The objective of this study was to investigate, in a single-blind manner over a period of 12 weeks, the efficacy and tolerability of venlafaxine versus clomipramine in the treatment of obsessive-compulsive disorder (OCD).
Patients with a DSM-IV diagnosis of OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) score >/= 16 were randomly assigned to receive venlafaxine, 225 to 350 mg/day (26 patients), or clomipramine, 150 to 225 mg/day (47 patients), for 12 weeks, with dosage adjustments according to tolerability and response to treatment. All patients were medication-free from at least 2 months prior to study enrollment. Efficacy measures were the YBOCS and the Clinical Global Impressions scale (CGI), which were completed at baseline and every 4 weeks. We defined responders as patients who had an improvement from baseline in YBOCS score of >/= 35% and a CGI score </= 2. An investigator who was blinded to patients' current medication administered rating scales independently. Moreover, patients were instructed not to reveal their current treatment to this investigator.
Twenty-five patients in the venlafaxine group and 40 in the clomipramine group completed the 12-week trial. Responder rates at the end of the 12 weeks were 36% for venlafaxine (9/25) versus 50% for clomipramine (20/40) according to the visitwise analysis and 34.6% (9/26) for venlafaxine versus 42.6% (20/47) for clomipramine according to the last-observation-carried-forward analysis, with no statistically significant difference between the 2 drugs. Adverse experiences were reported by 61.5% of patients receiving venlafaxine (16/26) and by 91.5% of those receiving clomipramine (43/47).
Our results indicate that venlafaxine might be as efficacious as clomipramine in the acute treatment of OCD, with fewer side effects.
"At study entry, general sociodemographic information (age, gender, occupational and marital status) was collected for each subject. Clinical data (age at OCD onset, duration of illness, Axis I and II comorbidities) were obtained through the administration of a semistructured interview that we developed and used in previous studies     and included the SCID-I and II. In addition, the following rating scales were included in the assessment: Y-BOCS  , Hamilton Anxiety Rating Scale (HAM-A) and 17-item Hamilton Depression Rating Scale (HAM-D)  . "
[Show abstract][Hide abstract] ABSTRACT: Objective:
The increased risk for metabolic syndrome (MetS) in individuals with schizophrenia and bipolar disorder has been documented. No study examined MetS in patients with obsessive-compulsive disorder (OCD), despite the fact that a great proportion of them are treated with antipsychotic addition. The aim of our study was to investigate the prevalence and the sociodemographic and clinical correlates of MetS in an Italian sample of patients with OCD.
Subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, OCD and a Yale-Brown Obsessive-Compulsive Scale score ≥ 16 were included. Sociodemographic and clinical characteristics, current and lifetime pharmacological treatments, lifestyle information, and comorbidity for cardiovascular diseases and diabetes were collected. MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III modified criteria.
We enrolled 104 patients with OCD. MetS was present in 21.2% (95% confidence interval: 13.7%-30.3%) of the sample. Abdominal obesity was present in 36.5%, hypertension in 42.3%, high triglycerides in 23.1%, low high-density lipoprotein cholesterol levels in 22.1% and fasting hyperglycemia in 4.8% of the sample. MetS was associated with cigarette smoking (duration of cigarette smoking), absence of physical activity, a higher body mass index and a greater proportion of obesity. Among pharmacological treatments, MetS was associated with the duration of the exposure (lifetime) to antipsychotics.
This is the first study that examined the prevalence and correlates of MetS in a sample of patients with OCD. Our cross-sectional evaluation found a prevalence of MetS higher than those reported in the Italian general population, although the confidence interval encompasses the general population estimate reported. Patients with OCD on antipsychotic treatment are particularly at risk for MetS and should be carefully monitored for metabolic abnormalities and cardiovascular complications.
General hospital psychiatry 11/2012; 35(2). DOI:10.1016/j.genhosppsych.2012.10.004 · 2.61 Impact Factor
"Venlafaxine has been found to have efficacy equivalent to that of clomipramine in short-term treatment, but with a more favorable safety profile.61 The majority of venlafaxine trials have demonstrated the efficacy of this compound in short-term and medium-term trials and in both treatment-naïve and treatment-resistant obsessive patients. "
[Show abstract][Hide abstract] ABSTRACT: Obsessional states show an average point prevalence of 1%-3% and a lifetime prevalence of 2%-2.5%. Most treatment-seeking patients with obsessions continue to experience significant symptoms after 2 years of prospective follow-up. A significant burden of impairment, distress, and comorbidity characterize the course of the illness, leading to an increased need for a better understanding of the nature and management of this condition. This review aims to give a representation of the current pharmacological and psychotherapeutic strategies used in the treatment of obsessive-compulsive disorder. Antidepressants (clomipramine and selective serotonin reuptake inhibitors) are generally the first-line choice used to handle obsessional states, showing good response rates and long-term positive outcomes. About 40% of patients fail to respond to selective serotonin reuptake inhibitors. So far, additional pharmacological treatment strategies have been shown to be effective, ie, administration of high doses of selective serotonin reuptake inhibitors, as well as combinations of different drugs, such as dopamine antagonists, are considered efficacious and well tolerated strategies in terms of symptom remission and side effects. Psychotherapy also plays an important role in the management of obsessive-compulsive disorder, being effective for a wide range of symptoms, and many studies have assessed its long-term efficacy, especially when added to appropriate pharmacotherapy. In this paper, we also give a description of the clinical and psychological features likely to characterize patients refractory to treatment for this illness, with the aim of highlighting the need for greater attention to more patient-oriented management of the disease.
"SNRIs lack CMI’s antagonism of alpha-1-adrenergic, cholinergic, and histaminergic receptors, and thus are less likely to trigger orthostatic hypotension, dry mouth, and urinary retention.90 In a small adult comparator study, VEN showed similar efficacy to CMI, and was better tolerated.91 In the only placebo-controlled VEN trial at a target dose of 225 mg daily in adults, a trend toward improvement was noted at 8 weeks, a short duration for an OCD trial. "
[Show abstract][Hide abstract] ABSTRACT: Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder. While medication and psychotherapy advances have been very helpful to patients, many patients do not respond adequately to initial trials of serotonergic medication or cognitive-behavioral therapy (CBT) and require multiple treatment trials or combination therapies. Comorbidity may also influence treatment response. The role of streptococcal infections in pediatric OCD has become an area of intense scrutiny and controversy. In this article, current treatment methods for OCD will be reviewed, with special attention to strategies for treating OCD in children and in patients with comorbid tic disorders. Alternative psychotherapy strategies for patients who are highly anxious about starting CBT, such as cognitive therapy or augmentation with D-cycloserine, will be reviewed. Newer issues regarding use of antibiotics, neuroleptics, and glutamate modulators in OCD treatment will also be explored.
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