively recruited at the Department of Neurosciences at the San Raffaele Hospital, Milan. Thirty-nine patients completed the study. All patients received 12 weeks of a standardized open-label fluvoxamine monotherapy and then continued for 6 weeks with placebo or risperidone in a double-blind design. Results showed a significant effect of risperidone addition, at the end of the double-blind phase (18th week), only for fluvoxamine-refractory patients. Five patients on risperidone (50%) and two (20%) on placebo became responders, with a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decrease > or =35%. Risperidone was generally well tolerated, except for a mild transient sedation and a mild increase in appetite. This preliminary study suggests that even very low (0.5 mg) risperidone doses are effective in OC patients who were nonresponders to a standardized treatment with fluvoxamine.

Topics: Adolescent; Adult; Aged; Analysis of Variance; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Synergism; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Retrospective Studies; Risperidone; Time Factors; Treatment Outcome

Longitudinal studies with very long follow-up periods of patients with obsessive-compulsive disorder (OCD) who have received adequate treatment are rare. In the current study, 30 of 37 inpatients (81%) with severe OCD were followed up 6-8 years after treatment with cognitive-behavioral therapy (CBT) in combination with either fluvoxamine or placebo in a randomized design. The significant improvements (with large effectsizes) in obsessive-compulsive symptoms from pre- to post-treatment (41% reduction on the Y-BOCS) remained stable at follow-up (45 %). Responder rates, defined as > or = 35% reduction on the Y-BOCS, were 67% and 60%, respectively. Depressive symptoms decreased significantly not only from pre- to post-treatment but also during follow-up. Re-hospitalization, which occurred in 11 patients (37 %), was associated with more severe depressive symptoms at pre-treatment and living without a partner. Full symptom remission at follow-up, defined as both Y-BOCS total score < or = 7 and no longer meeting diagnostic criteria for OCD, was achieved by 8 patients (27 %). Patients without full remission at follow-up had a significantly longer history of OCD, assessed at pretreatment, compared to remitted patients. The shortterm treatment outcome had no predictive value for the long-term course. Throughout the naturalistic follow-up, nearly all patients (29 patients) received additional psychotherapy and/or medication. This might indicate that such chronic OCD patients usually need additional therapeutic support after effective inpatient treatment to maintain their improvements over long periods.

Topics: Adult; Age of Onset; Antidepressive Agents, Second-Generation; Cognitive Behavioral Therapy; Combined Modality Therapy; Depressive Disorder; Double-Blind Method; Employment; Female; Fluvoxamine; Follow-Up Studies; Hospitalization; Humans; Male; Marriage; Obsessive-Compulsive Disorder; Socioeconomic Factors; Treatment Outcome

The aim of this study was to confirm and compare the efficacy of fluvoxamine (the only licensed SSRI for treatment for OCD in Japan) and behavior therapy in treating Japanese patients with OCD. In addition, we investigated predictors of these treatments.. Thirty-one outpatients meeting the DSM-III-R criteria for OCD without any axis I disorder were randomly assigned to one of three treatment conditions: BT (behavior therapy +/- pill placebo), FLV [autogenic training (a psychological placebo for OCD) +/- fluvoxamine] and control group [autogenic training (psychological placebo) +/- pill placebo] for 12 weeks of treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression-Improvement Scale (CGI-I) were administered blindly at baseline and week 4, 8 and 12.. Twenty-eight patients completed this study. Patients in the BT and FLV groups showed significantly more improvement than those in the control group in the mean score of total Y-BOCS; moreover, the BT group showed significantly more reduction in total Y-BOCS score at the end of treatment than the FLV group (BT > FLV, p < 0.01). Patients with lower baseline total Y-BOCS, past history of a major depressive episode and absence of cleaning compulsion improved more with fluvoxamine.. We confirmed the effectiveness of behavior therapy and fluvoxamine for Japanese patients with OCD. Behavior therapy improved the condition of OCD patients more than fluvoxamine.

Topics: Adolescent; Adult; Behavior Therapy; Combined Modality Therapy; Diagnostic and Statistical Manual of Mental Disorders; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Neurological soft-sign abnormalities have been implicated in obsessive-compulsive disorder (OCD). This first comprehensive data analysis evaluated the association between baseline neurological soft signs and treatment response in 117 OCD patients treated with controlled-release fluvoxamine in a double-blind placebo-controlled trial. Total and right-sided soft signs for the responders and the nonresponders did not differ significantly. Left-sided visuospatial soft signs were significantly increased in treatment nonresponders compared to responders. These subtle neurological abnormalities may implicate a potential subgroup of OCD patients with poorer treatment response. This may have treatment implications and therefore serve as a screening tool in OCD.

Topics: Double-Blind Method; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Personality Inventory; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome

Information regarding the long-term effectiveness of the combination of pharmacotherapy and cognitive-behavioral therapy (CBT) in the treatment of obsessive-compulsive disorder (OCD) is limited. Our study is the first to examine the long-term effectiveness of cognitive therapy (CT) and to compare long-term effectiveness of CT alone, exposure in vivo with response prevention (ERP) alone, and CBT (either CT or ERP) in combination with fluvoxamine in the treatment of OCD.. Of 122 outpatients with primary DSM-III-R-defined OCD originally enrolled in 2 randomized controlled trials, 102 patients (45 male/57 female; mean +/- SD age = 36.2 +/- 10.7 years; range, 19-64 years) were available to be assessed for the presence and severity of OCD and comorbid psychopathology at follow-up. Follow-up data were collected from November 1996 to June 1999.. After 5 years, 54% of the participants no longer met the DSM-III-R criteria for OCD. Long-term outcome did not differ between the 3 treatment groups. At follow-up, treatment dropouts appeared to have more severe OCD complaints compared with treatment completers. Compared with patients receiving CT alone, significantly (p < .005) more patients receiving CBT with fluvoxamine used antidepressants 5 years later.. This study demonstrates that at 5-year follow-up (1) prevalence of OCD had declined in all 3 treatment conditions, (2) the clinical benefits of all 3 treatment conditions were maintained, (3) OCD complaints were more severe for treatment dropouts than for treatment completers, and (4) about half of the patients initially treated with fluvoxamine continued antidepressant use.

Topics: Adult; Ambulatory Care; Cognitive Behavioral Therapy; Combined Modality Therapy; Comorbidity; Female; Fluvoxamine; Follow-Up Studies; Humans; Implosive Therapy; Longitudinal Studies; Male; Middle Aged; Obsessive-Compulsive Disorder; Patient Compliance; Patient Dropouts; Personality Inventory; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome

The presence of overvalued ideation (OVI) in patients with obsessive-compulsive disorder (OCD) has been theoretically linked to poorer treatment outcome. OVI has recently been shown to predict treatment outcome in OCD. The purpose of the present study is to determine whether OVI predicts medication treatment response, controlling for initial symptom severity and measurement error. The sample consisted of 34 outpatients diagnosed with OCD who completed an open-label clinical trial of fluvoxamine of 10 weeks' duration. Clinicians administered the Overvalued Ideas Scale (OVIS) at baseline. Symptom severity was rated at baseline and at the end of week 10 using the Yale-Brown Obsessive-Compulsive Scale. Of those who completed the trial, 68% showed a reliable change in obsessions and 62% showed a reliable change in compulsions. Analysis of variance showed that baseline OVIS predicted outcome for obsessions, but not compulsions. A key limitation was the relatively low number of individuals in the upper quartile on the OVIS, thus reducing the predictive power of the measure in relation to treatment outcome. Future research should examine medication treatment outcome with higher scoring patients.

Topics: Adult; Attitude; Diagnostic and Statistical Manual of Mental Disorders; Female; Fluvoxamine; Follow-Up Studies; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Prognosis; Prospective Studies; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome

The effect of extended anti-depressant treatment on weight has been poorly investigated. Also unknown is whether different compounds have differential effects. The aim of the present study was to assess changes in weight in obsessive-compulsive disorder (OCD) patients treated for 2.5 years with clomipramine or selective serotonin reuptake inhibitors.. 138 DSM-IV OCD patients who responded to 6-month acute treatment at the Mood and Anxiety Disorders Unit, Department of Neuroscience, University of Turin, Italy, were followed-up for 2 years while receiving open-label clomipramine, citalopram, fluoxetine, fluvoxamine, paroxetine, or sertraline. Patients were consecutively recruited and followed from May 1998 to March 2003. The mean percentage change in weight was compared for each group, as was the proportion of patients who had a > or = 7% weight increase from baseline.. At the end of the 2.5-year study period, patients had gained a mean of 2.5% of their body weight with respect to baseline (1.58 kg); 14.5% of the total sample experienced a significant (> or = 7%) weight increase. Within each but the fluoxetine treatment group, paired t tests showed a significant increase in weight from baseline to final visit. Analysis of variance showed a significant difference between treatment groups (p = .009), with clomipramine being associated with the highest weight increase and fluoxetine and sertraline with the lowest. A higher proportion of clomipramine-treated patients (34.8%) gained > or = 7% in weight as compared with sertraline and fluoxetine, which accounted for the lowest percentage of patients with a significant weight gain (4.5% and 8.7%, respectively), although this difference was not statistically significant.. Risk of weight gain during extended serotonin reuptake inhibitor treatment for OCD differs depending on which compound is used. The differences among antiobsessive drugs may affect compliance with medication and health risks.

Topics: Adult; Ambulatory Care; Citalopram; Clomipramine; Female; Fluoxetine; Fluvoxamine; Follow-Up Studies; Humans; Male; Obesity; Obsessive-Compulsive Disorder; Paroxetine; Patient Compliance; Prospective Studies; Risk Factors; Selective Serotonin Reuptake Inhibitors; Sertraline; Weight Gain

Previous studies stressed the role of decision-making functioning in predicting antiobsessive treatment outcome with serotonin reuptake inhibitors drugs in patients with obsessive-compulsive disorder. Nevertheless, the use of an augmentation strategy with atypical antipsychotic drugs has proved to be effective in obsessive-compulsive patients nonresponding to serotonin reuptake inhibitors treatment. We investigated whether the performance at the Iowa Gambling Task (IGT), a used neuropsychologic task which assesses decision-making, can be an effective criterion for pharmacologic treatment choice in these patients and whether the use of different treatment strategies, according IGT performance, can increase the rate of antiobsessive outcome.. Thirty patients with obsessive-compulsive disorder were treated in a single-blind design with fluvoxamine plus placebo or fluvoxamine plus risperidone according to their IGT performance. Treatment outcome was recorded after 6 and 12 weeks.. Patients with good IGT performance showed a good antiobsessive treatment outcome with fluvoxamine only, while only adopting an augmentation strategy with risperidone, the number of responders patients within the subjects with bad IGT performance increased.. IGT performance may be considered an effective criterion for pharmacologic treatment choice in obsessive-compulsive patients given that antiobsessive treatment outcome is increased to 85% of responders choosing an appropriate drug strategy according to the IGT performance.

Topics: Adult; Analysis of Variance; Chi-Square Distribution; Decision Making; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Middle Aged; Neuropsychological Tests; Obsessive-Compulsive Disorder; Risperidone; Single-Blind Method

What is the long-term outcome of patients with obsessive-compulsive disorder (OCD) who are treated with exposure and response (ritual) prevention (EX/RP) alone, serotonergic medications alone, or their combination? How is the long-term outcome of these patients affected by the discontinuation? Follow-up assessments were conducted with 62 patients treated for OCD an average of 17 months posttreatment (range: 6-43 months). Patients received one of three treatments: serotonergic medications (fluvoxamine or clomipramine), intensive behavior therapy involving EX/RP, or intensive EX/RP with concurrent antidepressant medication. At follow-up, no differences in OCD symptom severity were found among the three treatment groups. However, when current medication use was taken into consideration, differences among the three treatment groups emerged. Among patients who were medication-free at the time of follow-up assessment (n=37), those in the EX/RP-alone and EX/RP-with-medication groups had lower symptom severity ratings than those in the medication-only group on 4 out of 6 measures. There were no differences in OCD severity ratings among patients taking medications at follow-up (n=25). Although these findings are interpreted with caution due to the uncontrolled nature of the study, results suggested that long-term outcome may be superior following EX/RP than following serotonergic medications, after discontinuation. For patients who remain on medications, the treatment produced benefits equivalent to EX/RP.

Topics: Clomipramine; Cognitive Behavioral Therapy; Combined Modality Therapy; Double-Blind Method; Fluvoxamine; Follow-Up Studies; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Stereotyped Behavior; Time

The aim of this 12-week, double-blind, flexible-dose, placebo-controlled, parallel-arm, multicenter trial was to determine the safety and efficacy of fluvoxamine in a controlled-release (CR) formulation in adult outpatients with obsessive-compulsive disorder (OCD).. 253 adult outpatients with DSM-IV OCD were randomly assigned to receive 100 to 300 mg of fluvoxamine CR (N = 127) or placebo (N = 126) once daily for 12 weeks. Intent-to-treat analyses of efficacy assessments with the Yale-Brown Obsessive Compulsive Scale (YBOCS), Clinical Global Impressions-Severity of Illness scale (CGI-S), and Clinical Global Impressions-Improvement scale (CGI-I) were conducted.. Fluvoxamine CR was significantly (p <.05) superior to placebo in decreasing YBOCS total score beginning at week 2. This early response was sustained at all subsequent visits. At endpoint, there was a mean decrease of 8.5 +/- 0.7 (31.7%) in the YBOCS total score compared with baseline in the fluvoxamine CR treatment group versus a mean decrease of 5.6 +/- 0.7 (21.2%) in the placebo group (p =.001). Fluvoxamine CR was also significantly superior to placebo in lowering the severity of illness (CGI-S, p =.002) and in producing clinical improvement (CGI-I, p <.01). At endpoint, significantly greater percentages of the fluvoxamine CR treatment group were responders (p =.002) and remitters (p =.019) compared with the placebo group.. Over 12 weeks, fluvoxamine CR treatment was associated with a statistically significant and clinically relevant reduction in OCD severity and was found to be safe and well tolerated. The early onset of therapeutic effect, starting from week 2, was of particular interest.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Delayed-Action Preparations; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Nausea; Obsessive-Compulsive Disorder; Placebos; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Sleep Initiation and Maintenance Disorders; Treatment Outcome

Recently, a role for a functional polymorphism within the promoter region of the serotonin transporter gene (5-HTTLPR) in conferring susceptibility to Obsessive Compulsive Disorder (OCD) has been suggested. The aim of this study was to test the hypothesis that allelic variation of the 5-HTTLPR could be associated with OCD susceptibility or influence the drug response in OCD. One hundred and eighty-one OCD patients were recruited; 92 patients underwent a standardized treatment with fluvoxamine. No significant differences in allele/genotype distribution of the 5-HTTLPR were found between 191 controls and OCD. No differences in fluvoxamine response in the three genotypes groups in OCD were found, considering Yale-Brown Obsessive Compulsive Scale (YBOCS) total scores. Nevertheless, a significant time per genotype interaction was found for the YBOCS subtotal compulsion scores. Considering patients without tic disorder co-diagnosis, a significant time per genotype interaction for both YBOCS total scores and compulsion scores was found.

Topics: Adult; Alleles; Antidepressive Agents, Second-Generation; Carrier Proteins; Female; Fluvoxamine; Gene Frequency; Genotype; Humans; Male; Membrane Glycoproteins; Membrane Transport Proteins; Nerve Tissue Proteins; Obsessive-Compulsive Disorder; Polymorphism, Genetic; Serotonin Plasma Membrane Transport Proteins

To determine the safety and efficacy of fluvoxamine for the treatment of children and adolescents with obsessive-compulsive disorder (OCD) with a double-blind, placebo-controlled, multicenter study.. Subjects, aged 8 to 17 years, meeting DSM-III-R criteria for OCD were recruited from July 1991 to August 1994. After a 7- to 14-day single-blind, placebo washout/screening period, subjects were randomly assigned to fluvoxamine 50 to 200 mg/day or placebo for 10 weeks. Subjects who had not responded after 6 weeks could discontinue the double-blind phase of the study and enter a long-term, open-label trial of fluvoxamine. Analyses used an intent-to-treat sample with a last-observation-carried-forward method.. Mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores with fluvoxamine were significantly (p < .05) different from those with placebo at weeks 1, 2, 3, 4, 6, and 10. Significant (p < .05) differences between fluvoxamine and placebo were observed for all secondary outcome measures at all visits. Based on a 25% reduction of CY-BOCS scores, 42% of subjects taking fluvoxamine were responders compared with 26% taking placebo. Forty-six (19 fluvoxamine, 27 placebo) of 120 randomized subjects discontinued early. Adverse events with a placebo-adjusted rate greater than 10% were insomnia and asthenia.. Fluvoxamine has a rapid onset of action and is well tolerated and efficacious for the short-term treatment of pediatric OCD.

Topics: Adolescent; Age Factors; Analysis of Variance; Child; Dose-Response Relationship, Drug; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; United States

The objective of this study was to examine the long-term course of obsessive-compulsive disorder (OCD) in patients treated with serotonin reuptake inhibitors (SRIs) and behavioral therapy and to identify predictors of clinical outcome.. Sixty outpatients meeting DSM-II-R or DSM-IV criteria for OCD were followed up for 1 to 5 years (mean = 2.5 years). All of them received prolonged pharmacologic therapy with an SRI.. Thirty-seven patients (61.7%) completed an adequate behavioral treatment. At long-term assessment, 22 patients (36.7%) exhibited a global Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score greater than 16 or a final reduction in Y-BOCS global score of less than 35% and were considered nonresponders. Patients who completed behavioral therapy showed a significant decrease in Y-BOCS compulsions subscale score (p = .01), whereas no significant differences in either Y-BOCS global or obsessions subscale scores between those who did and those who did not undergo behavioral therapy were detected. Obsessions of sexual/religious content were the unique factor related to a poorer long-term outcome.. A substantial number of OCD patients showed persistent disabling symptoms at the long-term follow-up in spite of combined pharmacologic and behavioral treatment. Major benefits from behavioral therapy appeared to be the improvement of ritualistic behaviors. Sexual/religious obsessions predicted poorer long-term outcome, whereas short-term response to SRI treatment failed to achieve predictive value in the long-term course of OCD.

Topics: Adolescent; Adult; Age of Onset; Ambulatory Care; Behavior Therapy; Clomipramine; Combined Modality Therapy; Drug Therapy, Combination; Female; Fluoxetine; Fluvoxamine; Follow-Up Studies; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Probability; Prognosis; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

The aim of this prospectively randomized, double-blind, parallel group, multicentre study was to compare the efficacy and tolerability of fluvoxamine and clomipramine in patients suffering from obsessive-compulsive disorder (OCD) (DSM-III-R). Fourteen centres participated in this trial. Sixty-eight patients were randomized to receive fluvoxamine and 65 to receive clomipramine. The duration of the study was 10 weeks. The two treatment groups showed a marked improvement of obsessive-compulsive symptomatology, as determined by the Yale-Brown Obsessive-Compulsive Scale, the National Institute of Mental Health Obsessive-Compulsive Global Scale and Clinical Global Impression. No statistically significant differences were found between fluvoxamine and clomipramine in terms of efficacy during the study. A similar number of patients in each group withdrew from the study prematurely, but there were more dropouts due to adverse events in the clomipramine group. Concerning tolerability, there were significantly more reports of constipation and dry mouth in the clomipramine group. The results show that fluvoxamine and clomipramine have similar efficacy in the treatment of patients suffering from OCD, but fluvoxamine is better tolerated. In view of the superior safety profile of fluvoxamine compared to clomipramine in terms of a risk-benefit assessment, the use of fluvoxamine would appear to be advantageous for this patient population.

Topics: Adult; Anti-Anxiety Agents; Antidepressive Agents, Tricyclic; Clomipramine; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Treatment Outcome

To examine the efficacy and tolerability of clomipramine compared with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive-compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 failed SSRI trials.. The literature on the pharmacotherapy of OCD was critically examined.. The available research evidence is not conclusive but suggests that clomipramine possesses greater anti-obsessional efficacy than do the SSRIs. In addition, when clomipramine is presented to patients in a positive way, and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs.. Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research evidence. Both clomipramine and the SSRIs may be used as first-line treatments for OCD.

Topics: Clomipramine; Double-Blind Method; Expert Testimony; Fluoxetine; Fluvoxamine; Guidelines as Topic; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

Patients with panic disorder are reported to have elevated cholesterol levels. There is also some evidence that cholesterol elevation is not so much a specific condition in panic disorder but is generally associated with anxiety. So far, there is little data on cholesterol levels in patients with obsessive compulsive disorders (OCD) which is also classified as anxiety disorder.. Thirty-three patients with OCD participated in the study. Serum cholesterol was measured as pretreatment and at the end of a ten-week treatment-period. All patients received behavior therapy and, in a double-blind fashion, fluvoxamine or placebo. Severity of OCD was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).. Pretreatment cholesterol values of OCD patients were compared with cholesterol levels of thirty panic disorder patients and thirty normal controls. OCD patients had elevated cholesterol levels comparable with those of panic disorder patients. Cholesterol levels decreased significantly from pre- to posttreatment. OCD patients with high cholesterol levels (> or = 240 mg/dl, n = 7) could make best use of the treatment whereas patients with desirable cholesterol levels (< 200 mg/dl, n = 11) did not change their cholesterol during treatment.. Our data support the assumption that not only panic disorder but also other anxiety disorders, e.g., obsessive compulsive disorders, may be associated with serum cholesterol elevations. Effective treatment (behavior therapy and/or treatment with a selective serotonin reuptake inhibitor [SSRI]) seems to decrease cholesterol levels, especially in patients with pathological cholesterol elevations.

