Risperidone addition in fluvoxamine-refractory obsessive-compulsive disorder: three cases.

BACKGROUND: Forty percent to 60% of patients with obsessive-compulsive disorder (OCD) remain unimproved after adequate treatment with serotonin uptake inhibitors (SUIs). The addition of low-dose haloperidol and pimozide to ongoing SUI treatment has been shown to be effective in up to 65% of SUI-refractory OCD patients, particularly in those with comorbid chronic tic disorder. Because OCD patients typically require prolonged pharmacotherapy, they are subject to the development of tardive dyskinesia during neuroleptic treatment. Risperidone is a highly potent and selective serotonin2 and dopamine2 receptor antagonist with a side effect profile that appears to be much more tolerable and safer than that of typical neuroleptics. METHOD: We report our experience with three OCD patients who were unimproved after a minimum of 12 weeks of treatment with the potent and selective SUI fluvoxamine, in whom we added risperidone in an open-label manner. RESULTS: All three patients showed significant improvement in their obsessive-compulsive symptoms as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) after risperidone 1 mg/day was added to ongoing fluvoxamine (250-300 mg/day). Within 4 weeks of adding risperidone, the three patients' Y-BOCS scores had decreased by 65%, 56%, and 43%, respectively. Other than mild or moderate sedation, no side effects were observed. CONCLUSION: These results suggest that risperidone addition to ongoing SUIs may be an effective treatment strategy for refractory OCD.

The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability.

The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.

Growth hormone response to apomorphine and diagnosis: a comparison of three diagnostic systems.

Our study takes a further look at the apomorphine test in the psychoses and affective disorders, with special reference to the use of different diagnostic systems. Patients meeting Research Diagnostic Criteria (RDC) for schizophrenia, schizoaffective disorder, or manic disorder were included. In addition to the RDC, diagnosis was also made using the DSM-III and ICD-9. All patients underwent an evaluation of peak GH response to apomorphine administration. The results show that RDC and ICD-9 are similar, in that for both systems, a high GH response correlates with a schizoaffective disorder and distinguishes those patients significantly from manic patients. The DMS-III brings in some new dimensions, in that schizophreniform disorder (6-month cut-off) is distinguished from schizophrenia. In addition, patients with affective symptoms and mood-incongruent psychoses are more closely related to schizophreniform disorder than to classical manic disorder.