Tag-arkiv: Serotonin

High-Dose Pharmaca Treatment Nonresponders to Acute Treatment for Obsessive-Compulsive Disorder

OCD suffers not responding to standard drug and CBT treatment might get greater symptom improvement with high-dose drug treatment. The Journal of Clinical Psychiatry has published a research article about high-dose treatment:

High-Dose Sertraline Strategy for Nonresponders to Acute Treatment for Obsessive-Compulsive Disorder: A Multicenter Double-Blind Trial Objective: To evaluate the efficacy and safety of high-dose sertraline for patients with obsessive-compulsive disorder (OCD) who failed to respond to standard sertraline acute treatment.

Method: Sixty-six nonresponders to 16 weeks of sertraline treatment who met DSM-III-R criteria for current OCD were randomly assigned, in a double-blind continuation phase of a multicenter trial, either to continue on 200 mg/day of sertraline or to increase their dose to between 250 and 400 mg/day for 12 additional weeks. Efficacy measures included the Yale-Brown Obsessive Compulsive Scale (YBOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH Global OC Scale), and the Clinical Global Impressions-Severity of Illness and -Improvement (CGI-I) scales. Data were collected from July 26, 1994, to October 26, 1995.

Results: The high-dose (250-400 mg/day, mean final dose= 357, SD = 60, N = 30) group showed significantly greater symptom improvement than the 200-mg/day group (N = 36) as measured by the YBOCS (p=.033), NIMH Global OC Scale (p = .003), and CGI-I (p = .011). Responder rates (decrease in YBOCS score of > = 25% and a CGI-I rating < = 3) were not significantly different for the 200-mg/day versus the high-dose sertraline group, either on completer analysis, 34% versus 52%, or on endpoint analysis, 33% versus 40%. Both treatments showed similar adverse event rates.

Conclusion: Greater symptom improvement was seen in the high-dose sertraline group compared to the 200-mg/day dose group during continuation treatment. Both dosages yielded similar safety profiles. Administration of higher than labeled doses of selective serotonin reuptake inhibitors may be a treatment option for certain OCD patients who fail to respond to standard acute treatment.

(J Clin Psychiatry 2006;67:15-22) The research is rather old, done back in 1995 and another thing is its sponsored by Pfizer, the maker of the SSRI sertraline (Zoloft). At the other hand high-dose treatment is not a new thing and drugs like clomipramine (Anafrenil) and paroxetine (Paxil/Seroxat) have been tested too and proven effective. Evidence-based pharmacotherapy of obsessive-compulsive disorder. Fineberg NA, Gale TM., Int J Neuropsychopharmacol. 2005 Mar;8(1):107-29. Epub 2004 Sep 28. Read the entire article at the journals homepage A qualitative analysis of nonresponse: management of treatment-refractory obsessive-compulsive disorder, Pallanti S, Hollander E, Goodman WK., J Clin Psychiatry. 2004;65 Suppl 14:6-10.

New treatment guidlines for OCD by NICE

Today The National Institute for Health and Clinical Excellence (NICE) in England published a new guidelines set to improve identification,diagnosis and treatment of obsessive-compulsive disorder in children and adults.

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Handbook of OCD: Concepts and Controversies

A new very interesting book is being published july 2005.

Handbook of OCD: Concepts and Controversies
Jonathan S. Abramowitz (Editor), Arthur C. Houts (Editor)

Product Details:
Concepts and Controversies in Obsessive-Compulsive Disorder
Series: Series in Anxiety and Related Disorders,
Abramowitz, Jonathan S.; Houts, Arthur C. (Eds.)
2005, XIV, 803 p. 5 illus., Hardcover
Publisher: Springer-Verlag New York Inc.

You can pre-order it at amazon.co.uk

Here is some information about the book:

Synopsis
Few conditions are as fascinating to a psychologist as obsessive-compulsive disorder (OCD), and few generate as much controversy. Experts disagree over topics related to classification, etiology, and treatment, and differing points of view also occur along disciplinary lines between psychology and psychiatry. Because of the insularity of various scientific communities that study OCD, there is rarely a forum for examining these issues from various perspectives, and for trying to provide a more complex and multifaceted picture of the disorder. This volume creates such a forum.

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Combined Cognitive-Behavior Therapy Plus Sertraline May Be Best for Children and Adolescents With Obsessive-Compulsive Disorder

Medscape Oct. 27, 2004.

News Author: Laurie Barclay, MD

Combined cognitive-behavior therapy (CBT) with sertraline may be best for adolescents with obsessive-compulsive disorder (OCD), according to the results of a randomized trial published in the Oct. 27 issue of JAMA. �The empirical literature on treatment of obsessive-compulsive disorder (OCD) in children and adolescents supports the efficacy of short-term OCD-specific cognitive behavior therapy (CBT) or medical management with selective serotonin reuptake inhibitors ([S]SRIs),� write John S. March, MD, MPH, from Duke University Medical Center in Durham, North Carolina, and colleagues from the Pediatric OCD Treatment Study (POTS) Team. �However, little is known about their relative and combined efficacy.� Læs resten