Intravenous clomipramine and obsessive-compulsive disorder

A 62 year old woman presented with a long history of obsessive-compulsive disorder, the symptoms of which were not adequately controlled by oral clomipramine. The patient was started on intravenous clomipramine. Drug levels of both clomipramine and its active metabolite desmethylclomipramine were measured. Symptoms were controlled during her hospital stay. A three year follow-up report indicated the patient is doing well with no evidence of obsessive-compulsive or depressive symptoms. A discussion of the blood levels obtained and the caution to be exercised during intravenous administration is presented.     

Prolactin in childhood obsessive-compulsive disorder: clinical correlates and response to clomipramine

Basal prolactin concentrations were measured before treatment in 18 children and adolescents with obsessive-compulsive disorder as well as in 15 of these patients after 4 and 8 weeks of clomipramine treatment. Basal prolactin levels were influenced by a history of chronic tic disorder and by the duration and severity of obsessive-compulsive symptoms. Clomipramine administration significantly increased basal prolactin levels. A slight decline in prolactin levels during the last 4 weeks of clomipramine treatment was positively correlated with a favorable treatment response and negatively correlated with duration of illness. If the changes in prolactin levels observed during clomipramine treatment are due primarily to changes in serotonergic neurotransmission, these data suggest that clomipramine treatment of obsessive-compulsive disorder produces an adaptive decrease in the responsiveness of serotonergic receptors.     

西酞普兰与氯米帕明治疗强迫症对照研究

目的：比较西酞普兰与氯米帕明治疗强迫症的疗效和不良反应。方法：以西酞普兰和氯米帕明治疗强迫症各30例,疗程8周。应用Yale—Brown强迫症量表（Y—BOCS）、汉密尔顿抑郁量表（HAUD）及汉密尔顿焦虑量表（HAMA）评定疗效。结果：西酞普兰组与氯米帕明组治疗后Y-BOCS、HAMD、HAMA分值均显著下降,两组间差异无显著性。西酞普兰组不良反应明显少于氯米帕明组。结论：西酞普兰治疗强迫症疗效与氯米帕明相仿,不良反应较轻,值得推广。     

Serotonergic responsivity in obsessive-compulsive disorder. Effects of chronic clomipramine treatment

Clomipramine is a potent serotonin reuptake blocker that decreases the symptoms of obsessive-compulsive disorder (OCD). To investigate whether clomipramine treatment in OCD affects brain serotonergic responsiveness, metachlorophenylpiperazine (mCPP), a selective serotonin agonist, and placebo were given under double-blind conditions to nine patients with OCD before and after treatment with clomipramine. Unlike our previous observations of a marked transient increase in obsessional symptoms and anxiety following 0.5 mg/kg of mCPP, readministration of mCPP after four months of treatment with clomipramine did not significantly increase obsessional symptoms and anxiety. Similarly, the hyperthermic effect of mCPP observed before treatment was eliminated after treatment with clomipramine. These findings are consistent with the development of adaptive subsensitivity to the serotonergic agonist mCPP during clomipramine treatment. A similar alteration in the response to endogenous serotonin may mediate clomipramine's antiobsessional effects.     

A double-blind desipramine substitution during long-term clomipramine treatment in children and adolescents with obsessive-compulsive disorder

Twenty-six children and adolescents with severe primary obsessive-compulsive disorder receiving long-term clomipramine hydrochloride maintenance treatment (mean +/- SD, 17.1 +/- 8.3 months; range, 4 to 32 months) entered an 8-month double-blind desipramine hydrochloride substitution study to assess the necessity of continued drug treatment. All patients received clomipramine for the first 3 months, then half continued with clomipramine therapy (nonsubstituted group) and half had desipramine blindly substituted for the next 2 months; all subjects again received clomipramine for the last 3 study months. Eight (89%) of nine of the substituted and only two (18%) of 11 of the nonsubstituted group subjects relapsed during the 2-month comparison period. Long-term clomipramine treatment seems necessary for this population of children and adolescents with obsessive-compulsive disorder. However, even patients receiving maintenance clomipramine treatment throughout the entire study had continued obsessive-compulsive symptoms, which varied in severity over time.     

Controlled comparison of buspirone and clomipramine in obsessive-compulsive disorder

Eighteen outpatients with obsessive-compulsive disorder were treated with either buspirone, a partial serotonin agonist, or clomipramine, a serotonin uptake inhibitor, in a double-blind, random-assignment study. Both drugs led to statistically significant and similar improvements in scores on the Yale-Brown Obsessive-Compulsive Rating Scale and other obsessive-compulsive and depression scales. This preliminary result warrants further exploration with a larger sample and other serotonergic agents.     

