Haloperidol Addition in Fluvoxamine-Refractory Obsessive-Compulsive Disorder: A Double-blind, Placebo-Controlled Study in Patients With and Without Tics

doi:10.1001/archpsyc.1994.03950040046006

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Vol. 51 No. 4, April 1994

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Haloperidol Addition in Fluvoxamine-Refractory Obsessive-Compulsive Disorder

A Double-blind, Placebo-Controlled Study in Patients With and Without Tics

Christopher J. McDougle, MD; Wayne K. Goodman, MD; James F. Leckman, MD; Nicole C. Lee, MSNC; George R. Heninger, MD; Lawrence H. Price, MD

Arch Gen Psychiatry. 1994;51(4):302-308.

Abstract

Background
To determine the efficacy of adding haloperidol to the treatmentof patients with obsessive-compulsive disorder (OCD), with orwithout a comorbid chronic tic disorder, who were refractoryto adequate treatment with the serotonin-uptake inhibitor fluvoxaminealone. It was hypothesized that OCD patients with a concurrentchronic tic disorder would preferentially respond to this treatment.

Methods
Sixty-two patients with a primary DSM-III-R diagnosis of OCDreceived placebo fluvoxamine for 1 week, followed by 8 weeksof active fluvoxamine. Thirty-four of these patients were refractoryto fluvoxamine and were randomized in a double-blind fashionto 4 weeks of treatment with either haloperidol (n=17) or placebo(n=17) added to ongoing fluvoxamine treatment. The placebo-treatedgroup included five women and 12 men, six inpatients and 11outpatients, and eight patients with a comorbid chronic ticdisorder. The haloperidol-treated group consisted of two womenand 15 men, three inpatients and 14 outpatients, and seven patientswith a comorbid chronic tic disorder. All 34 patients completedthe entire study. The Yale-Brown Obsessive Compulsive Scale(Y-BOCS) and the Clinical Global Impression scale were the principalmeasures of treatment outcome.

Results
Haloperidol addition was significantly better than placebo inreducing the severity of obsessive-complusive symptoms as measuredby the Y-BOCS. Eleven of 17 patients responded to the haloperidol,compared with none of 17 patients given placebo. Eight of eightpatients with comorbid chronic tic disorders, such as Tourette'sdisorder, responded to double-blind haloperidol addition toongoing fluvoxamine treatment. Haloperidol addition was of littlebenefit in treating OCD patients without tics. Fluvoxamine bloodlevels were not related to treatment response.

Conclusions
The results of this study suggest that OCD patients with a comorbidchronic tic disorder constitute a clinically meaningful subtypeof OCD that might require conjoint serotonin-uptake inhibitor/neuroleptictherapy for effective symptom reduction.

Author Affiliations

From the Department of Psychiatry, Yale University School of Medicine (Drs McDougle, Goodman, Leckman, Heninger, and Price and Ms Lee), the Clinical Neuroscience Research Unit, Abraham Ribicoff Research Facilities, Connecticut Mental Health Center (Drs McDougle, Goodman, Heninger, and Price and Ms Lee), and The Yale Child Study Center (Drs McDougle and Leckman), New Haven, Conn.

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