Het gebruik van antipsychotica bij therapieresistente obsessief-compulsieve stoornis: een systematische literatuurstudie

Abstract

The use of antipsychotics in refractory obsessive-compulsive disorder: a systematic review Obsessive-compulsive disorder (OCD) is a psychiatric diagnosis, characterized by obsessions and/or compulsions. The primary pharmacological treatment consists of selective serotonin reuptake inhibitors (SSRIs). In practice, only 40% to 60% of the patients reaches clinical response on SSRI treatment. The objective of this literature study is to make an analysis of the literature concerning the efficacy of antipsychotic augmentation in refractory OCD. A systematic literature search was performed in the PubMed and Web of Science databases. The inclusion criteria (among others) were limited to double-blind, randomized and placebo-controlled clinical studies (RCTs). Twelve RCTs were included: 3 studies comparing risperidone to a placebo, 1 comparing aripiprazole to a placebo, 2 comparing olanzapine to a placebo, 1 comparing paliperidone to a placebo, 4 comparing quetiapine to a placebo and 1 comparing quetiapine to clopramine and a placebo. A descriptive analysis and an overview of the results were drawn up. There is rather limited scientific evidence for augmentation treatment with antipsychotics in refractory OCD. Each of the included trials individually shows a certain positive effect, but they globally have several shortcomings. Especially the heterogeneity between the different trials makes a comparative analysis difficult. There is a need for more well-designed and homogeneous research in this field. Due to the lack of evidence, it is rather premature to formulate recommendations on antipsychotic augmentation.