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OCD Patients on Serotonin Reuptake Inhibitor Should Be Given Cognitive-Behavior Therapy Before Antipsychotic to Relieve Ongoing Symptoms

New Study by Dr. Blair Simpson
September 11, 2013


 Contact:         Dacia Morris


                        (212) 543-5421


EMBARGOED UNTIL: Wednesday, September 11 at 4 p.m. EST



New Study:  OCD Patients on Serotonin Reuptake Inhibitor Should Be Given Cognitive-Behavior Therapy Before Antipsychotic to Relieve Ongoing Symptoms


New York, NY – September 9, 2013 – A new multi-site study of obsessive–compulsive disorder (OCD) treatment, and the first to compare the two recommended treatments for ongoing OCD symptoms, found that cognitive-behavioral therapy (CBT) was superior to the antipsychotic medication risperidone as an add-on treatment to a serotonin reuptake inhibitor (SRI).The study will be published online in JAMA Psychiatry on September 11.


While SRIs are FDA-approved for OCD, a significant number of patients remain crippled by unremitting symptoms, leaving clinicians to grapple with what treatment to try next. Practice guidelines, note the authors, recommend adding either an antipsychotic or exposure and ritual prevention therapy (EX/RP), which involves confronting the feared object or idea without engaging in the usual compulsive response.


“These data lead to new treatment recommendations for OCD,” said Blair Simpson, MD, PhD, professor of clinical psychiatry at Columbia University Medical Center and director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute. “OCD patients on SRIs who still have ongoing symptoms should be offered CBT before an antipsychotic like risperidone.”


Dr. Simpson and colleagues recruited 100 adults with OCD, all of whom had received 12 weeks of SRI but were still experiencing moderately severe symptoms. Patients were randomized to receive 8 weeks of risperidone, EX/RP, or a placebo as an add-on to their SRI treatment. The authors found that 80 percent of patients receiving EX/RP showed improvement, compared with about 23 percent of those treated with risperidone and 15 percent with placebo. Furthermore, 43 percent of patients who received EX/RP experienced remission, more than the 13 percent on risperidone and the 5 percent who received placebo.


Funding for this research study was provided by National Institute of Mental Health grants R01 MH045436 and R01 MH45404.


Conflict of Interest Disclosures: During this study, in addition to medication at no cost from Janssen Scientific Affairs LLC, Dr. Simpson received research funds from Transcept Pharmaceuticals (2011-2013) and Neuropharm Ltd (2009), served on a scientific advisory board for Pfizer (for Lyrica, 2009-2010) and Jazz Pharmaceuticals (for Luvox CR [controlled release], 2007-2008), and received royalties from Cambridge University Press and UpToDate Inc. Dr. Foa was a consultant  to Jazz Pharmaceuticals (for Acetelion) and receives royalties from Bantam and Oxford University Press for book sales, including a manual of cognitive-behavioral therapy for OCD. Dr. Liebowitz received research funds from pharmaceutical companies (Abbott, Allergan, AstraZeneca, Avera, Cephalon, Endo, Forest, GlaxoSmithKline, Gruenthal, Horizon, Indevus, Jazz Pharmaceuticals, Johnson & Johnson, Lilly, Lundbeck, MAP, Novartis, Ortho-McNeil, Pfizer, PGX Health, Purdue Pharma, Sepracor, Takeda, Tikvah, and Wyeth), consulted (for AstraZeneca, Avera, Eisai, Lilly, Otsuka, Pfizer, Pherin Pharmaceutical, Takeda, Tikvah, and Wyeth), presented talks or posters (for Pherin Pharmaceutical, Pfizer, and Wyeth), has equity ownership in Pherin Pharmaceutical, ChiMatrix LLC (ended 2011) and the Liebowitz Social Anxiety Scale, and has licensed software for the Liebowitz Social Anxiety Scale to Avera, Endo, GlaxoSmithKline, Indevus, Lilly, Pfizer, Servier, and Tikvah. Dr. Hahn received research funds from AstraZeneca, GlaxoSmithKline, and Pfizer. No other disclosures were reported.




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