Topics: Adult; Anxiety Disorders; Body Mass Index; Cholesterol; Cognitive Behavioral Therapy; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

The purpose of this study was to examine the safety and efficacy of fluvoxamine in the treatment of psychogenic (neurotic) skin excoriation. Fourteen subjects with psychogenic excoriation were given fluvoxamine in a 12-week, open-label trial after completion of the Structured Clinical Interview for DSM-IV. All subjects met DSM-IV criteria for at least one comorbid psychiatric disorder, with mood disorder the most common. Most subjects' excoriation had features of an impulse control disorder. Both completers (N = 7) and the entire group had significant improvement on the modified Yale-Brown Obsessive Compulsive Scale but no improvement on the Hamilton Rating Scale for Depression. In the self-report data, the seven completers had significant reduction in behaviors involving the skin (e.g., scratching, picking, gouging, or squeezing) and in global assessment of symptoms. Endpoint analysis of all 14 subjects' self-report data demonstrated significant improvement in the presence of skin sensations, skin appearance and lesions, behaviors involving the skin, control over skin behavior, and global assessment. The results of this preliminary open trial suggest that fluvoxamine may be effective in reducing psychogenic excoriation, and this effect seems to be independent of mood. Controlled studies are needed to confirm these findings.

Topics: Adult; Aged; Aged, 80 and over; Antidepressive Agents, Second-Generation; Female; Fluvoxamine; Humans; Male; Middle Aged; Neurotic Disorders; Obsessive-Compulsive Disorder; Skin Diseases; Treatment Outcome

Previous studies on serotonergic responsivity in obsessive-compulsive disorder (OCD) showed about 50% of patients experiencing an acute worsening of OC symptoms when administered meta-chlorophenylpiperazine or i.v. clomipramine. The aim of this study was to determine what variables influence the response to acute i.v. clomipramine. Could this response be predictive of the response to chronic treatment with two serotonergic drugs with differing selectivity profiles: clomipramine and fluvoxamine?. Fifty OC patients were consecutively recruited. All underwent a challenge with 25 mg i.v. clomipramine and placebo and were administered 10-week oral clomipramine or fluvoxamine according to a double-blind design. The efficacy of the antiobsessional treatment was evaluated by Yale-Brown Obsessive-Compulsive Scale and Clinical Global Impression scale scores.. Obsessions worsened in 42% patients as rated by change values in 100-mm visual analogue scale scores for the clomipramine vs. placebo infusion. There was a significant difference in gender distribution between "worsened" and "unchanged" patients, since female subjects were more frequently "unchanged." Thirty-one patients completed the 10-week treatment. According to both qualitative and quantitative evaluations, female subjects showed a better antiobsessional response, and this difference was enhanced in the clomipramine-treated group.. Results suggest a role for reproductive hormones in the pathophysiology or treatment of OC patients.

Topics: Administration, Oral; Adult; Analysis of Variance; Chi-Square Distribution; Clomipramine; Double-Blind Method; Drug Interactions; Drug Resistance; Female; Fluvoxamine; Humans; Injections, Intravenous; Male; Obsessive Behavior; Obsessive-Compulsive Disorder; Prospective Studies; Selective Serotonin Reuptake Inhibitors; Serotonin Agents; Sex Factors; Single-Blind Method

Obsessive-Compulsive (OC) symptoms are observed in a substantial proportion of schizophrenic patients and pose a significant therapeutic challenge. Based on findings of the benefit of the anti-obsessive agent clomipramine, we designed an open-label study to examine the effect of adding the serotonin-selective reuptake inhibitor (SSRI) fluvoxamine to the ongoing antipsychotic regimen of schizo-obsessive patients. The study population consisted of ten neuroleptic-stabilized chronic schizophrenic patients with OC symptoms. Fluvoxamine (up to 150 mg/day) was added to the ongoing antipsychotic treatment, which remained unchanged for the entire 12-week trial period. The patients were evaluated before the trial and at weeks 1, 2, 4, 6, 8 and 12 (end point) with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Schedule for Assessment of Positive Symptoms and the Schedule for Assessment of Negative Symptoms. The results showed a significant improvement in obsessions (P < 0.02) (but not compulsions) and both positive (P < 0.01) and negative (P < 0.05) schizophrenic symptoms. By the end of the trial, three patients showed a more than 50% reduction in the Y-BOCS score, with complete amelioration of the OC symptoms in one of them. Three patients were dropped from the study during the first 4 weeks, two because of aggressiveness and one because of psychotic exacerbation. No exacerbation or new onset of extrapyramidal side-effects (EPS), as measured by the Barnes Akathisia Scale (BARS) and the Simpson-Angus Scale (SAS), was noted during the course of the trial and there were no other significant clinical side-effects of fluvoxamine addition. We conclude that fluvoxamine may be an effective adjunctive agent in some schizo-obsessive patients.

Topics: Adult; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology

We report the results of an open trial of cognitive-behavioral therapy (CBT) using exposure and ritual prevention as an adjunct to serotonin reuptake inhibitors (SRIs) in obsessive-compulsive disorder (OCD). We hypothesized that exposure and ritual prevention would significantly reduce OCD symptoms in patients who remained symptomatic despite an adequate trial of an SRI and enable patients to discontinue their medication.. OCD patients taking an adequate dose of an SRI > or = 12 weeks who remained symptomatic (i.e., a Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score > or = 16) were eligible. While taking a stable dose of an SRI, patients received 17 sessions of exposure and ritual prevention. For the intent-to-treat group, the paired t test was used to compare scores on the Y-BOCS, the National Institute of Mental Health (NIMH) Global OCD scale, the Clinical Global Impressions scale, and the Hamilton Rating Scale for Depression before and after exposure and ritual prevention.. Six of 7 eligible patients entered the study, and 5 completed it. All 6 improved on all OCD measures. The mean +/- SD Y-BOCS score was 23.8 +/- 2.6 prior to exposure and ritual prevention and 12.2 +/- 4.3 after it (p < .001). The mean percentage decrease on the Y-BOCS was 49% (range, 26%-61%). Patients were rated by the therapist and rated themselves as much (N = 4) or very much (N = 2) improved. Blood drug levels did not change in most patients during exposure and ritual prevention; thus, the improvement was attributed to this type of therapy. No patients discontinued their medication.. This open trial suggests that CBT using exposure and ritual prevention can lead to a significant reduction in OCD symptoms in patients who remain symptomatic despite an adequate trial of an SRI.

Topics: Ambulatory Care; Cognitive Behavioral Therapy; Combined Modality Therapy; Drug Administration Schedule; Fluoxetine; Fluvoxamine; Follow-Up Studies; Humans; Implosive Therapy; Obsessive-Compulsive Disorder; Pilot Projects; Psychiatric Status Rating Scales; Secondary Prevention; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

The purpose of this treatment package design study was to investigate the differential efficacy of cognitive therapy or exposure in vivo with response prevention for obsessive compulsive disorder (OCD) versus the sequential combination with fluvoxamine. Patients with OCD (N = 117) were randomized to one of the following five conditions: a) cognitive therapy for weeks 1 to 16, b) exposure in vivo with response prevention for weeks 1 to 16, c) fluvoxamine for weeks 1 to 16 plus cognitive therapy in weeks 9 to 16, d) fluvoxamine for weeks 1 to 16 plus exposure in vivo with response prevention in weeks 9 to 16, or e) waiting list control condition for weeks 1 to 8 only. Assessments took place before treatment (pretest) and after 8 (midtest), and 16 weeks (posttest). In the first 8 weeks, six treatment sessions were delivered. During weeks 9 to 16, another 10 sessions were given. Thirty-one patients dropped out. Outcome was assessed by patient-, therapist- and assessor-ratings of the Anxiety Discomfort Scale, the Yale-Brown Obsessive Compulsive Scale, and the Padua Inventory-Revised. In contrast with the four treatments, after 8 weeks the waiting list control condition did not result in a significant decrease of symptoms. After 16 weeks of treatment, all four treatment packages were effective on these OCD ratings, but they did not differ among each other in effectiveness. In OCD, the sequential combination of fluvoxamine with cognitive therapy or exposure in vivo with response prevention is not superior to either cognitive therapy or exposure in vivo alone.

Topics: Adult; Antidepressive Agents, Second-Generation; Cognitive Behavioral Therapy; Combined Modality Therapy; Desensitization, Psychologic; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Patient Dropouts; Personality Inventory; Psychiatric Status Rating Scales; Severity of Illness Index; Treatment Outcome

On the basis of recent results indicating that adjuvant pindolol has the positive effect of shortening latency to antidepressant response to selective serotonin reuptake inhibitors, the primary aim of our study was to evaluate the effect of pindolol on latency to antiobsessional response to fluvoxamine. Fifteen non-depressed obsessive-compulsive inpatients (six men and nine women) were consecutively recruited and randomly assigned to an 8-week standardized double-blind treatment with fluvoxamine and pindolol (group A) or fluvoxamine and placebo (group B). Patients were assessed weekly using rating scales for obsessive-compulsive disorder [Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), National Institute of Mental Health Obsessive-Compulsive Scale], co-occurent depressive symptoms (Hamilton Depression Scale) and global function (Clinical Global Improvement), from baseline to the end of the study. In accordance with data from the literature, response to treatment was defined as a reduction in YBOCS total scores of > or = 35% and a score on the 'global improvement' item of the Clinical Global Improvement of < 3. Data were analysed using analyses of variance with repeated measures performed on YBOCS and Hamilton Depression Scale scores to evaluate the mean quantitative response within and between groups and, additionally, employing a survival analysis to compute the percentage of responders within each group. Neither quantitative nor qualitative analysis revealed any differences between the two treatment groups, and pindolol did not shorten the latency of antiobsessional response to fluvoxamine. The results of this preliminary study indicate that different biological mechanisms underly the antiobsessional and antidepressant responses to fluvoxamine.

Topics: Adult; Antidepressive Agents, Second-Generation; Depression; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Pindolol; Psychiatric Status Rating Scales; Serotonin Antagonists; Time Factors

We investigated whether the combination of multi-modal behaviour therapy (BT) with fluvoxamine is superior to BT and placebo in the acute treatment of severely ill in-patients with obsessive-compulsive disorder (OCD).. In a randomised, double-blind design, 30 patients were treated for nine weeks with BT plus placebo and 30 patients with BT plus fluvoxamine (maximum dosage 300 mg, mean dose 288.1 mg). BT included exposure with response prevention, cognitive restructuring and development of alternative behaviours.. Both groups showed a highly significant symptom reduction after treatment. There were no significant differences between the groups concerning compulsions. Obsessions were significantly more reduced in the fluvoxamine and BT group than in the placebo and BT group. Furthermore, the group BT plus fluvoxamine showed a significantly higher response rate (87.5 v. 60%) according to a previously defined response criterion. Severely depressed patients with OCD receiving BT plus placebo presented a significantly worse treatment outcome (Y-BOCS scores) than all other groups.. The results suggest that BT should be combined with fluvoxamine when obsessions dominate the clinical picture and when a secondary depression is present.

Topics: Adult; Behavior Therapy; Combined Modality Therapy; Depression; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

The aim of this study was to investigate whether obsessive-compulsive patients previously treated successfully with clomipramine or fluvoxamine could tolerate reduction of the daily dosage without worsening of the clinical condition. Thirty informed obsessive-compulsive patients, given a diagnosis according to DSM-III-R criteria, were recruited consecutively into the study. Patients were blindly assigned to one of the groups of treatment with different rates of reduction of the previously effective daily drug dosage: group 1 (control group, no reduction), group 2 (reduction of 33-40%), and group 3 (reduction of 60-66%). The entire study lasted 102 days. From baseline to the end of the study, the clinical condition was evaluated by the administration of standardized tests (Yale-Brown Obsessive-Compulsive Scale, Hamilton Rating Scale for Depression, Clinical Global Impression [CGI] scale), and blood samples were collected for plasma drug level determinations. The criterion for discontinuation of the study was the worsening of obsessive-compulsive symptoms, arbitrarily defined by an increase of > 5% from the baseline total Yale-Brown Obsessive-Compulsive Scale score, as measured in two successive assessments, and a worsening of global clinical condition as measured by the CGI scale. The main result of the study was borne out from the survival analysis. There were no significant differences in the cumulative proportion of patients from each group of treatment who did not worsen during the 102 days of observation. This preliminary result, which needs to be confirmed in larger samples, suggests that long-term maintenance therapy for obsessive-compulsive disorder might be provided with lower dosages of the antiobsessional drug, with clear advantages for tolerability and compliance.

Topics: Adult; Clomipramine; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Fluvoxamine; Humans; Long-Term Care; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Inventory; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Previous reports have stressed the implication of Personality Disorders as predictors of a poorer treatment outcome in Obsessive-Compulsive Disorder (OCD). The aim of this study was to see whether or not Obsessive-Compulsive Personality Disorder in Obsessive-Compulsive Disorder may be predictive for a poorer outcome to antiobsessive pro-serotonergic pharmacological treatment. For this purpose, 30 OCD patients were divided into two groups according to the presence or absence of Obsessive-Compulsive Personality Disorder. Ten-week standardized treatments with oral SRI drugs were given to look for different outcomes between the two groups in Obsessive-Compulsive symptom severity. At the end of the study we found that the presence of Obsessive-Compulsive Personality Disorder, along with the total number of Personality Disorders, did predict poorer response to pharmacological treatment in OCD.

Topics: Adult; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Clomipramine; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Predictive Value of Tests; Psychiatric Status Rating Scales

The purpose of this study was to investigate the pharmacokinetics of fluvoxamine in the human brain by using fluorine-19 magnetic resonance spectroscopy (19F MRS) and to assess the relationships among fluvoxamine brain levels, fluvoxamine plasma levels, and clinical efficacy.. Eight subjects with DSM-IV obsessive-compulsive disorder were entered into a prospective, open-label treatment trial of fluvoxamine. 19F MRS measurements of whole brain drug and metabolite concentrations and spin-lattice (T1) relaxation times were performed serially in seven subjects for up to 5 months. A psychiatric determination of clinical response and a blood sample for plasma fluvoxamine measurement were obtained at each 19F MRS session.. The subjects achieved steady-state brain concentrations of fluvoxamine within 30 days after consistent daily dosing, as determined by stabilization of brain fluvoxamine concentrations. The mean brain-to-plasma ratio at steady state was 24 to 1. Brain fluvoxamine T1 values from 140 to 230 msec were observed. All but one subject experienced substantial improvement in symptoms. The one nonresponder exhibited several-fold higher plasma and brain fluvoxamine levels.. Brain fluvoxamine levels were substantially higher than plasma levels. Steady-state brain levels correlated to plasma levels but not to dose. Systematic assessment of treatment response in relation to brain or plasma fluvoxamine level was not feasible because of the marked and rapid clinical response during open-label treatment. These data suggest that fluvoxamine attains brain steady-state levels substantially faster than fluoxetine, with corresponding clinical implications.

Topics: Adolescent; Adult; Aged; Brain; Brain Chemistry; Drug Administration Schedule; Fluorine; Fluoxetine; Fluvoxamine; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Obsessive-Compulsive Disorder; Tissue Distribution; Treatment Outcome

The authors report the results of an open trial of fluvoxamine in the treatment of compulsive buying.. Ten nondepressed subjects were recruited through word-of-mouth and rnet restrictive inclusion/exclusion criteria. Subjects were assessed with the Yale-Brown Obsessive-Compulsive Scale modified for compulsive buying, the Clinical Global Impression scale, and other measures. After a single-blind 1-week placebo run-in, subjects received fluvoxamine up to 300 mg daily for 9 weeks.. Nine of 10 subjects improved and were less preoccupied with shopping, spent less time shopping, and reported spending less money.. We conclude that compulsive buyers can be recruited for research and their symptoms measured and monitored and, finally, that fluvoxamine may be effective in its treatment.

Topics: Adult; Aged; Compulsive Behavior; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Patient Selection; Psychiatric Status Rating Scales; Severity of Illness Index; Treatment Outcome

Obsessive-compulsive disorder (OCD) has been successfully treated with proserotonergic agents for some years. Clomipramine was the first drug used, but several clinical trials have been conducted more recently to assess the antiobsessional efficacy of selective serotonin reuptake inhibitors (SSRIs). The aim of this study was to compare the antiobsessional efficacy of three SSRIs, fluvoxamine, paroxetine, and citalopram. Thirty obsessive-compulsive patients without comorbid axis I diagnoses except for tic disorder as assessed by DSM-III-R criteria gave informed consent and were recruited consecutively; they underwent a 10-week randomized treatment with fluvoxamine, paroxetine, or citalopram. Ratings were performed under blind conditions every 2 weeks from baseline to the end of the study and by the Yale-Brown Obsessive-Compulsive Scale, the National Institute of Mental Health-Obsessive-Compulsive Scale, the Clinical Global Impressions Scale, and the Hamilton Rating Scale for Depression. Quantitative and qualitative analyses of the antiobsessional efficacy of the three drugs were completed with analysis of variance with repeated measures and survival analysis. The results showed no significant differences between the three treatments. The preliminary conclusions drawn from this study concern the interchangeable antiobsessional effects of different SSRIs, although further studies of "cross-response" to these drugs are needed.

Topics: Adult; Antidepressive Agents, Second-Generation; Citalopram; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Paroxetine; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Single-Blind Method

A double-blind trial was carried out to assess the efficacy and safety of fluvoxamine, a selective serotonin reuptake inhibitor, in comparison with clomipramine, a classical tricyclic antidepressant, in the treatment of obsessive-compulsive disorder. A total of 26 individuals with obsessive-compulsive disorder and with no comorbid disorders at baseline were included in the study. The obsessive-compulsive disorder symptom severity was rated using the Yale-Brown Obsessive-Compulsive Scale and the Clinical Global Impression Scale. The primary efficacy measures indicated an equal improvement in the two groups (38% in the patients taking fluvoxamine and 40% in those taking clomipramine, as compared with baseline values), but onset was faster in the clomipramine group. Side effects, in particular anticholinergic side effects, were more prominent in the clomipramine group. The present double-blind trial confirms an equal efficacy of clomipramine and fluvoxamine in obsessive-compulsive patients. Although clomipramine had a faster onset, fluvoxamine was better tolerated, so that it seems more suitable for long-term treatment of obsessive-compulsive patients.

Topics: Adolescent; Adult; Aged; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Clomipramine; Double-Blind Method; Female; Fluvoxamine; Humans; Italy; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales

The purpose of this study was to determine whether combined treatment with a selective serotonin reuptake inhibitor (SSRI) and a norepinephrine reuptake inhibitor, desipramine, effectively reduces obsessive-compulsive symptoms in patients who do not respond to SSRIs.. In a double-blind study, desipramine or placebo was added for 6 or 10 weeks to the treatment of 30 patients with obsessive-compulsive disorder whose symptoms were refractory to SSRI treatment (fluvoxamine, fluoxetine, or sertraline) alone.. There were no significant differences between the adjunctive desipramine and placebo groups in obsessive-compulsive or depressive symptoms.. These data suggest that clomipramine's possibly superior efficacy in the treatment of obsessive-compulsive symptoms may not stem from its capacity to inhibit reuptake of norepinephrine.

Topics: 1-Naphthylamine; Adrenergic Uptake Inhibitors; Adult; Clomipramine; Desipramine; Double-Blind Method; Drug Therapy, Combination; Female; Fluoxetine; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Placebos; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

Although several studies have directly explored serotonin (5-HT) transmission in patients with obsessive-compulsive disorder (OCD), their results have been inconsistent and their clinical relevance is doubtful.. According to a double-blind placebo-controlled design, plasma prolactin (PRL) response to a specific serotonergic probe, d-fenfluramine, was measured in 20 drug-free obsessive-compulsive patients and in 20 matched healthy controls. After the neuroendocrine test, 15 patients completed a 10-week treatment with fluvoxamine. Psychopathological assessment was performed before and after therapy.. PRL response in OCD patients was blunted under the drug-free condition; correlated inversely with pretreatment ratings of obsessive-compulsive and depressive symptomatology; and correlated inversely with the improvement in obsessive-compulsive score observed after fluvoxamine treatment.. These results support the idea of a dysfunction of 5-HT transmission in OCD, and suggest that the greater this impairment, the better the response to drugs which selectively block the reuptake of 5-HT.

Topics: Adolescent; Adult; Biomarkers; Double-Blind Method; Female; Fenfluramine; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Prolactin; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

In this study, follow-up results of cognitive-behaviour therapy and of a combination of cognitive-behaviour therapy with a serotonergic antidepressant were determined. The study also examined factors that can predict this treatment effect, both in the long term and in the short term. In addition, it investigated whether differential prediction is possible for cognitive-behaviour therapy vs. a combination of cognitive-behaviour therapy with a serotonergic antidepressant. A total of 99 patients were included in the study. Treatment lasted 16 weeks, and a naturalistic follow-up measurement was made 6 months later. Of the 70 patients who completed the treatment, follow-up information was available for 61 subjects. Significant time effects were found on all outcome measures at both post-treatment measurement and follow-up. No differences in efficacy were found between the treatment conditions. Effectiveness at post-treatment measurement appears to predict success at follow-up. However, 17 of the 45 non-responders at the post-treatment measurement had become responders by the follow-up. The severity of symptoms, motivation for treatment and the dimensional score on the PDQ-R for cluster A personality disorder appear to predict treatment outcome. No predictors were found that related specifically to cognitive-behaviour therapy or combined treatment. These results indicate that the effectiveness of cognitive-behaviour therapy or a combination of cognitive-behaviour therapy and fluvoxamine at the post-treatment measurement is maintained at follow-up. However, non-response at post-treatment does not always imply non-response at follow-up. Patients with more severe symptoms need a longer period of therapy to become responders. Although predictors for treatment success were found, no evidence was found to determine the choice of one of the treatment modalities.

