Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. A double-blind, placebo-controlled study in patients with and without tics

C. J. McDougle, W. K. Goodman, J. F. Leckman, N. C. Lee, G. R. Heninger and L. H. Price
Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.

BACKGROUND: To determine the efficacy of adding haloperidol to the treatment of patients with obsessive-compulsive disorder (OCD), with or without a comorbid chronic tic disorder, who were refractory to adequate treatment with the serotonin-uptake inhibitor fluvoxamine alone. It was hypothesized that OCD patients with a concurrent chronic tic disorder would preferentially respond to this treatment. METHODS: Sixty-two patients with a primary DSM-III-R diagnosis of OCD received placebo fluvoxamine for 1 week, followed by 8 weeks of active fluvoxamine. Thirty-four of these patients were refractory to fluvoxamine and were randomized in a double-blind fashion to 4 weeks of treatment with either haloperidol (n = 17) or placebo (n = 17) added to ongoing fluvoxamine treatment. The placebo-treated group included five women and 12 men, six inpatients and 11 outpatients, and eight patients with a comorbid chronic tic disorder. The haloperidol-treated group consisted of two women and 15 men, three inpatients and 14 outpatients, and seven patients with a comorbid chronic tic disorder. All 34 patients completed the entire study. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression scale were the principal measures of treatment outcome. RESULTS: Haloperidol addition was significantly better than placebo in reducing the severity of obsessive-compulsive symptoms as measured by the Y-BOCS. Eleven of 17 patients responded to the haloperidol, compared with none of 17 patients given placebo. Eight of eight patients with comorbid chronic tic disorders, such as Tourette's disorder, responded to double-blind haloperidol addition to ongoing fluvoxamine treatment. Haloperidol addition was of little benefit in treating OCD patients without tics. Fluvoxamine blood levels were not related to treatment response. CONCLUSIONS: The results of this study suggest that OCD patients with a comorbid chronic tic disorder constitute a clinically meaningful subtype of OCD that might require conjoint serotonin-uptake inhibitor/neuroleptic therapy for effective symptom reduction.

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References
APPI Online CME 2007;2007:2-2.
FULL TEXT  

Obsessive-Compulsive Disorder
Greist and Jefferson
Focus 2007;5:283-298.
ABSTRACT | FULL TEXT  

Obsessive-Compulsive Disorder: An Update for the Clinician
Koran
Focus 2007;5:299-313.
FULL TEXT  

Obsessive-Compulsive Disorder in Tourette Syndrome
Goodman et al.
J Child Neurol 2006;21:704-714.
ABSTRACT  

A review of antipsychotics in the treatment of obsessive compulsive disorder
Fineberg et al.
J Psychopharmacol 2006;20:97-103.
 

Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology
Baldwin et al.
J Psychopharmacol 2005;19:567-596.
ABSTRACT  

Risperidone for the Core Symptom Domains of Autism: Results From the Study by the Autism Network of the Research Units on Pediatric Psychopharmacology
McDougle et al.
Am. J. Psychiatry 2005;162:1142-1148.
ABSTRACT | FULL TEXT  

Placebo-Controlled Study of Pimozide Augmentation of Fluoxetine in Body Dysmorphic Disorder
Phillips
Am. J. Psychiatry 2005;162:377-379.
ABSTRACT | FULL TEXT  

A Review of Pharmacologic Treatments for Obsessive-Compulsive Disorder
Kaplan and Hollander
Focus 2004;2:454-461.
ABSTRACT | FULL TEXT  

A Review of Pharmacologic Treatments for Obsessive-Compulsive Disorder
Kaplan and Hollander
Psychiatr. Serv. 2003;54:1111-1118.
ABSTRACT | FULL TEXT  

Item-by-Item Factor Analysis of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist
Feinstein et al.
J. Neuropsychiatry Clin. Neurosi. 2003;15:187-193.
ABSTRACT | FULL TEXT  

Antiobsessional Effect of Risperidone Add-On Treatment in Serotonin Reuptake Inhibitor-Refractory Obsessive-Compulsive Disorder May Be Dose-Dependent
Ramasubbu et al.
Arch Gen Psychiatry 2002;59:472-473.
FULL TEXT  

Low-Dose Sertraline in Children with Obsessive-Compulsive Disorder
Procter et al.
Clinical Child Psychology and Psychiatry 2001;6:545-550.
ABSTRACT  

A 45-Year-Old Woman With Obsessive-Compulsive Disorder
Jenike
JAMA 2001;285:2121-2128.
FULL TEXT  

A Double-blind, Placebo-Controlled Study of Risperidone Addition in Serotonin Reuptake Inhibitor-Refractory Obsessive-compulsive Disorder
McDougle et al.
Arch Gen Psychiatry 2000;57:794-801.
ABSTRACT | FULL TEXT  

Tourette syndrome, associated conditions and the complexities of treatment
Robertson
Brain 2000;123:425-462.
ABSTRACT | FULL TEXT  

Catechol-O-methyltransferase-deficient mice exhibit sexually dimorphic changes in catecholamine levels and behavior
Gogos et al.
Proc. Natl. Acad. Sci. USA 1998;95:9991-9996.
ABSTRACT | FULL TEXT  

Genotype determining low catechol-O-methyltransferase activity as a risk factor for obsessive-compulsive disorder
Karayiorgou et al.
Proc. Natl. Acad. Sci. USA 1997;94:4572-4575.
ABSTRACT | FULL TEXT  

The Neurobiology of Obsessive-Compulsive Disorder
Stein
Neuroscientist 1996;2:300-305.
ABSTRACT  

Friday the 13th and obsessive compulsive disorder
Veale
BMJ 1995;311:963-964.
FULL TEXT  

Neurochemical and some related psychopharmacological aspects of Tourette's syndrome: an update
Baker et al.
J Psychopharmacol 1995;9:273-280.
ABSTRACT