Pharmacotherapy of childhood obsessive-compulsive disorder

OCD appears in children and adolescents in virtually the same form as adults. Antipsychotics, anxiolytics, and antidepressants (other than CMI and other serotonergic reuptake blockers) are not consistently helpful in treating OCD. Adult controlled studies have found that CMI, a serotonin reuptake blocker, is selectively and specifically effective for treating OCD. The two controlled studies of CMI in a pediatric sample found that CMI was significantly better than placebo and desipramine in ameliorating the symptoms of OCD. CMI appears to be safe, well tolerated, and effective for OCD at dosages targeting 3 mg per kg per day in children and adolescents. Further studies of its use in long-term maintenance are indicated. Based on anecdotal information, fluoxetine appears to be promising for use in OCD, although it is currently only approved for use as an antidepressant in adults. Fluvoxamine, which has not been tried in a pediatric population, appears to be efficacious for adult OCD. Controlled studies of their safety and efficacy in the pediatric population need to be done. The long-term prognosis for children with OCD is unknown. It appears that all treatment modalities should be utilized, including psychopharmacologic, behavioral, and other psychotherapeutic interventions.     

A case report of refractory obsessive-compulsive disorder improved by risperidone augmentation of clomipramine treatment

A male patient aged 43 years, suffering from symptoms of obsessive-compulsive disorder (OCD), such as washing hands and feet frequently and checking documents compulsively, had received intensive pharmacotherapeutic and behavior therapy. Although the administration of anxiolytic drugs and/or clomipramine did not show curative effects, a combination of clomipramine and risperidone showed much greater effect in improving these symptoms.     

Clomipramine treatment of obsessive-compulsive disorder. II. Biochemical aspects

Concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), the dopamine metabolite homovanillic acid, and the noradrenaline metabolite 4-hydroxy-3-methoxyphenyl glycol were measured in CSF before and after three weeks' treatment of severe obsessive-compulsive disorder with clomipramine hydrochloride. Patients who responded to clomipramine treatment had significantly higher CSF levels of 5-HIAA before treatment. The amelioration of obsessive-compulsive symptoms was positively correlated to the reduction of CSF concentrations of 5-HIAA during clomipramine treatment but negatively correlated to plasma concentrations of clomipramine. Reduction of CSF concentrations of 5-HIAA, which probably reflects drug action on central serotonin neurons, was maximal at a plasma clomipramine concentration of about 300 nmole/L. At higher levels, the reduction of CSF levels of 5-HIAA was smaller. The antiobsessive effect of clomipramine may be connected to its capacity to inhibit serotonin uptake.     

帕罗西汀与氯米帕明治疗难治性强迫症对照研究

目的：观察帕罗西汀和氯米帕明对难治性强迫症的疗效和不良反应。方法：对难治性强迫症患者60例,随机分为两组,分别用帕罗西汀和氯米帕明治疗8周。采用强迫症量表（Y-BOCS）和副反应量表（TESS）评价疗效及不良反应。结果：两药的总体疗效相仿。帕罗西汀对强迫行为疗效较好,不良反应小,尤其是心血管系统及抗胆碱能不良反应少。结论：帕罗西汀尤适用于以强迫行为为主的难治性强迫症患者。     

舍曲林与氯丙咪嗪治疗少年强迫症的对照研究

目的 探讨舍曲林与氯丙咪嗪治疗少年强迫症的临床疗效及不良反应.方法 将64例少年强迫症患者随机分为舍曲林组和氯丙咪嗪组,疗程均为8周.分别于治疗前和治疗后2、4、6、8周采用Yale-Brown强迫量表(Y-BOCS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效,采用副反应量表(TESS)评定不良反应.结果 舍曲林组和氯丙咪嗪组治疗后,Y-BOCS、HAMD、HAMA分值均显著下降,差异无统计学意义.舍曲林不良反应发生率明显少于氯丙咪嗪.结论 舍曲林治疗少年强迫症与氯丙咪嗪疗效相当,不良反应较轻.     