Topics: Adult; Behavior Therapy; Cognitive Behavioral Therapy; Combined Modality Therapy; Female; Fluvoxamine; Follow-Up Studies; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Inventory; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Abnormalities of platelet serotonin (5-HT) transporter, which are supposed to reflect similar dysfunctions in the central nervous system (CNS), have been reported in obsessive-compulsive disorder (OCD). Other platelet parameters altered in OCD are represented by phenolsulfotransferase (PST) activity, an enzyme involved in the catabolism of catecholic neuro-transmitters, and peripheral benzodiazepine receptors. Since no information is available on the behavior of these putative markers during antiobsessive treatments, the aim of the present study was to measure and compare 3H-imipramine (3H-IMI) binding, which labels the 5-HT transporter, PST activity, and 3H-PK 11,195 binding, which labels peripheral benzodiazepine receptors, in a group of 18 patients with obsessive-compulsive disorder (OCD) before and after a treatment with fluvoxamine versus clomipramine. The results showed that at baseline the patients had a decreased number of 3H-IMI binding sites, which correlated negatively with the Y-BOCS total score, an increased PST activity and no difference in 3H-PK 11,195 binding, as compared with healthy volunteers. After eight weeks of treatment with either clomipramine or fluvoxamine, which was effective in all patients, the number of 3H-IMI binding sites increased significantly toward normal values, while the PST showed no change. These findings suggest that the reduction in 3H-IMI binding sites in OCD may be related to the severity of the illness and possibly to a positive response to serotonin re-uptake inhibitors, and might be considered as a state-dependent marker, whereas the PST activity would seem to be a trait of the illness.

Topics: Adult; Anti-Anxiety Agents; Arylsulfotransferase; Biomarkers; Blood Platelets; Carrier Proteins; Clomipramine; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Membrane Glycoproteins; Membrane Transport Proteins; Nerve Tissue Proteins; Obsessive-Compulsive Disorder; Receptors, GABA-A; Selective Serotonin Reuptake Inhibitors; Serotonin Plasma Membrane Transport Proteins

Combination treatment with tricyclic antidepressants (TCAs) and serotonin selective reuptake inhibitors (SSRIs) is an increasingly employed strategy especially in depressed patients unresponsive to monotherapy. Comedications with SSRIs, however, may be hazardous owing to pharmacokinetic interactions that can result in elevated serum TCA levels. For the combinations, safety and tolerability data are lacking.. We report tolerability and safety of combined treatment with fluvoxamine and clomipramine (CMI) in 22 patients. Most patients suffered from depression and obsessive-compulsive symptoms. Diagnoses were made according to DSM-III-R criteria. Serum levels of CMI, N-desmethylclomipramine (DCMI), and 8-hydroxylated metabolites were determined. EEG, ECG, and laboratory parameters and adverse effects reported by the patients, as well as global clinical improvement, were assessed.. Generally, fluvoxamine/clomipramine comedication was well tolerated. Serum CMI levels reached 500 to 1200 ng/mL in half of the patients, while corresponding levels for DCMI and 8-hydroxylated metabolites were low. Moreover, the ratios of N-demethylation DCMI:CMI calculated from the ratios of drug concentrations in serum were markedly lower under comedication than under CMI monotherapy. Alterations in EEG, ECG, and laboratory parameters that had clinical relevance were rarely observed and were reversible after dose reduction of CMI. However, 2 patients developed myoclonic jerks. A majority of patients improved clinically during combination treatment. Clinically relevant side effects were absent in patients with serum CMI and DCMI levels below 450 ng/mL and ratios of N-demethylation below 0.3.. Our results suggest that comedication of fluvoxamine and clomipramine will result in markedly elevated serum clomipramine levels. Therefore, combination treatment with fluvoxamine and clomipramine should be carefully monitored by determination of serum levels of the TCA. Clinically, the pharmacokinetic interactions between fluvoxamine and clomipramine may be well tolerated in a majority of patients. However, in a few patients, higher serum levels may be associated with an increased risk of EEG changes and changes of intracardiac conductance. EEG and ECG should be used regularly to monitor comedicated patients.

Topics: Adult; Aged; Antidepressive Agents, Tricyclic; Clomipramine; Depressive Disorder; Dose-Response Relationship, Drug; Drug Monitoring; Drug Therapy, Combination; Electroencephalography; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

The efficacy and tolerability of fluvoxamine (100-300 mg/day) and clomipramine (100-250 mg/day) were compared in a randomized, double-blind, parallel-group study of 79 patients with obsessive-compulsive disorder (OCD) without coexisting major depression. After a 2-week placebo lead-in period, patients were randomized to fluvoxamine (37 patients) or clomipramine (42 patients) for 10 weeks. Efficacy was evaluated with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive-Compulsive scale, and Patient and Clinical Global Improvement scales. Hamilton Rating Scale for Depression scores and somatic symptoms were also assessed. Seventy-eight percent of fluvoxamine patients and 64% of clomipramine patients completed the study. At the end of treatment, 56% of fluvoxamine patients were classified as responders (> or = 25% decrease in Y-BOCS score), compared with 54% of clomipramine patients. Both groups showed steady improvement throughout the study; no statistically significant differences were observed between the groups for any efficacy variable at any time. A similar percentage of patients in both groups withdrew because of adverse events. No serious adverse events related to drug occurred with either drug. Insomnia, nervousness, and dyspepsia were more statistically frequent with fluvoxamine; dry mouth and postural hypotension were more frequent with clomipramine. In this study, fluvoxamine and clomipramine were equally effective in reducing OCD symptoms over a 10-week treatment period but displayed different side effect profiles.

Topics: Adolescent; Adult; Aged; Clomipramine; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Inventory; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

One hundred and sixty patients with a primary diagnosis of obsessive-compulsive disorder were enrolled in a multicentre, randomized, double-blind, placebo-controlled study of fluvoxamine. After a placebo washout phase, patients were randomized to treatment with placebo or fluvoxamine (100-300 mg/day) for 10 weeks. Seventy-eight patients in each group were evaluable for efficacy. Fluvoxamine was significantly more effective than placebo as assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive-Compulsive (NIMH-OC) scale and the Global Improvement item of the Clinical Global Impression (CGI) scale. The percentage of patients classified as "responders" (much or very much improved according to the Global Improvement item) was also significantly higher in the fluvoxamine group from Week 6 onwards, with 33.3% of fluvoxamine-treated patients and 9.0% of those given placebo classified as "responders" at endpoint. The "responders" to fluvoxamine experienced a substantial clinical benefit as reflected in decreases in their Y-BOCS and NIMH-OC scores. Fluvoxamine was well tolerated with the majority of adverse events considered mild or moderate.

Topics: Adult; Aged; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

A new scale to measure severity and change in persons with compulsive buying is described. Data were gathered during an open-label study in which compulsive buyers were treated with fluvoxamine, a serotonin reuptake inhibitor. The instrument showed good-to-excellent interrater reliability and high internal consistency. Its 10 separate items showed at least moderate correlations with the total score. The instrument was also sensitive to clinical change and correlated highly with other measures of illness severity. We conclude that this new instrument is both reliable and valid in measuring severity and change in persons with compulsive buying.

Topics: Adult; Depression; Female; Fluvoxamine; Humans; Internal-External Control; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Inventory; Psychometrics; Reproducibility of Results; Selective Serotonin Reuptake Inhibitors

A 2-year, open-label followup was performed on 130 obsessive-compulsive patients who were responders to a previous 6-month treatment with clomipramine (150 mg/day), fluoxetine (40 mg/day), or fluvoxamine (300 mg/day). Continuation treatment with the same daily dose was compared to continuation with half doses or to discontinuation of pharmacotherapy. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impressions (CGI) scale were used every 3 months, or whenever a worsening of symptoms was experienced. Maintenance treatments were found significantly superior to discontinuation in preventing relapses, and no differences in efficacy were found between full and half doses. A comparison of the three subgroups of patients who were withdrawn from drug therapy failed to demonstrate any statistical difference.

Topics: Adult; Clomipramine; Dose-Response Relationship, Drug; Female; Fluoxetine; Fluvoxamine; Follow-Up Studies; Humans; Male; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Time Factors

In an open multicentre study designed to closely reflect the clinical situation, 315 out-patients diagnosed by their psychiatrist as having depression and/or obsessive-compulsive disorder (OCD), and/or panic disorder, were treated for 12 weeks with fluvoxamine (100-300 mg/day). Twelve weeks of fluvoxamine therapy was completed by 229 (73%) patients. Longer illness duration prior to treatment was associated with a significantly reduced rate of treatment withdrawal, whereas a diagnosis of OCD was predictive of treatment withdrawal. The main reasons patients discontinued fluvoxamine therapy were adverse effects experienced before Week 8, and clinical improvement thereafter. Age, sex, and diagnosis had no predictive value for treatment outcome; however, psychiatric antecedents and duration and severity of illness at baseline were significant predictors of disease severity at endpoint. Fluvoxamine decreased both the frequency and severity of baseline symptoms, with improvement continuing for the duration of the study. Nausea was the only symptom to show an initial increase in frequency and severity, but this subsided after 4 weeks to levels below baseline frequency and severity.

Topics: Adult; Affect; Ambulatory Care; Anxiety Disorders; Depressive Disorder; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Panic Disorder; Patient Compliance; Prevalence; Treatment Outcome

The authors examined 21 outpatients with obsessive-compulsive disorder for five neurological soft signs and abnormalities on two neuropsychological tests before and after 10 to 12 weeks of treatment with serotonin reuptake inhibitors. Patients showed a mean of 1.8 soft signs. Prevalences were finger-to-finger, 10%; adventitious movements, 29%; mirror movements, 33%; impaired cube drawing, 33%; and agraphesthesia, 76%. The Stroop Color and Word Test was abnormal in 10% and the Controlled Oral Word Association Test was abnormal in 14% of patients. Neither the presence of specific soft signs, the number of signs present, nor a combination of signs and test abnormalities predicted a poorer response to pharmacological treatment. Some baseline soft signs and abnormalities disappeared at endpoint in medication responders and nonresponders; no clear pattern of change emerged.

Topics: 1-Naphthylamine; Adult; Attention Deficit Disorder with Hyperactivity; Double-Blind Method; Female; Fluvoxamine; Frontal Lobe; Gyrus Cinguli; Humans; Male; Middle Aged; Neuropsychological Tests; Obsessive-Compulsive Disorder; Prognosis; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

The present study is the first controlled study that evaluates the effects of cognitive therapy along the lines of Beck (1976) [Cognitive therapy and the emotional disorder. New York: International University Press] and Salkovskis (1985) [Behaviour Research and Therapy, 23, 571-583] in obsessive compulsive disorder (OCD) and compares these effects with those of self-controlled exposure in vivo with response prevention. Seventy-one patients were randomly assigned to either cognitive therapy or exposure in vivo. In each treatment condition seven patients dropped out. Both treatments consisted of 16 sessions. Cognitive therapy as well as exposure in vivo led to statistically significant improvement. Multivariate significant differences suggesting a superior efficacy of cognitive therapy in comparison to exposure in vivo on the obsessive compulsive measures and on the measures for associated psychopathology. However, no univariate differences were found. Further, in both treatment conditions a considerable percentage of the patients was rated as "recovered". Significantly more patients were rated as "recovered" in the cognitive therapy. The results show that this form of cognitive therapy is an effective treatment for OCD and suggest that cognitive therapy may be even more effective than exposure in vivo.

Topics: Adult; Cognitive Behavioral Therapy; Combined Modality Therapy; Desensitization, Psychologic; Female; Fluvoxamine; Follow-Up Studies; Humans; Internal-External Control; Male; Middle Aged; Obsessive-Compulsive Disorder; Treatment Outcome

A review of the efficacy of antidepressant drug treatment in patients with obsessive-compulsive disorder (OCD), using a meta-analytic approach.. Randomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica-Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive-compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms.. Clomipramine was superior to placebo in reducing both obsessive-compulsive symptoms considered together (g = 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% CI = 0.36 to 1.42) and compulsions (g = 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted mean g being respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive-compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y-BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties.. Antidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive-compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive-compulsive symptoms.

Topics: 1-Naphthylamine; Adolescent; Adult; Antidepressive Agents; Child; Clomipramine; Double-Blind Method; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Placebos; Sertraline; Treatment Outcome

To examine the efficacy of fluvoxamine and clomipramine in obsessive compulsive disorder and to compare their tolerabilities.. In this multicenter, randomized, double-blind trial, fluvoxamine (100-250 mg/day) was compared with clomipramine (100-250 mg/day) for 10 weeks in the treatment of 66 psychiatric outpatients, aged 18 to 65 years, with a diagnosis of obsessive compulsive disorder. The main efficacy variable was the Yale-Brown Obsessive Compulsive Scale; secondary variables were the National Institute of Mental Health Global Obsessive Compulsive Scale and the Clinical Global Impressions-Improvement scale.. Seventeen patients withdrew prematurely, 6 in the fluvoxamine group and 11 in the clomipramine group. In the intent-to-treat population (34 fluvoxamine patients and 30 clomipramine patients), there were no significant differences with respect to the mean reduction in total Yale-Brown Obsessive Compulsive Scale score (last observation carried forward) at any time-point; a mean reduction of 8.6 (33%) was seen in the fluvoxamine group and 7.8 (31%) in the clomipramine group. Similar results were obtained in virtually all secondary variables. The only exception was the obsession-free interval for the Yale-Brown Obsessive Compulsive Scale, which was significantly longer in the fluvoxamine group, especially in a population of patients with disease of > 12 months' duration (F = 5.298, df = 1, p = .026). Adverse events were mostly tolerable; 9 patients (5 receiving fluvoxamine, 4 receiving clomipramine) withdrew due to adverse events related to treatment.. Fluvoxamine and clomipramine were equally effective in the treatment of obsessive compulsive disorder. Both agents were well tolerated; fluvoxamine produced fewer anticholinergic side effects and caused less sexual dysfunction than clomipramine, but more reports of headache and insomnia.

Topics: Adult; Ambulatory Care; Clomipramine; Double-Blind Method; Female; Fluvoxamine; Headache; Humans; Male; Obsessive-Compulsive Disorder; Patient Dropouts; Psychiatric Status Rating Scales; Sleep Initiation and Maintenance Disorders; Treatment Outcome

To determine the efficacy of adding haloperidol to the treatment of patients with obsessive-compulsive disorder (OCD), with or without a comorbid chronic tic disorder, who were refractory to adequate treatment with the serotonin-uptake inhibitor fluvoxamine alone. It was hypothesized that OCD patients with a concurrent chronic tic disorder would preferentially respond to this treatment.. Sixty-two patients with a primary DSM-III-R diagnosis of OCD received placebo fluvoxamine for 1 week, followed by 8 weeks of active fluvoxamine. Thirty-four of these patients were refractory to fluvoxamine and were randomized in a double-blind fashion to 4 weeks of treatment with either haloperidol (n = 17) or placebo (n = 17) added to ongoing fluvoxamine treatment. The placebo-treated group included five women and 12 men, six inpatients and 11 outpatients, and eight patients with a comorbid chronic tic disorder. The haloperidol-treated group consisted of two women and 15 men, three inpatients and 14 outpatients, and seven patients with a comorbid chronic tic disorder. All 34 patients completed the entire study. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression scale were the principal measures of treatment outcome.. Haloperidol addition was significantly better than placebo in reducing the severity of obsessive-compulsive symptoms as measured by the Y-BOCS. Eleven of 17 patients responded to the haloperidol, compared with none of 17 patients given placebo. Eight of eight patients with comorbid chronic tic disorders, such as Tourette's disorder, responded to double-blind haloperidol addition to ongoing fluvoxamine treatment. Haloperidol addition was of little benefit in treating OCD patients without tics. Fluvoxamine blood levels were not related to treatment response.. The results of this study suggest that OCD patients with a comorbid chronic tic disorder constitute a clinically meaningful subtype of OCD that might require conjoint serotonin-uptake inhibitor/neuroleptic therapy for effective symptom reduction.

Topics: Adolescent; Adult; Age of Onset; Behavior Therapy; Comorbidity; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Haloperidol; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Placebos; Psychiatric Status Rating Scales; Tic Disorders; Treatment Outcome

To determine the efficacy and safety of a serotonin selective reuptake inhibitor (SSRI) combined with moclobemide in the treatment of 11 patients with various DSM-III-R diagnoses.. Subjects received moclobemide in doses of 150 to 800 mg/day together with sertraline (N = 5) in doses of 25 to 200 mg/day or fluvoxamine (N = 6) in doses of 50 to 200 mg/day. Patients were carefully monitored for side effects and for clinical response at the end of the trial, which lasted a minimum of 5 weeks.. The combination was tolerated extremely well. Insomnia was the most common side effect, occurring in 5 of 11 subjects. A marked or complete therapeutic response was noted in 8 of 11 subjects.. This open clinical trial suggests that combined SSRI-moclobemide treatment appears to be safe and well tolerated. It may also have therapeutic effects in treatment-refractory patients.

Topics: 1-Naphthylamine; Adult; Benzamides; Depressive Disorder; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Mental Disorders; Middle Aged; Moclobemide; Monoamine Oxidase Inhibitors; Obsessive-Compulsive Disorder; Panic Disorder; Selective Serotonin Reuptake Inhibitors; Sertraline

Sixty outpatients with obsessive-compulsive disorder (OCD, 22 men, 38 women) were randomized to receive 6 months of antiexposure therapy with fluvoxamine (group F), exposure therapy with fluvoxamine (group Fe), or exposure therapy with placebo (group Pe). Patients in group F did not comply with antiexposure therapy, so it was in fact a neutral condition. Patients began with depressed mood (mean Hamilton depression score = 19). Fifty patients were reevaluated at week 8, 44 at week 24 (posttest), 37 at week 48, and 33 at 18 months, 1 year posttreatment (group F, n = 10; group Fe, n = 12; group Pe, n = 11). The three groups improved on rituals and depression. There was a drug effect on rituals at week 8 and on depression at week 24; both these effects disappeared at week 48. The 33 18-month completers had been comparable at baseline to those not followed up, apart from having more severe behavioral avoidance. At 18-month followup, patients as a whole remained improved with no between-group differences; over 80% of the Fe and Pe patients versus 40% of the F patients were not receiving antidepressant treatment (Fe vs. F: p < 0.04; Pe vs. F: p = 0.053; Fe vs. Pe: NS). In OCD fluvoxamine and exposure therapy were synergistic in the short term, and exposure reduced subsequent need for antidepressants in the followup year after they had been stopped.

Topics: Adult; Behavior Therapy; Combined Modality Therapy; Depressive Disorder; Double-Blind Method; Female; Fluvoxamine; Follow-Up Studies; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Inventory; Single-Blind Method; Treatment Outcome

This retrospective case-controlled analysis evaluated treatment response to the serotonin reuptake inhibitor fluvoxamine in patients with obsessive-compulsive disorder (OCD), with or without a comorbid chronic tic disorder. Thirty-three fluvoxamine-treated OCD patients with a concurrent chronic tic disorder were compared with 33 age- and sex-matched OCD patients without chronic tics who had received fluvoxamine treatment in the same setting during the same period of time and in a similar manner. Although both groups of patients demonstrated statistically significant reductions in obsessive-compulsive, depressive, and anxiety symptoms with fluvoxamine treatment, the frequency and magnitude of response of obsessive-compulsive symptoms was significantly different between the two groups. A clinically meaningful improvement in obsessive-compulsive symptoms occurred in only 21% of OCD patients with comorbid chronic tics compared with a 52% response rate in OCD patients without chronic tics. Moreover, OCD patients with a concurrent chronic tic disorder showed only a 17% reduction in Yale-Brown Obsessive-Compulsive Scale scores compared with a 32% decrease in the severity of obsessive-compulsive symptoms in those OCD patients without chronic tics. These results suggest that serotonin reuptake inhibitor monotherapy may be less efficacious for improving obsessive-compulsive symptoms in OCD patients with than without tics. Combined with differences in the clinical phenomenology between these two groups, these treatment response data support the hypothesis that OCD patients with a comorbid chronic tic disorder may be a clinically meaningful subtype.

Topics: Adult; Comorbidity; Depressive Disorder; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Retrospective Studies; Single-Blind Method; Tic Disorders; Tourette Syndrome

Topics: Adult; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Dystonia; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Sulpiride

The authors found that buspirone added to the treatment of 33 patients with obsessive-compulsive disorder who were refractory to the serotonin reuptake inhibitor fluvoxamine was no better than placebo in reducing obsessive-compulsive, depressive, or anxiety symptoms. This finding suggests that addition of buspirone to ongoing fluvoxamine therapy is not an effective treatment strategy for most patients with obsessive-compulsive disorder.

