Obsessive-compulsive disorder, frontostriatal system and effect upon the serotonergic system

Objectives: Focal issues of recent research on obsessive-compulsive disorde rs have been the involvement of the frontostriatal system in the patho-phys iology, as well as the manner of effect and efficacy of the serotonin re-up take inhibitors the unfold their specific efficacy in the frontostriatal sy stem. The course of treatment among adolescent inpatients with obsessive-co mpulsive disorder was analyzed with regard to the medications used and thei r effects upon the course of treatment. Methods: The data for all adolescents with obsessive-compulsive disorder ad mitted as inpatients to the Hospital for Child and Adolescent Psychiatry in Mannheim since 01.01.1990 were analyzed with regard to medication and the parameters for course and outcome. Results: Five patients dropped out of treatment, five patients received no medication, eight received sulpiride, ten were treated with clomipramine, a nd three with fluvoxamine. The average length of inpatient stay was longer for the groups treated with sulpiride and clomipramine than for the group t hat received no medication, but equivalent for theses two groups. The succe ss of treatment for obsessive-compulsive disorder was rated as higher in th ese 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. Conclusions: 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 occur red in patients on clomipramine indicate a more frequent use of SSRI to inc rease compliance as regards medication intake.