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Risperidone Appears Safe, Effective as Augmentation Strategy in Patients With Resistant Obsessive-Compulsive Disorder

Use of risperidone may be an effective and well-tolerated augmentation strategy in subjects with obsessive-compulsive disorder (OCD) who are resistant to serotonin reuptake inhibitors (SRIs), according to the findings of a new study.

Some previous studies have suggested that risperidone augmentation in resistant OCD patients causes extrapyramidal symptoms and akathisia.

To evaluate this issue further, Eric Hollander, MD, with the Mount Sinai School of Medicine, New York, United States, and colleagues conducted a double-blind, placebo-controlled trial. They evaluated the efficacy and tolerability of 8 weeks of risperidone augmentation of SRI treatment in 16 adult subjects with treatment-resistant OCD, defined as failure of at least two SRI trials.

Ten patients were randomly assigned to augmentation with 8 weeks of risperidone (0.5-3.0 mg/d) and 6 to placebo (n = 6), following at least 12 weeks of SRI treatment.

Four patients on risperidone and none on placebo responded with both a Clinical Global Impression - Improvement (CGI-I) score of 1 or 2 and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decrease of 25% or more.

The researchers found that risperidone was generally well tolerated. Three patients dropped out, 1 was on risperidone and 2 on placebo. In addition, better Y-BOCS insight score at baseline significantly correlated with a greater CGI-I score at endpoint on risperidone augmentation.

Dr. Hollander and colleagues conclude that "risperidone was well tolerated in this augmentation trial, and there was no significant difference in dropout rates due to adverse events with risperidone augmentation versus placebo."

The researchers point out that the response rate of 40% on risperidone versus 0% on placebo is consistent with that of previous studies, suggesting that approximately 30 to 50% of resistant OCD patients may respond to augmentation with an atypical antipsychotic such as risperidone.

They note that "controlled studies in larger samples are needed to replicate these preliminary findings to confirm tolerance over long-term treatment." They also point out that the duration of risperidone augmentation and ways to manage withdrawal of therapy need to be established.



Int J Neuropsychopharmacol 2003 Oct 31;[Epub ahead of print]. "Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study"

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