Topics: Adult; Anxiety Disorders; Buspirone; Depressive Disorder; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Placebos; Psychiatric Status Rating Scales

Two- and 4-week double-blind placebo-controlled trials of lithium augmentation of ongoing fluvoxamine treatment trials were conducted in 20 and 10 patients, respectively, with primary obsessive-compulsive disorder (OCD) who had failed to respond to fluvoxamine alone. Although 2 weeks of double-blind lithium augmentation produced a small but statistically significant reduction in obsessive-compulsive symptoms, most patients did not have a clinically meaningful response. Furthermore, there was no statistical or clinical improvement in obsessive-compulsive symptoms during the subsequent 4-week double-blind, placebo-controlled trial of lithium augmentation. On the basis of treatment response criteria, only 18% and 0% of the patients responded to lithium augmentation of fluvoxamine during the 2- and 4-week treatment trials, respectively. In light of the previously reported 44% response rate to lithium augmentation in treatment-resistant depressed patients on fluvoxamine, the results of this study suggest that pathophysiological differences may exist between OCD and depression. The routine use of lithium augmentation in the management of patients with OCD who are refractory to serotonin reuptake inhibitors is not supported by these findings.

Topics: Adult; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Lithium; Male; Middle Aged; Obsessive-Compulsive Disorder; Oximes; Psychiatric Status Rating Scales; Serotonin Antagonists

DSM-3 obsessive-compulsive out-patients were randomly assigned to fluvoxamine with antiexposure (F), fluvoxamine with exposure (Fe), or placebo with exposure (Pe) for 24 weeks. Of 65 patients offered treatment 60 entered the trial, 50 reached week 8, 44 completed treatment to week 24, and 37 reached follow up to week 48. On average the patient had depressed mood (mean Hamilton depression rating scale = 19). Drop-out numbers, clinical status and behavioural measures were comparable across groups. Most F patients did not do antiexposure, but Fe and Pe patients complied in doing exposure. All three groups improved in rituals and depression from week 0 to week 24 and 48, with a slight but non-significant superiority for combined treatment up to week 24. At week 8 there was a drug between-group effect on rituals, but not on depression. At week 24 there was a drug between-group effect on depression, but not on rituals. The drug superiority was short-lived. At week 48 there was no between-group difference in rituals or depression. Depression was related to ritual outcome at week 24 in F, and tended to be so in Fe.

Topics: Adult; Antidepressive Agents; Depression; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Oximes; Patient Compliance; Psychiatric Status Rating Scales; Randomized Controlled Trials as Topic

To evaluate whether serotonin reuptake inhibition is critical to the treatment of obsessive-compulsive disorder, 40 outpatients with a principal diagnosis of obsessive-compulsive disorder were randomized in a double-blind fashion to 8 weeks of treatment with either the serotonin reuptake inhibitor fluvoxamine maleate (n = 21) or the norepinephrine reuptake inhibitor desipramine hydrochloride (n = 19). Fluvoxamine was significantly better than desipramine in reducing the severity of obsessive-compulsive symptoms, as measured by the Yale-Brown Obsessive Compulsive Scale and by the global response rate ("responder" equaling "much improved"). Eleven of 21 patients were responders with fluvoxamine compared with 2 of 19 patients with desipramine. Fluvoxamine, but not desipramine, was also effective in reducing the severity of "secondary" depression. Fluvoxamine-induced improvement in symptoms of obsessive-compulsive disorder was not correlated with the severity of baseline depressive symptoms. This study provides additional evidence that the acute serotonin reuptake properties of a drug are predictive of its anti-obsessive-compulsive efficacy. It is hypothesized that the mechanism of action of serotonin reuptake inhibitors in obsessive-compulsive disorder may be related to chronic treatment-induced adaptive changes in presynaptic serotonin receptor function (eg, autoreceptor desensitization) and/or indirect influences on dopaminergic function (eg, in the basal ganglia).

Topics: Adult; Anxiety Disorders; Basal Ganglia; Depressive Disorder; Desipramine; Dopamine; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Oximes; Panic; Psychiatric Status Rating Scales; Randomized Controlled Trials as Topic; Receptors, Serotonin; Serotonin; Serotonin Antagonists

Ninety percent of obsessive compulsive patients can be helped by treatment with behavior therapy and drug treatment, used sequentially or concurrently. The effectiveness of these treatments has been demonstrated in controlled clinical trials and is superior to electroconvulsive therapy and dynamic or cognitive psychotherapies for this disorder. Potent serotonin uptake inhibiting drugs, from the class of heterocyclic antidepressants, are the most effective antiobsessional medications currently available. Although these drugs usually do not induce complete remission, they can reduce obsessive compulsive symptoms by 30% to 42%. Behavior therapy combines exposure and response prevention, which the patient first learns with the therapist and then practices independently. With behavior therapy, patients confront the triggers for their anxiety and then delay, diminish, or discontinue their rituals. Reduction in symptoms with behavior therapy averages 50% or greater. Behavior therapy is usually not effective in patients who are substantially depressed, are delusional, fail to comply, or undermine therapy with covert rituals or avoidance techniques. The rare patient with very severe obsessive compulsive disorder who does not respond to behavior or drug therapy may be a candidate for psychosurgery. Modern psychosurgical procedures are quite safe and can improve symptoms in the majority of otherwise unresponsive patients.

Topics: Antidepressive Agents; Behavior Therapy; Clinical Trials as Topic; Combined Modality Therapy; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Oximes; Psychosurgery; Serotonin Antagonists

A 25-year-old man with a history of Tourette's syndrome presented for treatment of OCD symptoms. Fluvoxamine worsened tics, led to coprolalia, and did not help the OCD. The addition of pimozide dramatically reduced both OCD and Tourette's symptoms. Double-blind sequential discontinuation of fluvoxamine and pimozide confirmed that pimozide alone reduced only tics and the combination of fluvoxamine and pimozide was required for the improvement in OCD. Tics may reflect a subtype of OCD. Some OCD patients unresponsive to a 5-HT reuptake inhibitor alone may benefit from the addition of a dopamine antagonist.

Topics: Adult; Double-Blind Method; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Neurologic Examination; Obsessive-Compulsive Disorder; Oximes; Pimozide; Serotonin Antagonists; Tourette Syndrome

Thirty-eight patients with primary obsessive-compulsive disorder participated in a 10-week, double-blind, placebo-controlled trial of the potent, selective serotonin reuptake inhibitor fluvoxamine. Fluvoxamine was significantly better than placebo on two of three measures of improvement in obsessive-compulsive symptoms. The authors also compared studies of the serotonergic agents fluvoxamine, sertraline, fluoxetine, and clomipramine and found that a greater effect size was associated with less serotonergic specificity and that some ability to affect other neurotransmitter systems may be a necessary but not sufficient requirement for antiobsessional activity. These data lend only partial support to a serotonin hypothesis of obsessive-compulsive disorder.

Topics: 1-Naphthylamine; Adult; Ambulatory Care; Clinical Trials as Topic; Clomipramine; Double-Blind Method; Female; Fluoxetine; Fluvoxamine; Humans; Male; Meta-Analysis as Topic; Obsessive-Compulsive Disorder; Oximes; Placebos; Psychiatric Status Rating Scales; Serotonin; Serotonin Antagonists; Sertraline

A six- to eight-week double-blind placebo-controlled trial of the potent and selective serotonin reuptake inhibitor fluvoxamine was conducted in 42 patients with primary obsessive-compulsive disorder (OCD). Approximately one half of the patients also had symptoms of major depression. Fluvoxamine was significantly better than placebo on all measures of obsessive-compulsive symptoms. Nine of 21 patients were responders ("much improved") with fluvoxamine compared with no responders with placebo, and fluvoxamine was effective in patients with OCD both with and without secondary depression. Response of OCD was not correlated with severity of baseline depression. These data lend partial support to the serotonin hypothesis of OCD. However, since a number of patients failed to respond to fluvoxamine, the role of other neurochemical systems in this disorder needs to be explored.

Topics: Adult; Clinical Trials as Topic; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Oximes; Personality Inventory; Placebos; Psychiatric Status Rating Scales; Time Factors

Ten obsessive-compulsive patients received single-blind treatment with fluvoxamine, a selective serotonin reuptake inhibitor, for several weeks following at least 2 weeks of placebo. The group showed significant improvement, as measured by several clinical scales and self-ratings; six patients were judged responders. Fluvoxamine appears effective in treating severe obsessive-compulsive disorder.

Topics: Adult; Clinical Trials as Topic; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Oximes; Personality Inventory; Psychiatric Status Rating Scales

A double-blind comparative study of clomipramine and fluvoxamine was performed in 50 patients suffering from anxiety disorders (DSM-III). Patients were treated for 6 weeks with either 150 mg of clomipramine or 100 mg of fluvoxamine. The results show that both drugs at the dosages used are equipotent in reducing anxiety symptoms as assessed with the Hamilton Anxiety Scale and the Spielberger State-Trait Anxiety Inventory. Clomipramine differed from fluvoxamine in its efficacy with respect to associated depressive symptomatology in that it had a more pronounced effect on the Self Rating Depression Scale. The results support the hypothesis that brain serotonergic pathways are implicated in the pathophysiology of anxiety disorders, particularly in agoraphobia and panic disorders.

Topics: Adult; Agoraphobia; Anxiety Disorders; Clinical Trials as Topic; Clomipramine; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Oximes; Panic; Psychological Tests; Serotonin Antagonists

Sixteen outpatients who met DSM-III criteria for obsessive-compulsive disorder completed a 20-week double-blind, crossover trial with fluvoxamine and placebo. Thirteen (81%) improved with fluvoxamine, while three (19%) improved with placebo. Fluvoxamine treatment was associated with significant improvement on measures of obsessive-compulsive symptoms, anxiety, and depression. Depressed subjects' improvement on obsessive-compulsive measures correlated with improvement in symptoms of depression. Nondepressed subjects also showed improvement on measures of obsessive-compulsive symptoms. In this trial, fluvoxamine was an effective and safe treatment for obsessive-compulsive disorder.

Topics: Adolescent; Adult; Ambulatory Care; Anxiety Disorders; Clinical Trials as Topic; Depressive Disorder; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Oximes; Personality Inventory; Placebos; Psychiatric Status Rating Scales

Rhabdomyolysis is a syndrome resulting from striated muscular breakdown, which may occur due to drug therapy with agents such as selective serotonin reuptake inhibitors (SSRIs). Although studies have shown that fluvoxamine can rarely cause myalgia, there are no reported cases of rhabdomyolysis due to fluvoxamine monotherapy. Here we describe a case of rhabdomyolysis due to fluvoxamine monotherapy for obsessive-compulsive disorder. The young adolescent developed pain in the extremities, and an increase in serum creatine kinase (CK) and myoglobin during fluvoxamine treatment. These adverse reactions were reversed immediately after the medicine was changed to another SSRI-sertraline. This is the first reported case of fluvoxamine-associated rhabdomyolysis. It is advisable to determine serum CK levels before starting fluvoxamine treatment, and then at regular intervals, to avoid the occurrence of severe acute kidney injury with possible life-threatening complications.

Topics: Adolescent; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Rhabdomyolysis; Sertraline

First-line drugs for obsessive-compulsive disorder (OCD) pharmacotherapy are selective serotonin reuptake inhibitors (SSRI). The medication must be continued for at least 12 weeks at an effective dosage to find the most effective SSRI. For treatment, the drug dose should be titrated to the highest tolerated dose. The manufacturer's recommended maximum dose of fluvoxamine is 300 mg per day. We reported remission after about 1 month of 600 mg (high dose) fluvoxamine, which was tolerated by a patient with OCD. The patient continued at this dose for 3 months and remained in remission.

Topics: Drug Therapy, Combination; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Obsessive-Compulsive disorder (OCD) is a long-term and persistent mental illness characterised by obsessive thoughts and compulsive behaviours. Numerous factors can contribute to the development or progression of OCD. These factors may result from the dysregulation of multiple intrinsic cellular pathways, including SIRT-1, Nrf2, and HO-1. Inhibitors of selective serotonin reuptake (SSRIs) are effective first-line treatments for OCD. In our ongoing research, we have investigated the role of SIRT-1, Nrf2, and HO-1, as well as the neuroprotective potential of Acetyl-11-keto-beta boswellic acid (AKBA) against behavioural and neurochemical changes in rodents treated with 8-OH-DPAT. In addition, the effects of AKBA were compared to those of fluvoxamine (FLX), a standard OCD medication. Injections of 8-OH-DPAT into the intra-dorso raphe nuclei (IDRN) of rats for seven days induced repetitive and compulsive behaviour accompanied by elevated oxidative stress, inflammatory processes, apoptosis, and neurotransmitter imbalances in CSF, blood plasma, and brain samples. Chronic administration of AKBA at 50 mg/kg and 100 mg/kg p.o. restored histopathological alterations in the cortico-striatal-thalamo-cortical (CSTC) pathway, including the cerebral cortex, striatum, and hippocampal regions. Our investigation revealed that when AKBA and fluvoxamine were administered together, the alterations were restored to a greater degree than when administered separately. These findings demonstrate that the neuroprotective effect of AKBA can serve as an effective basis for developing a novel OCD treatment.

Topics: 8-Hydroxy-2-(di-n-propylamino)tetralin; Animals; Cerebral Cortex; Fluvoxamine; NF-E2-Related Factor 2; Obsessive-Compulsive Disorder; Plasma; Rats; Triterpenes

Topics: Case-Control Studies; COVID-19 Drug Treatment; Double-Blind Method; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Age of Onset; Aged; Anti-Anxiety Agents; Antipsychotic Agents; Aripiprazole; Dementia; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Quetiapine Fumarate; Self-Injurious Behavior; Tomography, Emission-Computed, Single-Photon

There is an increasing demand for fast and sensitive determination of antidepressants in human body fluids because of the present scenario of rising depression cases at the global level. A simple and sensitive voltammetric method using edge plane pyrolytic graphite electrode (EPPGE) as a novel sensor is presented for the determination of antidepressant fluvoxamine in urine and blood plasma samples of obsessive-compulsive disorder (OCD) patients. EPPGE is delineated the first time for this determination. EPPGE exhibited strong electrocatalytic activity and enhanced reduction signal towards the sensing of fluvoxamine. Fluvoxamine gave a well-defined reduction peak at ~ - 670 mV using EPPGE. The fluvoxamine reduction peak current was linear to its concentration in the range 5.00 × 10

Topics: Biosensing Techniques; Electrodes; Fluvoxamine; Graphite; Humans; Obsessive-Compulsive Disorder; Reproducibility of Results

Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder with complex genetic inheritance. Findings suggest a role for brain-derived neurotrophic factor (BDNF) in OCD, but reports are limited. Here we studied the association of BDNF polymorphisms rs6265 and rs2883187 with OCD and its clinical characteristics in Iranian patients as well as the fluvoxamine-treatment outcome of OCD patients. Iranian OCD patients who were diagnosed according to DSM-IV-TR entered the study. DNAs were extracted from blood samples and were genotyped by means of PCR-RFLP. A total of 200 OCD cases and 225 controls for rs6265 and 219 cases and 224 controls for rs2883187 were studied in the genetic association analysis. Pharmacotherapy was defined as 12 weeks treatment with fluvoxamine (daily dose: 150-300 mg), and patients were classified into 3 groups (responders, nonresponders, and refractory) based on the reduction in their Y-BOCS severity scores. Data of 94 patients for rs6265 and 106 patients for rs2883187 was analyzed to evaluate the association of these single nucleotide polymorphism (SNPs) with treatment response. A significant association was detected between the BDNF polymorphism rs2883187 and OCD (p = .00). The other BDNF polymorphism, rs6265, was not associated with OCD, but a weak association with the cleaning-contamination subtype was detected (p = .038). No association was detected between BDNF SNPs and sex, age of onset, and family history. None of the studied BDNF SNPs or their haplotypes were associated with fluvoxamine treatment response. Results propose BDNF SNP, rs2883187, as a candidate genetic factor in OCD but not in OCD treatment response with fluvoxamine. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Topics: Adult; Brain-Derived Neurotrophic Factor; Female; Fluvoxamine; Genotype; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Polymorphism, Single Nucleotide

There have been controversial results in the literature on the association between HTR1A polymorphisms (rs10042486, C-1019G, and Gly272Asp) and obsessive-compulsive disorder (OCD). Here, the plausibility for such genetic and pharmacogenetic association was investigated by assessing a sample of Iranian OCD patients.. OCD patients had fulfilled the criteria for DSM-IV-TR with Y-BOCS scores higher than 9. A total of 207 controls and 205 patients' blood samples were genotyped by means of PCR-RFLP.. The results showed that there was no association between these three SNPs and the treatment response. The distribution of rs10042486 genotypes was significantly different in the patients compared to the controls. The association analyses of the C-1019G showed significant differences in the genotypic frequency of the patients with or without a positive family history of psychiatric disorders. Similar differences in female patients were also observed. We found that the age of onset also associates with the C-1019G polymorphism but only in the female patients. No association of Gly272Asp polymorphism and OCD was observed in this study.. We concluded that among the HTR1A polymorphisms, only the association of rs10042486 CT genotype and OCD was statistically significant. The association of C-1019G with OCD by considering the age of onset and family history was just significant in the female patients. No significant association between the studied HTR1A SNPs with treatment response was observed. Acquiring both positive and negative pharmacogenetic outcomes in each population helps to select the appropriate medication for a particular patient with fewer side effects.

Topics: Adult; Age of Onset; Female; Fluvoxamine; Genetic Association Studies; Genetic Predisposition to Disease; Humans; Iran; Male; Middle Aged; Obsessive-Compulsive Disorder; Outcome Assessment, Health Care; Pharmacogenomic Testing; Polymorphism, Single Nucleotide; Receptor, Serotonin, 5-HT1A; Selective Serotonin Reuptake Inhibitors; Sex Factors; Young Adult

Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder. Selective serotonin reuptake inhibitors (SSRIs) are the first line of medication for OCD treatment; however, 40%-60% of patients with OCD do not respond to SSRIs adequately. There are growing pieces of evidence which suggest a significant role for the glutamatergic system in the genesis of OCD and its consequent treatment. In the present study, we aimed to assess the association of SLC1A1 polymorphisms (rs301430, rs2228622 and rs3780413) with OCD and its clinical characteristics, as well as the importance of these SNPs in the response of OCD patients to SSRI pharmacotherapy.. Sample study consisted of 243 OCD cases and 221 control subjects. Patients were treated 12 weeks with fluvoxamine (daily dose: 150-300 mg). Based on the reduction in obsessive and compulsive severity scores using Y-BOCS severity scale, patients were classified as responders, non-responders and refractory. A total of 239, 228 and 215 patients were genotyped for rs301430, rs2228622 and rs3780413, respectively, by the means of PCR-RFLP.. No association was detected between SLC1A1 SNPs and OCD, except an association between the familial form of the disease in males with rs2228622 (P = 0.033). The results of pharmacogenetic studies revealed the associations of two SLC1A1 SNPs, rs2228622 (P = 0.031) and rs3780413 (P = 0.008), with treatment response.. Results of the current study suggest a role for the glutamate transporter in OCD treatment response with SSRIs which should encourage researchers to further investigate the importance of glutamate transporter in OCD pharmacogenetics.

Topics: Adult; Excitatory Amino Acid Transporter 3; Female; Fluvoxamine; Genetic Predisposition to Disease; Genotype; Humans; Iran; Male; Middle Aged; Obsessive-Compulsive Disorder; Pharmacogenomic Testing; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Polymorphism, Single Nucleotide; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Sex Factors; Treatment Outcome; Young Adult

Topics: Adult; Antipsychotic Agents; Carbon Monoxide Poisoning; Combined Modality Therapy; Electroconvulsive Therapy; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Sulpiride; Tics; Treatment Outcome

The current study evaluated the role of strain and compulsive trait differences in response to fluvoxamine, a common obsessive-compulsive disorder (OCD) drug, in two different mouse strains (BIG1 and BIG2) with a spontaneous compulsive-like phenotype. For compulsive-like nest-building behavior, dose-dependent attenuation of nesting by fluvoxamine was observed for the BIG1 compulsive-like strain during the first hour after administration. No significant differences were found for the BIG2 strain during the first hour, although a dose-dependent trend similar to that in the BIG1 strain was observed. Fluvoxamine dose dependently decreased the number of marbles buried in both strains 1 h after administration. For anxiety-like behaviors in the open field, no significant drug effects were found for the latency to leave the center and the number of line crossings. Significant strain differences were observed, with the BIG2 strain showing higher anxiety-like behaviors and reduced locomotor activity compared with the BIG1 strain. Consequently, this study adds predictive validity to our mouse model of OCD, whereas the anxiety-like differences between the strains add heterogeneity to our mouse model, similar to the heterogeneity observed in OCD.

Topics: Animals; Anxiety; Anxiety Disorders; Compulsive Behavior; Disease Models, Animal; Fluvoxamine; Male; Mice; Mice, Inbred Strains; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Drug-induced intracranial hypertension is a well-established entity. We report a rare case of intracranial hypertension with papilledema in a 10-year-old boy following use of fluvoxamine, a selective serotonin reuptake inhibitor. On discontinuing the drug, the papilledema resolved over 4 months without any residual visual anomalies. To the best of our knowledge, this is the first report of fluvoxamine-induced intracranial hypertension with papilledema.

