RISPERIDONE AUGMENTATION OF SRI TREATMENT FOR REFRACTORY OBSESSIVE-COMPULSIVE DISORDER

Background: Although serotonin reuptake inhibitors (SRIs) are the main stay of pharmacologic treatment for obsessive-compulsive disorder (OCD ), many patients do not have an adequate response to these medications . One approach to treating SRI-refractory OCD patients has been to add other classes of medications to the SRI. We. predicted that augmentat ion with risperidone would alleviate symptoms in SRI-refractory OCD pa tients. Method: 21 patients were treated openly with the combination o f an SRI and adjunctive risperidone (mean dose = 2.75 mg/day). All met DSM-IV criteria for obsessive-compulsive disorder and had a variety o f comorbid disorders. Prior to addition of risperidone, all patients h ad failed to respond to at least one adequate trial of an SRI. Respons e was determined by clinical judgment and standardized rating scales. Results: 5 (24%) of the 21 patients experienced side effects (most com monly, akathisia), which forced discontinuation of risperidone. Of the 16 patients who tolerated combined treatment, 14 (87%) had substantia l reductions in obsessive-compulsive symptoms within 3 weeks. Patients with horrific mental imagery had the strongest and fastest response, often within a few days. Patients with comorbid psychotic disorders im proved gradually over 2 to 3 weeks, Patients with comorbid tic disorde rs had the poorest rate of response and highest rate of akathisia. Con clusion: These results suggest that risperidone augmentation is effect ive and well tolerated in patients with SRI-refractory obsessive-compu lsive disorder. Response to risperidone augmentation appears to be inf luenced by symptom subtypes and comorbid conditions. Controlled trials are required to confirm the efficacy of risperidone augmentation for refractory OCD.