SSRIs治疗强迫症对照分析

目的：比较５羟色胺回收抑制剂（ＳＳＲＩｓ）与氯丙咪嗪对强迫症的临床疗效及副反应。方法：对３５例强迫症患者应用ＳＳＲＩｓ（１８例）与氯丙咪嗪（１７例）进行对照分析。采用Ｙａｌｅ－Ｂｒｏｗｎ强迫量表（Ｙ－ＢＯＣＳ）、汉密尔顿抑郁量表（ＨＡＭＤ）、副反应量表（ＴＥＳＳ）和临床疗效评定标准评定疗效及副反应。结果：ＳＳＲＩｓ与氯丙咪嗪疗效相似,两组显效率和有效率无显著差异。ＳＳＲＩｓ组副反应较氯丙咪嗪组少且     

西酞普兰与氯米帕明治疗强迫症Meta分析

目的:探讨西酞普兰与氯米帕明治疗强迫症的疗效及不良反应的差异. 方法:用Meta分析对9项西酞普兰与氯米帕明治疗强迫症对照研究进行再分析. 结果:西酞普兰治疗前后的自身对照表明治疗强迫症疗效显著(χ2=135.02,P<0.01).西酞普兰与氯米帕明在治疗2周和治疗结束时的组间疗效比较,分别为d=-0.83,95%CI(-1.34,-0.31),χ2=9.99,P<0.01;YX<合并>=-0.08,95%C/(-0.27,0.10),综合显著性检验差异无显著性(χ2=0.81,P>0.05).提示西酞普兰起效较快,两组疗效相仿.西酞普兰的不良反应显著少于氯米帕明. 结论:西酞普兰治疗强迫症疗效与氯米帕明相仿,但起效快,不良反应少.     

Post-treatment effects of exposure therapy and clomipramine in obsessive-compulsive disorder

We sought to determine whether adults with obsessive-compulsive disorder (OCD) who respond to intensive exposure and response (ritual) prevention (EX/RP) with or without clomipramine (CMI) fare better 12 weeks after treatment discontinuation than responders receiving CMI alone. After receiving 12 weeks of treatment (EX/RP, CMI, EX/RP+CMI, or pill placebo [PBO] in a randomized clinical trial conducted at three outpatient research centers), 46 adults with OCD who responded to treatment (18 EX/RP, 11 CMI, 15 EX/RP+CMI, 2 PBO) were followed after treatment discontinuation for 12 weeks. Patients were assessed every 4 weeks with the Yale-Brown Obsessive-Compulsive Scale, the National Institutes of Health Global Obsessive-Compulsive Scale, and the Clinical Global Impressions scale by an evaluator who was blind to original treatment assignment. The primary hypothesis was that EX/RP and EX/RP+CMI responders would be less likely to relapse 12 weeks after treatment discontinuation than responders to CMI alone. Twelve weeks after treatment discontinuation, EX/RP and EX/RP+CMI responders, compared to CMI responders, had a significantly lower relapse rate (4/33 = 12% versus 5/11 = 45%) and a significantly longer time to relapse. The CMI relapse rate was lower than previously reported. Nonetheless, responders receiving intensive EX/RP with or without CMI fared significantly better 12 weeks after treatment discontinuation than responders receiving CMI alone.     

西酞普兰合并氯丙咪嗪治疗难治性强迫症

目的探讨西酞普兰以及西酞普兰合并氯丙咪嗪治疗难治性强迫症的疗效和不良反应。方法将16例难治性强迫症患者随机分为2组(n=8)，分别给予西酞普兰，西酞普兰合并氯丙咪嗪治疗。采用耶鲁布朗强迫症量表(YBOCS)和副反应量表(TESS)评定疗效和副反应。结果西酞普兰合并氯丙咪嗪组的所有病人的YBOCS减分率均大于35％，有6例出现副反应。西酞普兰组仅有一例患者的YBOCS减分率大于35％，有3例出现副反应。结论西酞普兰合并氯丙咪嗪治疗难治性强迫症的疗效优于单用西酞普兰，但副反应明显多于西酞普兰组。     

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: preliminary findings

The effectiveness of a 14-week cognitive-behavioral family treatment protocol for childhood obsessive-compulsive disorder (OCD) was piloted using a volunteer sample of seven children aged 10-14 years. The primary outcome measures were diagnostic status, symptom severity, and global functioning which were assessed at pre- and post-treatment, and at three-month follow-up. A series of self-report measures assessing obsessive-compulsive symptomatology, depression, and family factors were also completed at pre- and post-treatment. The results indicated that six participants no longer met criteria for OCD at post-treatment, with a mean reduction of 60% in symptom severity. Self-reported obsessive-compulsive symptomatology and family involvement in the disorder also significantly decreased across time. The findings support the efficacy of cognitive-behavioral treatment with a structured family component for childhood OCD. Further research investigating the comparative efficacy of treatment with and without family involvement is warranted.