Topics: Anti-Anxiety Agents; Child; Fluvoxamine; Humans; Intracranial Hypertension; Intracranial Pressure; Magnetic Resonance Angiography; Male; Obsessive-Compulsive Disorder; Papilledema

Topics: Adult; Anti-Anxiety Agents; Antidepressive Agents; Antidepressive Agents, Second-Generation; Anxiety Disorders; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Lamotrigine; Mirtazapine; Obsessive-Compulsive Disorder; Serotonin and Noradrenaline Reuptake Inhibitors; Tic Disorders; Venlafaxine Hydrochloride

Topics: Adult; Affect; Antidepressive Agents; Antipsychotic Agents; Aripiprazole; Bipolar Disorder; Clomipramine; Depression, Postpartum; Diagnosis, Differential; Female; Fluvoxamine; Humans; Lithium Compounds; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales

Topics: Adult; Antipsychotic Agents; Binge Drinking; Ceremonial Behavior; Clonazepam; Cognitive Behavioral Therapy; Compulsive Behavior; Fluvoxamine; GABA Modulators; Humans; Magic; Male; Obsessive-Compulsive Disorder; Risperidone; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Female; Fluvoxamine; Humans; Infant, Newborn; Male; Obsessive-Compulsive Disorder; Pregnancy; Prenatal Exposure Delayed Effects; Selective Serotonin Reuptake Inhibitors

Obsessive-compulsive and related disorders (OCRDs) have been introduced in a revision to DSM-5 as a novel category that is distinct from other anxiety disorders in DSM-IV. OCRDs consist of 5 primary disorders: obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), skin picking disorder (SPD), and hair pulling disorder (HPD), which share core clinical features such as preoccupation or recurrent thoughts and/or repetitive behaviors. Repetitive behaviors in BDD and HD can be differentially characterized by the presence of cognitive components associated with preceding anxiety from those in SPD or HPD, which are only observed as motoric components that regulate emotions or alleviate tension. Thus, the validity of the OCRD category and specific interrelationships between each OCRD remain uncertain. In the present study, therefore, we presented a case of multiple comorbidities of OCRDs in order to discuss the nature of the OCRD category. Our patient was a 20-year-old female university student. At the age of 11 years old, she started picking at acne on her face. The psychopathological, and treatment features observed in this case indicated possible interrelationships among OCRDs, especially between cognitive and motoric OCRDs, which supported the clinical utility and continuous nature of this category.

Topics: Adult; Antipsychotic Agents; Aripiprazole; Body Dysmorphic Disorders; Clonazepam; Combined Modality Therapy; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Drug Therapy, Combination; Female; Fluvoxamine; Haloperidol; Hoarding Disorder; Humans; Obsessive-Compulsive Disorder; Psychotherapy; Self-Injurious Behavior; Skin; Trichotillomania; Young Adult

Among antiserotonergic second generation antipsychotics (SGA), particularly treatment with clozapine (CLZ) is associated with the development of second-onset obsessive compulsive symptoms (OCS) in schizophrenia. However, less is known regarding the factors that increase the individual susceptibility for the development of SGA-associated second-onset OCS in schizophrenia. Here we present the case of a 29-year-old female patient with disorganized schizophrenia who exhibited OCS due to fluvoxamine-induced elevation of CLZ serum levels via inhibition of CYP 1A2 und 2C19. The severity of the observed OCS featured an association with CLZ serum levels. The case illustrates the interaction between fluvoxamine add-on and CLZ serum levels on the development of OCS in schizophrenia and emphasizes the need of regular therapeutic drug monitoring.

Topics: Adult; Antipsychotic Agents; Clozapine; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Schizophrenia

Topics: Adult; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Photosensitivity Disorders; Selective Serotonin Reuptake Inhibitors

Obsessive-compulsive personality disorder (OCPD) is an early-onset disorder characterized by perfectionism, need for control, and cognitive rigidity. Its nosological status is currently under review. Historically, OCPD has been conceptualized as bearing a close relationship with obsessive-compulsive disorder (OCD). In this article, we discuss the diagnosis of OCPD in anticipation of its review for the ICD-11, from the perspective of clinical utility, global applicability, and research planning. Considering the recent establishment of an obsessive-compulsive and related disorders (OCRD) category in DSM-5, we focus on the relationship between OCPD and the disorders that are currently thought to bear a close relationship with OCD, including DSM-5 OCRD, and other compulsive disorders such as eating disorder and autistic spectrum disorder (that were not included in the DSM-5 OCRD category), as well as with the personality disorders, focusing on nosological determinants such as phenomenology, course of illness, heritability, environmental risk factors, comorbidity, neurocognitive endophenotypes, and treatment response. Based on this analysis, we attempt to draw conclusions as to its optimal placement in diagnostic systems and draw attention to key research questions that could be explored in field trials.

Topics: Anti-Anxiety Agents; Comorbidity; Compulsive Personality Disorder; Diagnostic and Statistical Manual of Mental Disorders; Fluvoxamine; Humans; Impulsive Behavior; International Classification of Diseases; Obsessive-Compulsive Disorder; Placebos

Severe social withdrawal (called hikikomori, and defined as isolation lasting more than six months and not due to an apparent mental disorder) has drawn increasing public attention in Japan. It is unclear whether hikikomori is merely a symptom or syndrome of social withdrawal.. To evaluate this phenomenon in relationship to social anxiety disorder (SAD), as few previous studies have.. One hundred and forty-one consecutive patients with SAD diagnosed according to DSM-IV criteria by a semi-structured interview were treated with a combination of psychotherapy, pharmacotherapy and group activity.. Twenty-seven (19%) SAD patients fulfilled the criteria for hikikomori, and these patients had earlier onset, more symptoms and less education than non-hikikomori SAD patients. Only 33% of hikikomori SAD patients spontaneously complained of SAD symptoms at first visit. There were no diagnostic differences between hikikomori and non-hikikomori SAD patients, except that comorbid obsessive-compulsive disorder was more frequent in hikikomori SAD patients. Functional impairment in 10 (37%) hikikomori SAD patients improved after several years of combination therapy.. Hikikomori may serve as a proxy for a severe form of SAD. Patients with comorbid SAD and hikikomori have lower treatment response rates than those with SAD alone.

Topics: Adolescent; Adult; Anti-Anxiety Agents; Cognitive Behavioral Therapy; Combined Modality Therapy; Comorbidity; Cyclopropanes; Diagnostic and Statistical Manual of Mental Disorders; Female; Fluvoxamine; Humans; Interview, Psychological; Japan; Male; Milnacipran; Obsessive-Compulsive Disorder; Paroxetine; Phobic Disorders; Psychotherapy, Group; Reactive Attachment Disorder; Retrospective Studies; Social Isolation; Treatment Outcome; Young Adult

Obsessive Compulsive Disorder (OCD) is characterized by recurrent, anxiety-producing thoughts accompanied by unwanted, overwhelming urges to perform ritualistic behaviors. Pharmacological treatments for this disorder (serotonin uptake inhibitors) are problematic because there is a 6-8 week delayed onset and half of the patients do not adequately respond. The present study evaluated whether Ritualistic Chewing Behaviors (RCBs) induced by the serotonin agonist mCPP in the rat is a behavioral model for OCD. The effects upon the RCBs induced by mCPP (1 mg/kg) were evaluated following treatments with either the serotonin antagonist mianserin (3 mg/kg), the dopamine antagonist haloperidol (1 mg/kg), the GABA modulator diazepam (10 mg/kg), or the serotonin uptake inhibitors clomipramine and fluvoxamine (15 mg/kg). The response to mCPP was blocked by acute treatment with mianserin, but not with acute haloperidol or diazepam. Further experiments revealed that the effects of mCPP were blocked by chronic, but not acute, treatment with clomipramine and fluvoxamine. A time-course demonstrated that 14 days of chronic treatment were required for blockade of the mCPP-evoked response. The current study demonstrates that mCPP-evoked RCBs may be a rodent model for OCD that can be used to predict the clinical efficacy and time course of novel OCD treatment. Future investigations may be able to use the current model as a tool for bench-marking corresponding changes in other measures of neurological activity that may provide insight into the mechanisms underlying OCD.

Topics: Animals; Behavior, Animal; Clomipramine; Diazepam; Disease Models, Animal; Dopamine Antagonists; Fluvoxamine; GABA Modulators; Haloperidol; Male; Mastication; Mianserin; Obsessive-Compulsive Disorder; Piperazines; Rats; Rats, Sprague-Dawley; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Serotonin Receptor Agonists

Topics: Anti-Anxiety Agents; Cognition Disorders; Epilepsy; ERG1 Potassium Channel; Ether-A-Go-Go Potassium Channels; Female; Fluvoxamine; Humans; Long QT Syndrome; Middle Aged; Multiple Sclerosis; Obsessive-Compulsive Disorder; Potassium Channel Blockers; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

National differences in licensing laws suggest that the use of medications for the treatment of Tourette syndrome differs between European countries. However, variability in prescribing practices has never been investigated. This study aims to systematically examine European prescribing practices in Tourette syndrome.. All members of the European Society for the Study of Tourette syndrome actively prescribing for paediatric and/or adult Tourette syndrome populations were invited to complete an online questionnaire covering pharmacological treatment of the five main symptom domains of Tourette syndrome: tics, attention-deficit hyperactivity symptoms, obsessive-compulsive symptoms, anxiety and depression.. Response rates were good, with 44/57 (77%) members returning the questionnaire. Risperidone (n=13), methylphenidate (n=21) and sertraline (n=17) were the most commonly prescribed medications for the treatment of tics, attention-deficit hyperactivity symptoms and obsessive-compulsive symptoms, respectively. However, there was a large variability in both the medication choices and the dosages used for each of these symptom domains.. This is the first large-scale survey on prescribing habits for the pharmacological management of Tourette syndrome in Europe. In general, dopamine blockers were widely used for tics, selective serotonin reuptake inhibitors for depression, obsessive-compulsive symptoms and anxiety, and stimulants for attention-deficit hyperactivity symptoms, but there was high variation within these choices. Future studies need to target specific patient groups.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Anxiety; Aripiprazole; Atomoxetine Hydrochloride; Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Child; Clonidine; Depression; Europe; Fluoxetine; Fluvoxamine; Health Care Surveys; Humans; Methylphenidate; Obsessive-Compulsive Disorder; Physicians; Piperazines; Propylamines; Psychiatry; Quinolones; Risperidone; Sertraline; Sulpiride; Tourette Syndrome

In the present study, we examined the effect of N-acetyl-L-cysteine (NAC), a glutamate-modulating agent, on marble-burying behavior in mice. Fluvoxamine (30 mg/kg, p.o.) and mirtazapine (3 mg/kg, i.p.) significantly inhibited marble-burying behavior without affecting locomotor activity. Similarity, NAC (150 mg/kg, i.p.) significantly inhibited marble-burying behavior without affecting locomotor activity. On the other hand, the antioxidant α-tocopherol (10, 30, and 100 mg/kg, p.o.) had no effect on the marble-burying behavior. These results suggest that the glutamatergic system is involved in the marble-burying behavior, and NAC may be useful for treatment of OCD.

Topics: Acetylcysteine; alpha-Tocopherol; Animals; Antipsychotic Agents; Anxiety Disorders; Behavior, Animal; Fluvoxamine; Male; Mianserin; Mice; Mice, Inbred ICR; Mirtazapine; Motor Activity; Obsessive-Compulsive Disorder

Topics: Adult; Antipsychotic Agents; Aryl Hydrocarbon Hydroxylases; Clomipramine; Clozapine; Comorbidity; Cytochrome P-450 CYP1A2; Cytochrome P-450 CYP1A2 Inhibitors; Cytochrome P-450 CYP2C19; Cytochrome P-450 CYP3A; Cytochrome P-450 CYP3A Inhibitors; Dose-Response Relationship, Drug; Drug Interactions; Drug Monitoring; Drug Therapy, Combination; Fluoxetine; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia; Selective Serotonin Reuptake Inhibitors

There is evidence that combining selective serotonin reuptake inhibitor (SSRI) antidepressant and antipsychotic drugs may improve negative symptoms in schizophrenia and resistant symptoms in obsessive-compulsive and affective disorders. To examine the mechanism of action of this treatment we investigated the molecular modulation of γ-aminobutyric acid-A (GABA(A)) receptor components and biochemical pathways associated with GABA(A) receptor function following administration of the SSRI fluvoxamine (Flu) combined with the first-generation antipsychotic haloperidol (Hal) and compared it to the individual drugs and the atypical antipsychotic clozapine (Clz). We analysed prefrontal cortices of Sprague-Dawley rats injected intraperitoneally (i.p.) with the combination of Flu (10 mg/kg) and Hal (1 mg/kg), each drug alone, or Clz (10 mg/kg) after 30 min and 1 h. We found that haloperidol plus fluvoxamine (Hal-Flu) co-administration, and Clz, decreased the level of GABAAβ2/3 receptor subunit in the cytosolic fraction, and increased it in the membrane compartment in rat PFC. Flu or Hal alone did not produce changes in GABAAβ2/3 receptor protein expression. Additionally, Hal-Flu and Clz regulated molecular signalling pathways that modulate GABA(A) receptor function, including protein kinase C (PKC) and extracellular signal-regulated kinase-2 (ERK2). In primary cortical culture, short-term treatment (15 min) with Hal-Flu combination and Clz increased GABAAβ subunit phosphorylation levels. Pretreatment of the cells with PKC inhibitor abolished the effect of the combined treatment, or Clz on phosphorylation of GABA(A) receptor. Inhibition of ERK2 did not alter the effect of drugs on GABA(A) receptor phosphorylation levels. Our findings provide evidence that the combined treatment regulates GABA(A) receptor function and does so via a PKC-dependent pathway.

Topics: Animals; Antidepressive Agents; Antipsychotic Agents; Cells, Cultured; Clozapine; Dopamine; Drug Therapy, Combination; Fluvoxamine; Haloperidol; Male; Mitogen-Activated Protein Kinase 1; Mood Disorders; Obsessive-Compulsive Disorder; Phosphorylation; Prefrontal Cortex; Protein Kinase C; Rats; Rats, Sprague-Dawley; Receptors, GABA-A; Schizophrenia; Selective Serotonin Reuptake Inhibitors

Obsessive-compulsive disorder (OCD) is a heterogenous disorder with different clinical presentations. The most common symptoms are those that involve contamination, possible harm, ordering/symmetry, aggressive/sexual/religious concerns and hoarding. A variety of less common symptoms have been described. Unusual OCD symptoms may lead to misdiagnosis, inappropriate treatment with possible serious side effects. In this report we present a case of an adolescent girl in which unusual OCD presentation and symptoms were misinterpreted to represent psychosis and exacerbation of OCD symptoms with risperidone and clozapine treatment. We discuss the possible pathophysiological mechanisms of OCD symptom exacerbation, clinical implications, and successful management of this case, with fluvoxamine therapy. This case may represent the first report of musical obsessions successfully managed with fluvoxamine therapy.

Topics: Adolescent; Antipsychotic Agents; Clozapine; Diagnostic Errors; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Psychotic Disorders; Risperidone

To examine characteristics of drop-outs from treatment for obsessive-compulsive disorder (OCD), we studied 121 participants who underwent exposure or cognitive treatment, either alone or with fluvoxamine. OCD symptoms were assessed at pre-treatment, post-treatment, and at every session. No differences in attrition were found between treatment conditions. Drop-outs from treatment (n=31) were divided into early (before session 6) and late (session 6 or after) drop-outs. We found that early drop-outs had more severe OCD symptoms at termination compared to completers, whereas late drop-outs did not differ from treatment completers. Higher levels of depressive symptoms were associated with early drop-outs, and lower levels with completers. These findings suggest that individuals with high levels of pretreatment depression are at risk for early drop-out with elevated OCD symptoms. Conversly, late drop-outs may be treatment responders who drop out after experiencing substantial improvement. Implications for allocation of resources for attrition prevention are discussed.

Topics: Adult; Anti-Anxiety Agents; Cognitive Behavioral Therapy; Combined Modality Therapy; Depressive Disorder; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Patient Dropouts; Randomized Controlled Trials as Topic; Treatment Outcome

Risperidone is associated with hyperprolactinemia and its consequent symptoms such as gynecomastia, galactorrhea and sexual dysfunction in adults, and less so in adolescents. Rarely, serotonin reuptake inhibitors are also associated with such adverse effects. We report a case of gynecomastia and galactorrhea in an adolescent male while on a combination of risperidone and fluvoxamine, although the serum prolactin was within normal range.

Topics: Drug Therapy, Combination; Fluvoxamine; Galactorrhea; Gynecomastia; Humans; Male; Obsessive-Compulsive Disorder; Prolactin; Risperidone; Selective Serotonin Reuptake Inhibitors; Young Adult

Catatonia is a syndrome with protean manifestations and multiple aetiologies. In this report, the authors describe the case of a young woman who presented for care after a 13-year period of catatonia-like symptoms, including mutism, refusal to eat and persistent neck flexion. Medical management included placement of a percutaneous endoscopic gastric tube for nutritional support. A thorough medical investigation later revealed the presence of a cervical spine haemangioma that was treated surgically, with improvement in neck posturing. Psychopharmacological treatment included lorazepam, aripiprazole and memantine. Addition of fluvoxamine to target obsessive compulsive disorder (OCD)-like symptoms resulted in clinical improvement, suggesting OCD as a possible cause of this patient's chronic catatonic state.

Topics: Adult; Antipsychotic Agents; Aripiprazole; Catatonia; Chronic Disease; Combined Modality Therapy; Dopamine Agents; Female; Fluvoxamine; GABA Modulators; Humans; Lorazepam; Memantine; Neurosurgical Procedures; Obsessive-Compulsive Disorder; Piperazines; Quinolones; Selective Serotonin Reuptake Inhibitors

Obsessive-compulsive disorder (OCD) is clinically heterogeneous. Previous studies have reported different patterns of treatment response to serotonin reuptake inhibitors (SRI) based on symptom dimension. Our objective was to replicate these results in OCD patients who participated in one of four randomized, placebo-controlled, clinical trials (RCT).. A total of 165 adult OCD subjects participated in one or more eight-week RCT with clomipramine, fluvoxamine, or fluoxetine. All subjects were classified as having major or minor symptoms in four specific OC symptom dimensions that were derived in a previous factor analytic study involving many of these same patients. Ordinal logistic regression was used to test the association between OC symptom dimensions and SRI response.. We found a significant association between the symptom dimension involving sexual, religious and harm-related obsessions as well as checking compulsions (AGG/SR) and improved SRI response. This increased rate of SRI response was experienced primarily by individuals with harm-related obsessions. Over 60% of patients with AGG/SR OCD symptoms were rated as very much improved after SRI treatment.. As some of the RCTs included were conducted prior to the development of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), improvement in OCD severity was assessed using the Clinical Global Improvement (CGI) Scale. Data from the double-blind and open-label continuation phases of these trials was collapsed together to increase statistical power.. Patients with OCD vary in their response to SRIs. The presence of AGG/SR symptoms is associated with an initial positive response to SRIs. These data add to the growing body of work linking central serotonin systems with aggressive behavior.

Topics: Adult; Clomipramine; Connecticut; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Inventory; Prognosis; Psychometrics; Randomized Controlled Trials as Topic; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Selective serotonin reuptake inhibitors (SSRIs) are usually well tolerated in the pediatric population, and widely used in the treatment of obsessive-compulsive disorder (OCD). Of the 51 pediatric patients with obsessive-compulsive disorder seen in our outpatient clinic between January 2009 and July 2009, 3 of them developed behavioral disinhibition after treatment with fluvoxamine. These cases are described and discussed in relation to the use of CYP2D6 and CYP2C19 pharmacogenetic testing in patients treated with serotonin-selective reuptake inhibitors.

Topics: Aryl Hydrocarbon Hydroxylases; Child; Cytochrome P-450 CYP2C19; Cytochrome P-450 CYP2D6; Fluvoxamine; Humans; Impulsive Behavior; Inhibition, Psychological; Male; Obsessive-Compulsive Disorder; Pharmacogenetics; Selective Serotonin Reuptake Inhibitors

Topics: Antipsychotic Agents; Clozapine; Comorbidity; Cytochrome P-450 CYP1A2; Cytochrome P-450 CYP1A2 Inhibitors; Cytochrome P-450 CYP3A; Cytochrome P-450 CYP3A Inhibitors; Drug Interactions; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Risk Factors; Schizophrenia; Schizophrenic Psychology; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Amisulpride; Antipsychotic Agents; Chronic Disease; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Hyperpigmentation; Obsessive-Compulsive Disorder; Photosensitivity Disorders; Selective Serotonin Reuptake Inhibitors; Sertraline; Sulpiride

Despite the recent progress in the pharmacological treatment of obsessive-compulsive disorder (OCD)--especially with high doses of serotonin reuptake inhibitors, alone or in combination with low doses of antipsychotics--a non-negligible proportion of patients remains refractory to it. For these patients augmentation tactics with drugs from other chemical classes, including antiepileptic drugs, seems advisable. We report on the case of a female inpatient with OCD, whereby the adjunction of tiagabine, a selective GABA reuptake inhibitor at 15 mg/day, to a fluvoxamine (400 mg/day)-risperidone (1 mg/day) combination led to the patient's marked improvement as reflected in the reduction by almost 47% of her score on the Yale-Brown Obsessive Compulsive Scale. With respect to tiagabine's specifically anti-OCD mechanism of action, we note that enhanced inhibitory GABAergic neurotransmission slows down excitatory glutamatergic transmission in the cortico-striato-thalamic system, which presumably constitutes the core pathophysiological mechanism of OCD symptoms.

