Summary
Potent 5-HT reuptake inhibitors (RUI), such as fluvoxamine, have clearly been established as the first-line pharmacologic treatment for patients with OCD. The controlled addition of agents which affect 5-HT function to ongoing treatment in 5-HT RUI-refractory OCD patients has not, in general, yielded robust clinical results. The addition of low-dose DA antagonists to ongoing 5-HT RUI treatment in refractory OCD patients has produced encouraging results. In particular, OCD patients with a comorbid chronic tic disorder, such as Tourette’s disorder, may have a preferential response to conjoint 5-HT RUI-DA antagonist treatment. These treatment response data suggest that the 5-HT systems and the DA systems may contribute to the pharmacotherapy and possibly the mediation of obsessive-compulsive symptoms in some patients with OCD.
Findings generated from an open study with low-dose neuroleptic and preliminary analysis of a controlled investigation of addition of haloperidol to ongoing treatment in OCD patients unresponsive to fluvoxamine alone will be presented.
Zusammenfassung
Wirksame 5-HT-Reuptake-Hemmer (5-HT-RUIs) wie Fluvoxamin sind als „Pharmakotherapie der Wahl“ bei der Behandlung von OCD-Patienten etabliert. Die kontrollierte Zugabe von Substanzen, die die 5-HT-Wirkungen bei fortgesetzter Therapie von 5-HT-RUI-refraktären OCD-Patienten mit 5-HT-Reuptake-Hemmern beeinflussen sollten, hat i. allg. nicht zu nachweislichen klinischen Resultaten geführt. Die Zugabe von niedrigdosierten DA-Antagonisten zu einer fortgesetzten RUI-Therapie der refraktären OCD-Patienten hat hingegen zu ermutigenden Ergebnissen geführt. Insbesondere OCD-Patienten mit einer comorbiden chronischen Tickstörung, wie z.B. dem Tourette-Syndrom, können eine gute Response auf eine Kopharmakotherapie von 5-HT-Reuptake-Hemmern mit DA-Antagonisten zeigen. Die Daten der Responder auf diese Behandlung lassen vermuten, daß das 5-HT-System und das DA-System möglicherweise die Pharmakotherapie und die Entstehung von Zwangssymptomen bei einigen OCD-Patienten beeinflussen. Die Ergebnisse einer offenen Studie mit niedrigdosierten Neuroleptika und erste Analysen einer kontrollierten Untersuchung von Haloperidolzugabe bei fortgesetzter RUI-Therapie bei OCD-Patienten, die auf Fluvoxamin allein nicht ansprachen, wird vorgestellt.
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Mcdougle, C.J. (1992). The Pharmacotherapy of Treatment-Resistant Obsessive-Compulsive Disorder. In: Hand, I., Goodman, W.K., Evers, U. (eds) Zwangsstörungen / Obsessive-Compulsive Disorders. Die Reihe dupbar med communication wird / Series dupbar med communication. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-77608-3_14
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