Topics: Adult; Drug Combinations; Drug Synergism; Drug Therapy, Combination; Female; Fluvoxamine; GABA Agonists; Humans; Nipecotic Acids; Obsessive-Compulsive Disorder; Risperidone; Selective Serotonin Reuptake Inhibitors; Tiagabine

Reported herein is a case of obsessive-compulsive disorder with persistent and distressing musical obsessions along with other symptoms. Advanced source analysis of electroencephalographic data indicated high spectral power over the bifrontal region. The musical symptoms were resistant to pharmacotherapy but there was some reduction in frequency and duration of musical obsessions with thought-stopping technique.

Topics: Antidepressive Agents, Second-Generation; Antipsychotic Agents; Drug Therapy, Combination; Electroencephalography; Electrophysiology; Fluvoxamine; Fourier Analysis; Hallucinations; Humans; Male; Music; Obsessive-Compulsive Disorder; Risperidone; Young Adult

Topics: Adaptation, Psychological; Adult; Auditory Perception; Cell Phone; Clomipramine; Fluvoxamine; Humans; Male; Music; Obsessive Behavior; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Anxiety Disorders; Area Under Curve; Child; Delayed-Action Preparations; Drug Approval; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; United States; United States Food and Drug Administration

Obsessive compulsive disorder (OCD) is an illness that considerably influences the family, academic, occupational and social functioning of patients. In this study, we aimed to investigate the impact of psychopharmacological treatment on quality of life in patients with OCD.. Using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS) and the World Health Organization Quality of Life Measurement Instrument Short Form, Turkish Version (WHOQOL-Bref TR) we assessed 53 patients who met the DSM-IV criteria for OCD to establish baseline values. The patients were consecutively assigned to receive either sertraline (100-200 mg/day), fluvoxamine (200-300 mg/day) or paroxetine (40-80 mg/day). We reassessed 36 (68%) of the initial group after 12 weeks.. The scores of obsession, compulsion and depression severity at follow-up were significantly lower than those of baseline scores. There is no significant difference between the pre and post-treatment quality of life domain scores. While psychological health scores at follow-up was significantly associated with baseline HDRS scores (r=-0.35, p<0.05), social relationship scores at follow-up was significantly associated with baseline social relationship scores (r=0.63, p<0.001) and compulsion scores (r=-0.37, p<0.05). Regression analyses revealed that social relationship scores at follow-up was associated with baseline compulsion severity whereas other follow-up quality of life domain scores were not predicted by any baseline variable.. Clinical viewpoint and objective evaluations should be essential in the evaluation of treatment outcome, and quality of life researches may be important complement to clinical researches.

Topics: Adult; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Paroxetine; Psychiatric Status Rating Scales; Quality of Life; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

The selective serotonin (5-HT) reuptake inhibitors (SSRIs) represent the first-line pharmacotherapy for obsessive-compulsive disorder (OCD), and atypical antipsychotic drugs, which block 5-HT2A receptors, are used in augmentation strategies. Opiate drugs are also effective in treatment-refractory OCD and Tourette syndrome. The 5-HT2A-related behavior (i.e., head twitch) has been related with tics, stereotypes, and compulsive symptoms observed in Tourette syndrome and OCD.. The aim of this study was to explore whether 5-HT2A-related behavior is affected by atypical opiate drugs.. Head-twitch response was induced in mice by administration of either 5-hydroxytryptophan (5-HTP) or the 5-HT2A/C agonist (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI). Dose-effect curves of atypical opiate drugs [(+/-)-tramadol, (-)-methadone and levorphanol], morphine, and other psychoactive drugs (fluvoxamine, desipramine, nefazodone, and clozapine) were performed. Opioid mechanisms were investigated by administration of naloxone.. All the opiates tested reduced both 5-HTP and DOI-induced behavior in a naloxone-reversible fashion, atypical opiates being more effective. The effects of the other drugs depended on the protocol, clozapine being the most effective.. Combined 5-HT and opioid properties result in a greater efficacy in antagonizing 5-HT2A-related behavior. These results provide behavioral evidence to support convergent effects of the 5-HT and opioid systems in discrete brain areas, offering the potential for therapeutic advances in the management of refractory stereotypes and compulsive behaviors.

Topics: 5-Hydroxytryptophan; Analgesics, Opioid; Animals; Clozapine; Desipramine; Disease Models, Animal; Dose-Response Relationship, Drug; Fluvoxamine; Indophenol; Levorphanol; Male; Methadone; Mice; Morphine; Naloxone; Narcotic Antagonists; Obsessive-Compulsive Disorder; Piperazines; Receptor, Serotonin, 5-HT2A; Receptor, Serotonin, 5-HT2C; Stereotyped Behavior; Tics; Tourette Syndrome; Tramadol; Triazoles

Numerous neuroimaging studies have suggested that obsessive-compulsive disorder (OCD) patients had a neurobiological abnormality in the frontal-subcortical circuits. On the other hand, there are distinct differences in the responses to pharmacological treatment among OCD patients. In the present study, we measured the concentration of N-acetyl aspartate (NAA), a putative marker of neuronal viability, with proton magnetic resonance spectroscopy (MRS) in OCD patients with different pharmacological responses. Participants comprised 20 patients and 26 healthy control subjects. OCD patients were divided into three groups according to the pharmacological response; responders to a selective serotonin reuptake inhibitor (SSRI) (group A: n=7), responders to SSRI with an atypical antipsychotic (group B: n=8) and non-responders to either SSRI or SSRI with an atypical antipsychotic (group C: n=5). Short echo proton MRS was used to measure NAA concentrations in the anterior cingulate, the left basal ganglia and the left prefrontal lobe of subjects. A significantly lower NAA concentration was observed only in group B compared with control subjects in the anterior cingulate. Our results suggest that a subgroup of OCD patients who respond to an SSRI with an atypical antipsychotic have distinct biological abnormalities in the anterior cingulate.

Topics: Adult; Antipsychotic Agents; Aspartic Acid; Basal Ganglia; Benzodiazepines; Dominance, Cerebral; Dose-Response Relationship, Drug; Drug Therapy, Combination; Energy Metabolism; Female; Fluvoxamine; Frontal Lobe; Gyrus Cinguli; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Nerve Net; Obsessive-Compulsive Disorder; Olanzapine; Paroxetine; Prefrontal Cortex; Risperidone; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

In the present study, we examined the involvement of the sigma1 receptor in the inhibitory effect of the selective serotonin reuptake inhibitor (SSRI) fluvoxamine, compared with that of paroxetine, on marble-burying behavior, which is an animal model of obsessive-compulsive disorder. Sigma1 receptor agonists (+)-SKF 10047 and PRE-084 significantly inhibited marble-burying behavior. Sigma receptor antagonist BD 1047 and selective sigma1 receptor antagonist BD 1063 significantly attenuated the inhibition of marble-burying behavior by fluvoxamine. In contrast, selective sigma2 receptor antagonist SM-21 failed to affect the inhibition of marble-burying behavior by fluvoxamine. On the other hand, BD 1047 and BD 1063 had no effect on the inhibition of marble-burying behavior by paroxetine. These observations show that activation of the sigma1 receptor is a necessary component in the inhibitory effect of fluvoxamine on marble-burying behavior, and that the mechanism of its action is clearly different from that of paroxetine.

Topics: Animals; Behavior, Animal; Brain; Butyrates; Disease Models, Animal; Dose-Response Relationship, Drug; Ethylenediamines; Fluvoxamine; Male; Mice; Mice, Inbred ICR; Morpholines; Obsessive-Compulsive Disorder; Paroxetine; Phenazocine; Piperazines; Psychotropic Drugs; Receptors, sigma; Selective Serotonin Reuptake Inhibitors; Sigma-1 Receptor; Tropanes

Two methods for predicting remissions in obsessive-compulsive disorder (OCD) treatment are evaluated. Y-BOCS measurements of 88 patients with a primary OCD (DSM-III-R) diagnosis were performed over a 16-week treatment period, and during three follow-ups.. Remission at any measurement was defined as a Y-BOCS score lower than thirteen combined with a reduction of seven points when compared with baseline. Logistic regression models were compared with a Cox regression for recurrent events model.. Logistic regression yielded different models at different evaluation times. The recurrent events model remained stable when fewer measurements were used. Higher baseline levels of neuroticism and more severe OCD symptoms were associated with a lower chance of remission, early age of onset and more depressive symptoms with a higher chance.. Choice of outcome time affects logistic regression prediction models. Recurrent events analysis uses all information on remissions and relapses. Short- and long-term predictors for OCD remission show overlap.

Topics: Anti-Anxiety Agents; Behavior Therapy; Cognitive Behavioral Therapy; Combined Modality Therapy; Depression; Desensitization, Psychologic; Fluvoxamine; Follow-Up Studies; Humans; Logistic Models; Neurotic Disorders; Obsessive-Compulsive Disorder; Outcome and Process Assessment, Health Care; Personality Inventory; Proportional Hazards Models; Psychometrics; Randomized Controlled Trials as Topic; Recurrence

The best currently available treatments for obsessive-compulsive disorder (OCD) are serotonin reuptake inhibitors (SRIs) and cognitive-behavioral therapy (CBT). It is generally recommended that patients who have been unsuccessfully treated with SRIs should receive supplementary CBT, although few studies have yet to investigate the proposal's validity. The purpose of the present study is to examine the effectiveness of CBT on a sample of nonselected, pharmacologically treatment-resistant OCD patients.. Thirty-six OCD patients (based on DSM-IV criteria) who had not responded to at least 1 adequate SRI trial conducted in our outpatient clinic were treated from January 2000 through April 2004 with CBT, incorporating exposure and ritual prevention. The therapy was conducted in a naturalistic setting and manualized guidelines were adapted to each patient. Pharmacologic treatment underwent no changes during the trial period. Outcome measures included the Yale-Brown Obsessive Compulsive Scale, the Clinical Global Impressions-Severity of Illness scale, and the Global Assessment of Functioning scale. The primary outcome measure was a rating of "much improved" or "very much improved" on the Clinical Global Impressions-Improvement scale (CGI-I).. Two patients (5%) refused CBT after 1 session, and 10 patients (28%) dropped out of the study. Three of the 24 remaining patients completed the trial at 6 months (T1) but did not follow through up to 12 months (T2). The 21 patients completing CBT showed statistically significant improvement (p < .0001) during follow-up on all outcome measures. At T2, 15 (42%) of 36 patients were rated as being "much improved" or "very much improved," as measured by the CGI-I. Symptom reduction was clinically modest but important, with nearly all patients presenting residual symptoms.. CBT could be usefully added to pharmacologic treatments for severe, real-world, medication-resistant OCD patients.

Topics: Adult; Citalopram; Clomipramine; Cognitive Behavioral Therapy; Combined Modality Therapy; Cyclohexanols; Demography; Drug Resistance; Female; Fluoxetine; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Paroxetine; Practice Guidelines as Topic; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome; Venlafaxine Hydrochloride

The effects of milnacipran, a serotonin and noradrenaline reuptake inhibitor (SNRI) on the obsessive compulsive disorder (OCD) model, marble burying behavior, were investigated in mice. Milnacipran above the dosage of 10 mg/kg inhibited marble burying behavior significantly in mice as similar to fluvoxamine. Milnacipran inhibiting marble burying behavior did not affect locomotor activity. These results suggest that milnacipran can inhibit marble burying behavior and that milacipran may be useful for OCD therapy.

Topics: Adrenergic Uptake Inhibitors; Animals; Behavior, Animal; Cyclopropanes; Fluvoxamine; Male; Mice; Mice, Inbred ICR; Milnacipran; Motor Activity; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Dysfunction of glutamatergic neurotransmission has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD) and recent clinical reports suggest that some glutamate modulating agents are efficacious in the treatment of this disorder. N-acetylcysteine (NAC) is a readily available amino acid compound that is thought to attenuate glutamatergic neurotransmission. NAC may be useful in treating psychiatric disorders involving glutamatergic dysfunction such as OCD.. To examine the efficacy of augmentation with NAC in a patient with serotonin reuptake inhibitor (SRI)-refractory OCD.. A patient with SRI-refractory OCD was treated with an off-label use of NAC augmentation of fluvoxamine over several weeks.. NAC augmentation of fluvoxamine resulted in a marked decrease in Yale-Brown Obsessive Compulsive Scale (Y-BBOCS) score and a clinically significant improvement in OCD symptoms.. NAC augmentation was effective in treating SRI-refractory OCD in this single case. Further research is warranted to investigate the use of NAC and other glutamate modulating agents in the treatment of OCD.

Topics: Acetylcysteine; Drug Resistance; Drug Synergism; Female; Fluvoxamine; Humans; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors

Topics: Clomipramine; Cognitive Behavioral Therapy; Combined Modality Therapy; Female; Fluoxetine; Fluvoxamine; Follow-Up Studies; Gyrus Cinguli; Humans; Middle Aged; Obsessive-Compulsive Disorder; Outcome Assessment, Health Care; Psychosurgery

The authors report on the successful treatment of obsessive-compulsive disorder (OCD) in three patients with the addition of risperidone to ongoing fluvoxamine treatment. Plasma homovanillic acid (HVA), but not 3-methoxy-4-hydroxyphenylglycol (MHPG) levels decreased after risperidone administration, and plasma levels of fluvoxamine did not change. In addition, serum brain-derived neurotrophic factor (BDNF) levels were not altered after the recovery from obsessive-compulsive symptoms, indicating that serum BDNF levels might not predict the patient's response to risperidone treatment. Taken together, a combination treatment of risperdone and fluvoxamine might improve obsessive-compulsive symptoms. In short, fluvoxamine enhances the activity of the serotonergic system by inhibiting serotonin transporters, and risperidone decreases that of the dopaminergic system by blocking D2 receptors.

Topics: Adult; Antipsychotic Agents; Brain-Derived Neurotrophic Factor; Catecholamines; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fluvoxamine; Homovanillic Acid; Humans; Male; Methoxyhydroxyphenylglycol; Obsessive-Compulsive Disorder; Risperidone; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists

Topics: Adult; Behavior Therapy; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder

Functional imaging studies have pointed to a role of the orbitofrontal cortex (OFC), striatum and thalamus in the pathophysiology of obsessive-compulsive disorder (OCD). Effective treatment has been found to change brain activity within this circuitry. The aim of the present study was to explore possible differential effects of OCD responders and non-responders to drug treatment on the regional cerebral blood flow (rCBF). Measurements of rCBF were carried out in 15 out of 22 patients with OCD who completed an open-label trial with fluvoxamine. Patients were studied with 99mTc-HMPAO single photon emission computed tomography (SPECT) before and after 12 weeks of treatment. In addition, structural magnetic resonance imaging was obtained on all patients. Regions of interest comprised the OFC, caudate nucleus, putamen and thalamus. Seven patients responded to treatment. Levels of rCBF decreased significantly in the left caudate nucleus and the left and right putamen in both responders and non-responders to treatment. In responders, but not in non-responders, a significant decrease in rCBF was found in the right thalamus. Pre-treatment cerebellar and whole brain HMPAO uptake was significantly higher in responders to treatment compared with non-responders. We suggest that the thalamus plays a central role in the response to drug treatment.

Topics: Adolescent; Adult; Cerebrovascular Circulation; Female; Fluvoxamine; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Obsessive-Compulsive Disorder; Regional Blood Flow; Selective Serotonin Reuptake Inhibitors; Thalamus; Tomography, Emission-Computed, Single-Photon

Functional neuroimaging studies have implicated hyperactivity of the frontal cortex in obsessive-compulsive disorder (OCD); however, relationships between abnormal brain activity, clinical improvement, and neuropsychological function have not been clarified in OCD. To clarify the pathophysiology of this disorder, regional changes in brain function were examined during administration of cognitive and symptom provocation tasks in patients with OCD before and after treatment.. Ten outpatients with OCD participated in the study. Functional magnetic resonance imaging (fMRI) was performed before and after treatment. Stroop and symptom provocation tasks were administered during fMRI. Each patient was randomly allocated to receive either pharmacotherapy with fluvoxamine 200 mg/day (n = 4) or behavior therapy (n = 6) for 12 weeks.. After 12-week treatment, mean (+/- SD) total score on the Yale-Brown Obsessive-Compulsive Scale decreased from 29.00 +/- 3.59 to 14.60 +/- 9.22, representing symptomatic improvement from moderate to mild. After symptom improvement, symptom provocation-related activation in the orbitofrontal, dorsolateral-prefrontal, and anterior cingulate cortices decreased. Conversely, Stroop task-related activation in the parietal cortex and cerebellum increased.. After improvement of OCD with either fluvoxamine or behavioral therapy, hyperactivation of the frontal lobe related to a symptom-provocative state decreases, and posterior brain activity related to action-monitoring function increases.

Topics: Antidepressive Agents, Second-Generation; Brain; Cognition; Cognitive Behavioral Therapy; Fluvoxamine; Frontal Lobe; Magnetic Resonance Imaging; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales

A 59-year-old man, who was being trieated for schizophrenia, exhibited a concurrence of obsessive compulsive (OC) symptoms and neuroleptics-induced deficit syndrome (NIDS). His symptoms were remarkably improved by the discontinuation of neuroleptics followed by the introduction of fluvoxamine. He was originally a prudent, suspicious and unsociable person, the character of which corresponds to a schizotypal personality disorder. From his early twenties OC-symptoms appeared along the theme of cleanliness, health, and ethics. After the first half of his forties OC-symptoms worsened with the emergence of a depressive state. He consulted a psychiatric unit at the age of 49 for the first time and was diagnosed as having schizophrenia of a negative symptoms-dominant type associated with obsessive-compulsive disorder. He was started on haloperidol but the condition did not improved at all so that the dose was gradually increased. When he finally moved to our hospital at the age of 57, serious NIDS such as slow thinking, difficulty in concentration, decrease in emotional reaction, and dysphoria was recognized, in addition to parkinsonism. In order to improve the NIDS, we gradually decreased the dose and reduced the variety of neuroleptics and substituted them for risperidone alone. During these periods, no emergence of psychotic symptoms or worsening of OC-symptoms was realized. Accordingly he was admitted to our hospital and started on fluvoxamine, and the NIDS and OC-symptoms were markedly improved. In conclusion the use of neuroleptics specifically for OC-symptoms should be done very carefully in consideration of the possibility of provoking NIDS.

Topics: Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Fluvoxamine; Haloperidol; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Disorders; Risperidone; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.

Topics: Adult; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluvoxamine; Gambling; Humans; Lithium; Male; Obsessive-Compulsive Disorder; Psychometrics; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Surveys and Questionnaires; Valproic Acid

Topics: Age Factors; Aged; Aged, 80 and over; Drug Administration Schedule; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Desensitization, Psychologic; Ephedra; Eye Movements; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Phytotherapy; Plant Preparations; Recurrence; Selective Serotonin Reuptake Inhibitors; Stress Disorders, Post-Traumatic; Weight Loss

To determine the pharmacokinetics of fluvoxamine in children and adolescents and to compare pharmacokinetic data from adolescents to adults from a previous study.. Fluvoxamine was titrated to a target dose of 100 mg b.i.d. in children (6-11 years) and 150 mg b.i.d. in adolescents (12-17 years) with obsessive-compulsive disorder or other disorder requiring fluvoxamine treatment. Serum samples were collected over 12 hours after 12 or more consecutive doses of 25, 50, 100, and 150 mg.. Sixteen children (seven females, nine males) and 18 adolescents (nine females, nine males) were included in the pharmacokinetic analyses. Children demonstrated higher mean peak plasma concentration, higher mean area under the plasma concentration-time curve, and lower apparent oral clearance compared with adolescents. Compared with male children, female children had higher mean area under the plasma concentration-time curve, higher mean peak plasma concentration, and more reports of adverse events. However, the area under the plasma concentration-time curve was not directly correlated with frequency or severity of adverse events. Pharmacokinetics were nonlinear over the dose range studied. No pharmacokinetic differences were apparent between adolescents and adults on 150 mg b.i.d.. These pharmacokinetic results suggest that children (especially females) have a higher exposure to fluvoxamine than adolescents, whereas adolescents and adults appear to have similar exposure to fluvoxamine.

Topics: Adolescent; Anti-Anxiety Agents; Anxiety Disorders; Child; Cytochrome P-450 CYP2D6; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder

Topics: Cognition Disorders; Corpus Striatum; Fluoxetine; Fluvoxamine; Frontal Lobe; Humans; Nerve Net; Neuropsychological Tests; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Pathological skin-picking is a self-injurious, impulsive behaviour with repetitive, and ritualistic characteristics. A number of studies show that selective serotonin reuptake inhibitors (SSRIs) may be efficacious in reducing skin-picking behaviour. Two case reports are presented demonstrating that SSRI-treatment may induce or aggravate pathological skin-picking behaviour. Possible mechanisms of SSRI-induced pathological skin-picking and implications for clinical care are discussed.

Topics: Adult; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Paroxetine; Selective Serotonin Reuptake Inhibitors; Self-Injurious Behavior; Skin

Topics: Adolescent; Antipsychotic Agents; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Risperidone; Selective Serotonin Reuptake Inhibitors; Serotonin Receptor Agonists; Sumatriptan

An 82-year-old man with treatment-resistant depression and early Alzheimer's disease was started on methylphenidate. Significant obsessive-compulsive behavior ensued but diminished over several weeks when methylphenidate was replaced by fluvoxamine. The patient had no prior psychiatric history, but he had a sister with obsessive-compulsive disorder. It appears that methylphenidate precipitated the patient's pathological behavior.

Topics: Aged; Aged, 80 and over; Anti-Anxiety Agents; Antidepressive Agents, Second-Generation; Anxiety Disorders; Buspirone; Central Nervous System Stimulants; Depressive Disorder; Dose-Response Relationship, Drug; Drug Therapy, Combination; Fluvoxamine; Follow-Up Studies; Humans; Male; Methylphenidate; Obsessive-Compulsive Disorder

To determine whether panic disorder is associated with elevated serum cholesterol levels. Serum cholesterol levels of panic disorder patients are reported to be elevated. This could explain the higher-than-expected cardiovascular mortality in this population. Some evidence exists wherein cholesterol levels are also increased in patients with general anxiety disorder and phobias. To date, there are only 2 reports on cholesterol levels of obsessive-compulsive disorder (OCD) patients, giving controversial results.. We compared serum cholesterol levels of anxiety disorder patients, OCD patients, and normal control subjects with each other (n = 60 in each group). Serum cholesterol was measured in each subject before treatment. Subjects of the 3 groups were matched by age and sex.. Patients with anxiety disorders and OCD had elevated cholesterol levels, compared with normal control subjects. Cholesterol levels in OCD patients were comparable with those in patients with phobia.. Our data support the assumption that elevation in cholesterol level is not a specific feature of panic disorder (as most assumed), but more generally associated with anxiety disorders. Increased cholesterol levels in patients with anxiety disorders and OCD may be of clinical relevance.

Topics: Adult; Agoraphobia; Anxiety Disorders; Cholesterol; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Panic Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Comorbidity; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Risperidone; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Sleep Disorders, Circadian Rhythm; Treatment Outcome

The purpose of this study was to identify neuroimaging predictors of medication response in contamination-related obsessive compulsive disorder (OCD). Prior studies of OCD had indicated that glucose metabolic rates within orbitofrontal cortex (OFC) were inversely correlated with subsequent response to serotonergic reuptake inhibitors (SRIs) and that glucose metabolic rates within posterior cingulate cortex (PCC) were positively correlated with subsequent response to cingulotomy. Nine subjects with contamination-related OCD underwent a 12-week open trial of treatment with the SRI fluvoxamine. Percent change in Yale-Brown Obsessive Compulsive Scale score, from pre- to post-treatment, served as the index of treatment response. Positron emission tomography (PET) measurements of regional cerebral blood flow (rCBF) were obtained prior to treatment, in the context of a symptom provocation paradigm. Statistical parametric mapping was used to identify brain loci where pre-treatment rCBF was significantly correlated with subsequent treatment response. Consistent with a priori hypotheses, lower rCBF values in OFC and higher rCBF values in PCC predicted better treatment response. This same pattern of associations was present regardless of whether the imaging data were acquired during a provoked or neutral state. These findings are consistent with prior studies of OCD, indicating that PET indices of brain activity within OFC are inversely correlated with subsequent response to SRIs. In addition, similar to findings regarding cingulotomy for OCD, indices of activity within PCC appear to be positively correlated with response to fluvoxamine as well. Finally, this pattern is sufficiently robust as to be relatively independent of symptomatic state at the time of tracer uptake.

Topics: Adolescent; Analysis of Variance; Cerebrovascular Circulation; Cohort Studies; Female; Fluvoxamine; Forecasting; Gyrus Cinguli; Humans; Linear Models; Male; Obsessive-Compulsive Disorder; Tomography, Emission-Computed

Topics: Adolescent; Amphetamine-Related Disorders; Antidepressive Agents; Antitussive Agents; Anxiety Disorders; Child; Dextromethorphan; Diagnosis, Differential; Drug Interactions; Female; Fluvoxamine; Hallucinogens; Humans; Male; N-Methyl-3,4-methylenedioxyamphetamine; Obsessive-Compulsive Disorder; Seizures; Selective Serotonin Reuptake Inhibitors; Serotonin Agents; Serotonin Syndrome; Sertraline

To present the case of a patient with acquired deafness who experienced musical hallucinations (MH) and to conduct a review of the relevant literature.. Although MH have been known to occur in some people with deafness, literature on this phenomenon, especially from the perspective of etiology and treatment, is limited.. The case report was prepared using a detailed history, general psychiatric and neurologic examinations, and neurobehavioral assessments, and the pertinent literature from 1965 to 2000 was reviewed.. The patient whose case is reported here had acquired deafness and was assessed to have MH and obsessive-compulsive symptoms that responded to the use of nonantipsychotic medication.. The phenomenon of MH with hearing problems that are either prelingual or acquired can exist separately or be a part of constellation of psychiatric symptoms. No precise etiologic basis is yet clearly identifiable; however, this report offers support for a central mechanism explained by the "Release Theory." Additionally, it appears that such hallucinations might be managed safely with psychotropic medications other than antipsychotics.

Topics: Adult; Carbamazepine; Comorbidity; Deafness; Drug Therapy, Combination; Fluvoxamine; Hallucinations; Humans; Male; Obsessive-Compulsive Disorder; Tinnitus

Pediatric populations, including those with autistic disorder or other pervasive developmental disorders, increasingly are being prescribed selective serotonin reuptake inhibitors (SSRIs). Little is known about the age-related brain pharmacokinetics of SSRIs; there is a lack of data regarding optimal dosing of medications for children. The authors used fluorine magnetic resonance spectroscopy ((19)F MRS) to evaluate age effects on whole-brain concentrations of fluvoxamine and fluoxetine in children taking SSRIs.. Twenty-one pediatric subjects with diagnoses of autistic disorder or other pervasive developmental disorders, 6-15 years old and stabilized with a consistent dose of fluvoxamine or fluoxetine, were recruited for the study; 16 successfully completed the imaging protocol. Whole-brain drug levels in this group were compared to similarly acquired data from 28 adults.. A significant relationship between dose and brain drug concentration was observed for both drugs across the age range studied. Brain fluvoxamine concentration in the children was lower, consistent with a lower dose/body mass drug prescription; when brain concentration was adjusted for dose/mass, age effects were no longer significant. Brain fluoxetine concentration was similar between age groups; no significant age effects on brain fluoxetine drug levels remained after adjustment for dose/mass. Observations of brain fluoxetine bioavailability and elimination half-life also were similar between age groups.. These findings suggest that fluvoxamine or fluoxetine prescriptions adjusted for dose/mass are an acceptable treatment approach for medicating children with autistic disorder or other pervasive developmental disorders. It must be determined whether these findings can be generalized to other pediatric populations.

Topics: Adolescent; Adult; Age Factors; Autistic Disorder; Brain; Brain Chemistry; Child; Child Development Disorders, Pervasive; Depressive Disorder; Dose-Response Relationship, Drug; Fluorine; Fluoxetine; Fluvoxamine; Half-Life; Humans; Magnetic Resonance Spectroscopy; Middle Aged; Obsessive-Compulsive Disorder; Panic Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Adolescent; Dopamine Antagonists; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Risperidone; Schizophrenia; Selective Serotonin Reuptake Inhibitors

Topics: Adolescent; Age Factors; Anti-Anxiety Agents; Child; Drug Approval; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Patient Selection; Selective Serotonin Reuptake Inhibitors; United States; United States Food and Drug Administration

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Polypharmacy; Priapism; Risperidone; Schizophrenia; Treatment Outcome

The aim of this study was to evaluate which clinical variables might influence the antiobsessional response to proserotonergic drugs in a sample of patients with obsessive-compulsive disorder (OCD). One hundred fifty-nine patients with DSM-IV OCD underwent a 12-week standardized treatment with fluvoxamine, clomipramine, citalopram, or paroxetine. According to treatment response, defined as a reduction of the Yale-Brown Obsessive Compulsive Scale total score >35%, patients were divided into two groups. Ninety patients (56.6%) responded to treatment and 69 (43.4%) did not. Responders had a significantly higher frequency of positive family history for OCD (FH-OCD) in their first-degree relatives, whereas nonresponders had an earlier onset and a higher frequency of "poor insight" subtype and somatic obsessions. The predictive value of all these variables was tested by a stepwise logistic regression analysis that confirmed poor insight and FH-OCD to be the best predictors of poor and good drug treatment response, respectively. These preliminary findings need additional investigations toward a better definition of the genetic and biological heterogeneity of patients with OCD, and they underlie the importance of collecting the insight score and family history for psychiatric disorders in the pretreatment assessment.

Topics: Adolescent; Adult; Aged; Analysis of Variance; Citalopram; Clomipramine; Drug Resistance; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Paroxetine; Predictive Value of Tests; Psychological Tests; Random Allocation; Regression Analysis; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Topics: Antidepressive Agents, Second-Generation; Female; Fluvoxamine; Humans; Middle Aged; Obsessive-Compulsive Disorder; Sulpiride

Focal issues of recent research on obsessive-compulsive disorders have been the involvement of the frontostriatal system in the patho-physiology, as well as the manner of effect and efficacy of the serotonin reuptake inhibitors that unfold their specific efficacy in the frontostriatal system. The course of treatment among adolescent inpatients with obsessive-compulsive disorder was analyzed with regard to the medications used and their effects upon the course of treatment.. The data for all adolescents with obsessive-compulsive disorder admitted as inpatients to the Hospital for Child and Adolescent Psychiatry and Psychotherapy in Mannheim since 01.01.1990 were analyzed with regard to medication and the parameters for course and outcome.. Five patients dropped out of treatment, five patients received no medication, eight received sulpiride, ten were treated with clomipramine, and three with fluvoxamine. The average length of inpatient stay was longer for the groups treated with sulpiride and clomipramine than for the group that received no medication, but equivalent for these two medication groups. The success of treatment for obsessive-compulsive disorder was rated as higher in these two groups than in the group without medication. On sulpiride, patients gained weight and exhibited fatigue and increased levels of prolactin. On clomipramine, half of the patients exhibited cardiac side effects.. This small, nonrandomized medicated sample analyzed under non-double-blind conditions shows no difference in the efficacy of clomipramine and sulpiride under post hoc analysis. Rather, the side effects that occurred in patients on clomipramine indicate a more frequent use of SSRI to increase compliance as regards medication intake.

Topics: Adolescent; Behavior Therapy; Child; Clomipramine; Combined Modality Therapy; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Prefrontal Cortex; Retrospective Studies; Sampling Studies; Selective Serotonin Reuptake Inhibitors; Serotonin; Sulpiride; Treatment Outcome

The authors present data from an open trial of fluvoxamine (median daily dosage: 200 mg) in the treatment of generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder in 19 older outpatients (mean age = 66.8). Of the 12 subjects completing the 21-week trial, 8 achieved a good response (50% reduction in symptom measures) and 7 were rated as much or very much improved. Fluvoxamine pharmacotherapy also had a significant effect in reducing comorbid depressive symptoms and in increasing levels of functioning. These data support the effectiveness of fluvoxamine in older subjects with anxiety disorders (particularly generalized anxiety disorder) and warrant further double-blind, placebo-controlled evaluation.

Topics: Aged; Ambulatory Care; Anxiety Disorders; Comorbidity; Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Fluvoxamine; Humans; Middle Aged; Obsessive-Compulsive Disorder; Panic Disorder; Treatment Outcome

Interest in the treatment of pediatric obsessive-compulsive disorder (OCD) has increased as our knowledge of adult OCD has expanded. Although adults are still the majority of patients, children and adolescents with OCD are being identified and treated more frequently. As this population is better identified, prognostic factors need to be addressed to improve treatment outcome. The purpose of this study was to determine the role of family psychiatric pathology in fluvoxamine treatment outcome. Eleven children and adolescents with OCD and one of their parents participated in the study. Four parents were diagnosed with OCD, six had an Axis I diagnosis other than OCD, and one had no mental disorder [Structured Clinical Interview for the DSM-Non-Patient edition (SCID-NP)]. Each patient received fluvoxamine for 58 weeks. Dependent measures included the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the NIMH-Global Obsessive Compulsive Scale (NIMH-GOCS) and the Clinical Global Impression (CGI). Based on CY-BOCS, CGI and NIMH-GOCS scores, patients with parents who have OCD showed a clinically and statistically significant reduction in symptoms from pre- to post-treatment. Patients whose parents did not have OCD also improved. However, the improvement was statistically but not clinically significant. The presence of OCD in one parent seems to modify a child's response to medication. The results suggest that family psychopathology, specifically presence of OCD, may contribute to treatment efficacy. Further research is suggested in this area.

Topics: Adolescent; Adolescent Behavior; Adult; Anti-Anxiety Agents; Child; Child Behavior; Family Health; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Parent-Child Relations; Prognosis; Treatment Outcome

Topics: Adolescent; Female; Fluvoxamine; Humans; Japan; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

A few studies have tried antipsychotic augmentation in obsessive-compulsive disorder (OCD) patients who are non-responders to selective serotonin reuptake inhibitors. The aim of this study was to investigate the efficacy and tolerability of olanzapine addition to fluvoxamine-refractory OCD patients and to assess if a comorbid chronic tic disorder or a concomitant schizotypal personality disorder was associated with response. Twenty-three OCD non-responders to a 6-month, open-label trial with fluvoxamine (300 mg/day) entered a 3-month open-label trial of augmentation with olanzapine (5 mg/day). OC symptom change was measured with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression (CGI) scale. Differences between responders and non-responders were assessed with regard to age, sex, duration of illness, baseline Y-BOCS score, and comorbidity with chronic tic disorders or schizotypal personality disorder. A significant decrease of mean Y-BOCS score between pre- and post-treatment (26. 8+/-3.0 vs. 18.9+/-5.9) was found at endpoint. Ten patients (43.5%) were rated as responders. The most common side effects were mild to moderate weight gain and sedation. In our sample, three patients (13. 04%) had a chronic motor tic disorder, and four (17.39%) had a codiagnosis of schizotypal personality disorder. Concomitant schizotypal personality disorder was the only factor significantly associated with response. It appears that augmentation of olanzapine in fluvoxamine-refractory OCD may be effective in a large number of patients, including those with comorbid schizotypal personality disorder.

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Benzodiazepines; Comorbidity; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Schizotypal Personality Disorder; Tic Disorders; Treatment Outcome

Topics: Child; Enuresis; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

No consistent predictors of outcome have been identified for the pharmaco-therapy of obsessive-compulsive disorder (OCD). Recent factor analytic studies have identified meaningful symptom dimensions that may be related to response to serotonin reuptake inhibitors and other treatments.. A total of 354 outpatients with primary OCD were administered the Yale-Brown Obsessive Compulsive Scale Symptom Checklist, and its 13 main symptom categories were factor analyzed by using principal components analysis. The identified symptom dimensions were then entered into multiple regression models as outcome predictors of response to serotonin reuptake inhibitors and placebo response in a group of 150 nondepressed subjects who completed six double-blind, placebo-controlled trials with a serotonin reuptake inhibitor (clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine). Eighty-four patients received a serotonin reuptake inhibitor and 66, placebo.. The principal components analysis identified five factors that explained 65.5% of variance in outcome: symmetry/ordering, hoarding, contamination/cleaning, aggressive/checking, and sexual/religious obsessions. Serotonin reuptake inhibitors were significantly superior to placebo on all outcome measures. Initial severity of OCD was related to greater posttreatment severity of OCD. Higher scores on the hoarding dimension predicted poorer outcome following treatment with serotonin reuptake inhibitors, after control for baseline severity. No predictors of placebo response were identified. Exclusion of clomipramine did not modify the overall results, suggesting a cross-serotonin reuptake inhibitor effect.. The identified symptom dimensions are largely congruent with those identified in earlier reports. Patients with OCD vary in their response to treatment with serotonin reuptake inhibitors. The presence of hoarding obsessions and compulsions is associated with poorer response to serotonin reuptake inhibitors.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Clomipramine; Comorbidity; Controlled Clinical Trials as Topic; Factor Analysis, Statistical; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Inventory; Placebo Effect; Placebos; Probability; Psychiatric Status Rating Scales; Regression Analysis; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Tic Disorders; Treatment Outcome

A patient with obsessive-compulsive disorder (OCD) onset resulting from a traumatic head injury underwent longitudinal brain imaging evaluation. Structural and functional brain imaging studies were repeatedly performed before and after treatment. Computerized tomography (CT) demonstrated bilateral prefrontal contusions immediately following the trauma and prior to the onset of OCD. Magnetic resonance imaging (MRI) demonstrated bilateral cortical abnormalities in the prefrontal and anterior-temporal regions a few months following the onset of OCD. Almost concurrently, single photon emission computerised tomography (SPECT) demonstrated bilateral perfusion deficits in fronto-temporal regions, and asymmetric increased perfusion in the anterior striatum. Six months later, after clinical improvement, a second SPECT study demonstrated improvement of brain perfusion, mostly in the striatum. The reflection of these results on a possible model of brain pathogenesis in OCD, and the role of brain imaging in neuropsychiatric evaluation, are demonstrated.

Topics: Adult; Anti-Anxiety Agents; Cerebral Cortex; Corpus Striatum; Craniocerebral Trauma; Fluvoxamine; Humans; Magnetic Resonance Imaging; Male; Obsessive-Compulsive Disorder; Radiography; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Pirenzepine; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

Topics: Adult; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Attention Deficit Disorder with Hyperactivity; Clomipramine; Depressive Disorder; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder

Topics: Adult; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Clomipramine; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder

Topics: Adult; Clozapine; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia, Paranoid; Selective Serotonin Reuptake Inhibitors; Sertraline

We have studied fasting plasma tryptophan (TRP) levels and tryptophan/large neutral amino acid (TRP/LNAA) ratios in 12 patients with obsessive-compulsive disorder (OCD) and 12 patients with OCD and a coexisting current diagnosis of major depressive disorder (OCD-MDD). Assessments were made at baseline and after 6 weeks of treatment with fluvoxamine. OCD-MDD patients had significantly lower baseline TRP levels and TRP/LNAA ratios than OCD patients. After 6 weeks of fluvoxamine treatment, OCD-MDD patients had significant increases in plasma TRP and TRP/LNAA ratio, whereas OCD patients had non-significant decreases. Our data suggest that a major depressive syndrome could be a state variable affecting the changes in plasma TRP and TRP/LNAA ratio in OCD patients.

Topics: Adult; Depressive Disorder; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Tryptophan

Topics: Antipsychotic Agents; Clozapine; Cytochrome P-450 CYP1A2; Drug Interactions; Fluvoxamine; Humans; Obsessive-Compulsive Disorder

The prolactin (PRL) responses to oral d-fenfluramine (30 mg) and placebo were assessed in 13 patients with obsessive-compulsive disorder (OCD) and in matched healthy subjects. After the neuroendocrine test, all patients were treated with fluvoxamine maleate (150-300 mg/day). At the end of the 10th week of treatment, 10 patients underwent again the neuroendocrine assessment. In drug-free patients, the PRL response to d-fenfluramine was significantly lower than in the comparison group. After 10-week fluvoxamine treatment, the PRL response to the serotonergic agent normalized. These findings suggest that, at least at the neuroendocrine level, central serotonergic responsivity is reduced in drug-free OCD patients, and that long-term fluvoxamine administration is associated with its normalization.

Topics: Adolescent; Adult; Brain; Female; Fenfluramine; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Prolactin; Selective Serotonin Reuptake Inhibitors; Serotonin; Serotonin Agents

A high degree of comorbidity appears to exist between obsessive-compulsive disorder (OCD) and depression, both with respect to symptomatology and at the syndromal level. It has been argued that nonspecific effects on dysphoric mood, anxiety, and depressive symptoms account for the therapeutic efficacy of antidepressants in OCD. However, several controlled studies have shown that neither the presence nor initial severity of depression has any impact on therapeutic improvement in OCD. In particular, studies with the serotonin selective reuptake inhibitors (SSRIs) fluvoxamine and fluoxetine have revealed beneficial effects in OCD, irrespective of the presence of depressive symptoms. The efficacy of the other SSRIs in OCD requires further study. In conclusion, the improvement in OC symptoms seen with fluvoxamine and fluoxetine does not depend on concomitant affective disorder.

Topics: Comorbidity; Depressive Disorder; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Antidepressive Agents, Second-Generation; Comorbidity; Compulsive Behavior; Fluvoxamine; Humans; Obsessive-Compulsive Disorder

Kleptomania is currently classified in psychiatric nomenclature as one of the impulse control disorders (DSM-IV, 1994). It is characterized by repeated failure to resist impulses to steal objects, not for personal use or monetary gain. The objects are therefore discarded, given away, or hoarded (ICD-10, 1992). This disorder is known since the early 18th century from the phenomenological and clinical viewpoints, yet is still debated with regard to therapeutic strategies and criminal liability. Although there are usually complications associated with the legal consequences of being caught and arrested, subjects continue to violate the law despite repeated arrests and convictions. In a 28-year old man suffering from kleptomania, years of psychodynamic psychotherapy were ineffective. Only when he was treated as suffering from an impulse control disorder or a variant of obsessive-compulsive disorder, was there significant improvement. The positive response to buspirone (5-HT1A) augmentation of fluvoxamine (SSRI) suggested that disturbed central serotonergic neurotransmission might play an important role in the pathogenesis of kleptomania. This concept is strengthened by the comorbidity of the syndrome with depression and by its compulsive traits. We stress that although kleptomaniacs cannot differentiate between right and wrong, testing shows that their sense of reality is intact, but they act under the influence of drives they cannot resist.

Topics: Adult; Buspirone; Disruptive, Impulse Control, and Conduct Disorders; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychotherapy; Syndrome; Theft

Topics: Adult; Alopecia Areata; Antidepressive Agents, Second-Generation; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder

To report a serotonin syndrome reaction in a patient taking fluvoxamine to replace an earlier SSRI agent.. A female patient with Obsessive Compulsive Disorder on paroxetine after resurgence in her obsessive ruminations was started on fluvoxamine 50 mg daily. One week later she became suicidal and was hospitalized. The fluvoxamine was increased to 50 mg morning and 100 mg bedtime and the paroxetine was discontinued. Over the next few days she began to have trouble with her concentration. A low grade fever set in after she experienced auditory hallucinations. Fluvoxamine was discontinued and she had an uneventful recovery after twenty-four hours.. Fluvoxamine is a recently approved serotonin selective reuptake inhibitor (SSRI) with few side effect profiles. It is effective in the treatment of Depressive Disorder and Obsessive Compulsive Disorder and is used to potentiate or replace other anti-OCD drugs including already available serotonin specific reuptake inhibitors (SSRI). We wish to draw attention to the potential for serotonin syndrome in patients on fluvoxamine who may have previously been on other SSRIs.

Topics: Adult; Antidepressive Agents, Second-Generation; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Paroxetine; Psychoses, Substance-Induced; Selective Serotonin Reuptake Inhibitors; Syndrome; Time Factors

Interest in the association of obsessive-compulsive (OC) symptoms and schizophrenia has been reawakened since the introduction of clozapine for treatment of schizophrenia. We describe the appearance of this disorder and examine the efficacy of adding fluvoxamine to ongoing clozapine treatment of the OC and schizophrenic symptoms. Four patients with DSM-III-R schizophrenic disorder, in whom OC symptoms appeared during the course of clozapine treatment, are reported. In two patients, fluvoxamine, a serotonin-selective reuptake inhibitor (SSRI), was added to clozapine under open-trial conditions. The patients were serially assessed by using the Brief Psychiatric Rating Scale, Yale-Brown Obsessive-Compulsive Scale, and Scale for the Assessment of Negative Symptoms. The de novo occurrence and eventual spontaneous reduction of OC symptoms were noted in two schizophrenic patients treated with clozapine. In the other two patients, one with previous and the other with a family history of OC disorder, the addition of fluvoxamine to clozapine was effective in eliminating the OC symptoms. A concomitant improvement in the schizophrenic symptomatology was seen as well. It appears that disabling OC symptoms may occur as in response to clozapine treatment in chronic drug-resistant schizophrenic patients. Some of the latter may benefit from the addition of an SSRI to the ongoing clozapine regimen.

Topics: Adult; Clozapine; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia

Topics: Adult; Comorbidity; Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fluvoxamine; Half-Life; Humans; Obsessive-Compulsive Disorder; Orgasm; Sexual Dysfunctions, Psychological

Topics: Adult; Akathisia, Drug-Induced; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Out of ten consecutive patients with DSM-III-R obsessive-compulsive disorder without any previous history of bipolarity, three patients showed antidepressant-induced hypomania (clomipramine, one patient; fluvoxamine, two patients) within the first 5 to 8 weeks of the drug treatment. These data support the previous results on a strong association between obsessive-compulsive disorder and bipolar affective illness.

Topics: Adolescent; Adult; Affective Disorders, Psychotic; Antidepressive Agents; Clomipramine; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Bulimia; Clozapine; Dose-Response Relationship, Drug; Drug Monitoring; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Schizophrenia

Topics: Drug Therapy, Combination; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Risperidone; Treatment Outcome

A 38-year-old patient with severe obsessive-compulsive disorder received fluvoxamine in a clinical study. Psychometric ratings showed marked clinical improvement in the third week of fluvoxamine administration, but after 8 weeks, at a dose of 300 mg per day, he suffered a grand mal seizure after drinking a glass of beer (0.2 liter). He had no history of previous epileptic seizures. Careful neurological evaluation including computer tomography and magnetic resonance imaging of the brain revealed no signs of acute disease. EEG before the fit did not show epileptiform activity; after the fit, spikes and spike-wave complexes appeared, which disappeared upon discontinuation of fluvoxamine. Since his obsessive-compulsive symptoms had responded well to fluvoxamine and worsened after its discontinuation, the drug was cautiously reintroduced. Improvement of the obsessive-compulsive symptoms was observed again, but spikes and spike-wave complexes reappeared at a dose of 50 mg per day. Under anticonvulsant treatment with carbamazepine, fluvoxamine was increased to 100 mg per day. No seizures occurred during a follow-up to two years.

Topics: Adult; Alcohol Drinking; Antidepressive Agents; Beer; Electroencephalography; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Seizures

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.

Topics: Adult; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Risperidone; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Treatment Outcome

The selective serotonin reuptake inhibitor (SSRI) fluvoxamine has been used in an attempt to understand whether there is a biological distinction among anxiety disorders. A comparison of fluvoxamine with the specific noradrenaline reuptake inhibitor maprotiline in patients with panic disorder showed fluvoxamine to be a potent anti-panic agent, whereas maprotiline had no effect on the frequency of panic attacks. This result supported the hypothesis of serotonergic involvement in the pathogenesis of panic disorder. In a second study, unlike fluvoxamine, the 5-HT2A/2C antagonist ritanserin had no effect on the number of panic attacks, or phobic avoidance. This suggested that the efficacy of antidepressants in panic disorder was not a result of down-regulation of postsynaptic 5-HT2 receptors. Most studies suggest that the efficacy of antidepressants in obsessive-compulsive disorder (OCD) is not related to their antidepressant or mood-enhancing effects. Fluvoxamine has also been shown to reduce general and phobic anxiety in social phobia patients. In conclusion, serotonergic systems are implicated in the pathophysiology of global anxiety irrespective of the nosological background, and SSRIs, exemplified by fluvoxamine, appear to be effective in panic disorder, OCD and probably also social phobia.

Topics: Anxiety Disorders; Fluvoxamine; Humans; Maprotiline; Obsessive-Compulsive Disorder; Panic; Receptors, Serotonin; Ritanserin; Selective Serotonin Reuptake Inhibitors; Time Factors

Extrapyramidal side effects induced by some selective serotonin reuptake inhibitors (SSRIs), i.e. fluoxetine and sertraline, have been previously reported in patients with depression and obsessive-compulsive disorder (OCD). However, the occurrence and management of akathisia induced by fluvoxamine have not been described. In the presented case fluvoxamine-induced akathisia in an OCD patient was partially resistant to the anticholinergic agent biperiden, and was successfully treated with the 5-HT2A/5-HT2C antagonist mianserin. Mianserin (15 mg/day at 21.00 h) was discontinued and then reinstituted (off-on-off-on design). Biperiden was transiently effective in the acute akathisia, while the more persistent akathisia was alleviated by mianserin. Discontinuation of mianserin resulted in recurrence of akathisia, while full amelioration of the symptoms of akathisia was noted when mianserin was reinstituted. No aggravation of OCD symptoms was noted during mianserin administration.

Topics: Adult; Akathisia, Drug-Induced; Biperiden; Fluvoxamine; Follow-Up Studies; Humans; Male; Mianserin; Obsessive-Compulsive Disorder

Topics: Drug Approval; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; United States

Topics: Fluvoxamine; Humans; Obsessive-Compulsive Disorder

Wisconsin Card Sorting Test (WCST) performances were studied in 33 patients with obsessive-compulsive disorder (OCD) and 33 age-, sex-, and education-matched normal comparison subjects; the OCD patients were divided into four subgroups on the basis of their symptomatology. Neither the two groups of subjects nor the four OCD subgroups differed on any of the WCST neuropsychological indices. No relationship was demonstrated between test performance and clinical-epidemiological characteristics of the OCD patients. All of the OCD patients were being treated with fluvoxamine maleate, which improves OCD symptoms and could also improve WCST performances. Nevertheless, no remarkable differences in the WCST indices were observed in patients treated with fluvoxamine when compared with patients who had not received a specific therapy for at least 3 weeks. Since the WCST is widely considered sensitive to dysfunction of the dorsolateral prefrontal cortex, our results do not support the involvement of that brain region in OCD.

Topics: Anti-Anxiety Agents; Attention; Discrimination Learning; Female; Fluvoxamine; Humans; Male; Neurocognitive Disorders; Neuropsychological Tests; Obsessive-Compulsive Disorder; Pattern Recognition, Visual; Prefrontal Cortex; Problem Solving

Topics: Buspirone; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychoses, Substance-Induced; Receptors, Serotonin; Serotonin Antagonists; Serotonin Receptor Agonists; Syndrome

The case of a 20 year old autistic woman with disabling repetitive behaviour that responded dramatically to treatment with fluvoxamine is reported. The connection between repetitive symptoms in autism and obsessive-compulsive disorder is considered, and the need for further evaluation of selective serotonin reuptake inhibitors in autism is discussed.

Topics: Adult; Autistic Disorder; Behavior; Female; Fluvoxamine; Follow-Up Studies; Humans; Obsessive-Compulsive Disorder; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Drug Therapy, Combination; Fluvoxamine; Humans; Isoxazoles; Male; Obsessive-Compulsive Disorder; Piperidines; Receptors, Serotonin; Risperidone; Schizophrenia; Schizophrenic Psychology; Serotonin

A 14-year-old boy with obsessive-compulsive disorder (OCD) developed, under fluvoxamine treatment, acute symptoms of Tourette's syndrome (TS) with aggravation of the OCD. The TS symptoms did not respond to dopamine blockers and disappeared only after withdrawal of fluvoxamine. Readministration of fluvoxamine caused a re-emergence of the same symptoms.

Topics: Adolescent; Arousal; Drug Therapy, Combination; Fluvoxamine; Humans; Loxapine; Male; Neurologic Examination; Obsessive-Compulsive Disorder; Recurrence; Sulpiride; Tourette Syndrome

Paraphilias are psychosexual disorders that are usually conceptualized as deviant in nature. Yet in some cases, paraphilia can be conceptualized as an obsessive compulsive disorder.. We describe an exhibitionist treated under partial single-blind conditions (patient was blind to placebo but was aware he was receiving desipramine and fluvoxamine) with the serotonin selective reuptake inhibitor fluvoxamine, followed by desipramine and a placebo that looked like fluvoxamine, in an ABACA design. He was serially assessed with the Yale-Brown Obsessive Compulsive Scale.. Fluvoxamine eliminated the undesired impulse and behavior without affecting sexual desire. Desipramine and single-blind fluvoxamine-placebo treatment were both associated with relapses.. A subset of paraphiliacs may be suffering from obsessive-compulsive-related disorders and may benefit from serotonergic agents.

Topics: Adult; Desipramine; Exhibitionism; Fluvoxamine; Humans; Male; Masturbation; Obsessive-Compulsive Disorder; Placebos; Psychiatric Status Rating Scales; Single-Blind Method; Treatment Outcome

Topics: Adult; Clomipramine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Severity of Illness Index

Obsessive-compulsive disorder (OCD) is an intriguing, difficult problem characterized by anxiety-producing intrusive thoughts and performance of anxiety-reducing rituals. Current evidence suggests that OCD may be associated with dysregulation of serotonin and dopamine neurotransmission. Numerous early studies involving the serotonin-specific reuptake inhibitor clomipramine led to the formulation of this hypothesis. Positive results with clomipramine initiated further research with other serotonin-specific reuptake inhibitors, such as fluoxetine, fluvoxamine, sertraline, and serotonergic agents such as buspirone and trazodone. Findings from a number of clinical trials suggest that drugs that inhibit serotonin reuptake or affect serotonergic transmission in other ways are of clear benefit in the treatment of OCD. These drugs may be more effective for obsessive thoughts than for compulsive rituals. Effective pharmacotherapy can dramatically decrease obsessive-compulsive symptoms and improve the patient's quality of life.

Topics: 1-Naphthylamine; Antidepressive Agents; Anxiety Disorders; Clomipramine; Depression; Dopamine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Serotonin; Sertraline; Synaptic Transmission; Trazodone

Topics: Adult; Aged; Antidepressive Agents, Tricyclic; Body Image; Delusions; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Inventory; Retrospective Studies

Topics: Adolescent; Adult; Aggression; Arousal; Depression; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Social Behavior

Topics: Bipolar Disorder; Clomipramine; Dose-Response Relationship, Drug; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Risk Factors

Topics: Adult; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Serotonin

We report a case of combined levomepromazine-fluvoxamine treatment-induced seizures. It seems that combined treatment of fluvoxamine with phenothiazines may possess proconvulsive activity.

Topics: Adult; Drug Therapy, Combination; Epilepsy, Tonic-Clonic; Female; Fluvoxamine; Humans; Methotrimeprazine; Obsessive-Compulsive Disorder; Schizotypal Personality Disorder

Paraphilias and related disorders have recently been thought of as sexual addictions. However, it has also been argued that these disorders are sexual compulsions. The question arises as to whether these disorders and obsessive compulsive disorder respond in the same way to pharmacotherapy.. We retrospectively reviewed outcome in 13 patients who presented with sexual symptoms and were treated with serotonin reuptake blockers. Symptoms were divided into paraphilias, nonparaphilic sexual addictions, and sexual obsessions.. Paraphilias had the least improvement, while sexual obsessions had the best response to medication.. Paraphilias and related disorders may be less responsive than sexual obsessions or compulsions to serotonin reuptake blockers. Perhaps paraphilias and related disorders are on the impulsive rather than the compulsive end of the spectrum of obsessive compulsive disorders. Controlled trials are, however, necessary to replicate these preliminary findings.

Topics: Adolescent; Adult; Behavior, Addictive; Clomipramine; Fenfluramine; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Neurotransmitter Uptake Inhibitors; Obsessive-Compulsive Disorder; Paraphilic Disorders; Psychiatric Status Rating Scales; Retrospective Studies; Serotonin

Treatment of obsessive compulsive disorder (OCD) with serotonin reuptake blockers has been demonstrated effective in 50% to 60% of patients in open and placebo-controlled studies. However, some reports indicate that comorbid Axis II psychopathology, including avoidant personality disorder, and deficiency of social skills could be predictors of a poor response to treatment in OCD patients.. A retrospective review elicited 12 patients who met DSM-III-R diagnostic criteria for both OCD and social phobia and were treated in our clinic last year with adequate trials of serotonin reuptake blockers or MAOIs.. Only 3 (27%) of the 11 patients treated with serotonin reuptake blockers had a substantial improvement of OCD symptoms. Among them, only 1 (11%) of 9 patients with generalized subtype of social phobia versus 2 (100%) of 2 patients with the nongeneralized subtype responded to serotonin reuptake blockers. Four (80%) of 5 patients with comorbid generalized social phobia receiving phenelzine had marked improvement of OCD symptoms. In general, response of social phobia occurred parallel to that of OCD.. Comorbid generalized social phobia seems to be associated with a poor response to serotonin reuptake blockers in OCD patients. Deficient social skills, as well as distinct biological mechanisms, may be involved. MAOIs might be an effective alternative medication in refractory cases. Larger and controlled studies are needed to define the implications of the association of OCD and social phobia.

Topics: Adult; Clomipramine; Comorbidity; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Phenelzine; Phobic Disorders; Probability; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Magnetic resonance images were used to measure the volume of the head of the caudate nucleus in 20 patients with obsessive-compulsive disorder and 16 normal control subjects. The obsessive-compulsive patients showed a significant increase in the volume of the right side of the head of the caudate nucleus compared with that of control subjects. This finding was not correlated with demographic, psychopathological, or clinical characteristics.

Topics: Adult; Basal Ganglia; Brain; Clomipramine; Female; Fluvoxamine; Functional Laterality; Humans; Magnetic Resonance Imaging; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Radiography; Trigeminal Caudal Nucleus

Topics: Adult; Bipolar Disorder; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome

Topics: Bipolar Disorder; Fluvoxamine; Humans; Obsessive-Compulsive Disorder

Topics: Clomipramine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Research Design; Serotonin Antagonists

Topics: Adult; Antidepressive Agents; Compulsive Personality Disorder; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Serotonin Antagonists

Nine of 17 patients with obsessive-compulsive disorder responded when neuroleptic was added to fluvoxamine with or without lithium. Comorbid occurrence of tic spectrum disorders or of schizotypal personality disorder was associated with response. Abnormalities in brain dopamine and serotonin may be implicated in such patients.

Topics: Adult; Antipsychotic Agents; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Lithium; Male; Obsessive-Compulsive Disorder; Oximes; Schizotypal Personality Disorder; Serotonin Antagonists; Tic Disorders

Seven patients who met DSM-III-R criteria for obsessive compulsive disorder and had only a partial response to the serotonin reuptake blockers fluoxetine, fluvoxamine, or clomipramine or were unable to tolerate therapeutic doses of these agents due to side effects underwent open treatment with fenfluramine augmentation. Fenfluramine is a serotonin releaser and reuptake blocker which is marketed as an anorectic agent. In doses of 20 to 60 mg/day, fenfluramine augmentation was well tolerated and resulted in a further decrease in obsessions and compulsions in six of these patients. Larger controlled studies are needed to confirm this finding.

Topics: Adult; Clomipramine; Drug Administration Schedule; Drug Therapy, Combination; Female; Fenfluramine; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Oximes; Serotonin Antagonists

Topics: Antidepressive Agents; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Oximes; Serotonin Antagonists

Eight patients with depersonalization disorder or with depersonalization symptoms in association with obsessive-compulsive and panic disorders were treated with serotonin reuptake blockers. There was clinical overlap of depersonalization disorder with obsessive-compulsive disorder, and the co-occurrence of obsessive-compulsive and panic features with depersonalization in these patients was associated with a favorable treatment outcome. The chronicity of illness and lack of prior response to a variety of treatments in these patients highlights the positive outcome with this treatment. In addition, issues are raised regarding the current hierarchical exclusion of depersonalization disorder in the presence of obsessive-compulsive and panic disorders.

Topics: Adolescent; Adult; Clomipramine; Depersonalization; Dose-Response Relationship, Drug; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Oximes; Panic; Serotonin Antagonists

This is a single-case report of fluvoxamine treatment of comorbid autistic disorder (AD) and obsessive-compulsive disorder (OCD). Psychological, neuroanatomical, and neurochemical parallels are drawn between AD and OCD. The implications of this case of coincident AD and OCD, as well as the response to fluvoxamine, are discussed with respect to nosology, pathophysiology, and treatment of these disorders.

Topics: Adult; Autistic Disorder; Dose-Response Relationship, Drug; Fluvoxamine; Humans; Male; Neurocognitive Disorders; Obsessive-Compulsive Disorder; Oximes; Serotonin Antagonists

Fluvoxamine, a potent and selective serotonin uptake inhibitor, effectively reduced compulsive handwashing and other rituals in a patient previously refractory to behaviour therapy, clomipramine, MAO inhibitors and other pharmacotherapy. Treatment effect was delayed but broadly patholytic, reducing anxiety and depression scores as well as ratings of obsessiveness.

Topics: Adult; Antidepressive Agents; Female; Fluvoxamine; Hospitalization; Humans; Obsessive-Compulsive Disorder; Oximes; Personality Tests

Patients with obsessive-compulsive disorder complain of anxiety-producing intrusive thoughts and/or perform repetitive, anxiety-reducing rituals. A combination of behavior therapy and drug therapy is generally beneficial in this relatively common disorder. Behavior therapy consists of exposing patients to anxiety-provoking situations and helping them avoid ritualistic responses. Drug therapy appears to work by blocking serotonin reuptake in the brain.

Topics: Adult; Behavior Therapy; Clomipramine; Diagnosis, Differential; Female; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Oximes; Physicians, Family; Serotonin Antagonists

Topics: Behavior Therapy; Clomipramine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Oximes

The development design and reliability of the Yale-Brown Obsessive Compulsive Scale have been described elsewhere. We focused on the validity of the Yale-Brown Scale and its sensitivity to change. Convergent and discriminant validity were examined in baseline ratings from three cohorts of patients with obsessive-compulsive disorder (N = 81). The total Yale-Brown Scale score was significantly correlated with two of three independent measures of obsessive-compulsive disorder and weakly correlated with measures of depression and of anxiety in patients with obsessive-compulsive disorder with minimal secondary depressive symptoms. Results from a previously reported placebo-controlled trial of fluvoxamine in 42 patients with obsessive-compulsive disorder showed that the Yale-Brown Scale was sensitive to drug-induced changes and that reductions in Yale-Brown Scale scores specifically reflected improvement in obsessive-compulsive disorder symptoms. Together, these studies indicate that the 10-item Yale-Brown Scale is a reliable and valid instrument for assessing obsessive-compulsive disorder symptom severity and that it is suitable as an outcome measure in drug trials of obsessive-compulsive disorder.

Topics: Adult; Ambulatory Care; Antidepressive Agents; Anxiety Disorders; Depressive Disorder; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Oximes; Psychiatric Status Rating Scales; Psychometrics; Sensitivity and Specificity; Severity of Illness Index

Topics: Adult; Anxiety Disorders; Fear; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Oximes; Panic

Topics: Adult; Drug Synergism; Drug Therapy, Combination; Fenfluramine; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Oximes; Receptors, Serotonin