PT609. A rapid improvement in obsessive-compulsive disorder with milnacipran in a schizophrenic patient

A substantial portion of schizophrenia patients with obsessive compulsive disorder fail to respond to regimen of antipsychotic and selective serotonin reuptake inhibitor. Herein, we report a schizophrenic patient who, after being switched from escitalopram to milnacipran, showed a rapid improvement of his debilitating OCD. A 23-year-old unemployed single man had been diagnosed with schizophrenia and OCD 4 years previously. A regimen with quetiapine 225 mg/day and escitalopram 20 mg/day has stabilized his psychotic symptoms, however, OCS persisted, with a score of 24 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We switched escitalopram to milnacipran at an initial dosage of 100 mg/day, without adding on any psychological or behavioral interventions. By the end of the first week after initiating milnacipran, his Y-BOCS score had dropped to 13. The dose of milnacipran was raised to 150 mg/day at the third week, the patient showed a reduction of about 45% in Y-BOCS score, which is considered to be a significant treatment response. Milnacipran is a unique SNRI in that it is twice as potent in inhibiting norepinephrine than serotonin reuptake. Among schizophrenic patients, the serotonergic system may receive complex dopaminergic modulations which are further complicated with antipsychotic treatment. In the present case, it is possible that a paradoxical downregulation of serotonergic receptors following his previous antipsychotic treatment may have hindered the therapeutic efficacy of SSRIs in treating OCS. SNRIs with preferential norepinephrine reuptake inhibition, such as milnacipran, may exert a superior efficacy by acting primarily on the noradrenergic circuit. Due to the complex interplay between serotonergic, dopaminergic and noradrenergic systems, the pathogenesis of OCS in patients with schizophrenia may be more complicated than the well-known serotonin hypothesis of OCD. Milnacipran, with its preferable noradrenergic reuptake blockade, can be a reasonable alternative if OCS fail to respond to SSRIs or other SNRIs. PT610 Aripriprazole augmentation in patient with OCD partially responsive to SSRI Borjanka Batinic, Duisin Dragana Clinical Centre of Serbia, Serbia Abstract Objective: Despite the efficacy of SSRIs and clomipramine, 40%60% of patients with obsessive-compulsive disorder do not respond adequately to the first line of treatment. This was the case of our patient, a 34-year old female, who demonstrated pronounced magical thinking and an obsessive fear that something terrible would happen to family members. She sought to reduce the impact of these thoughts with mental and motor compulsions (counting, repeating thoughts, bringing things into order and symmetry). Obsessive thoughts and compulsions took up several hours a day, making her exhausted, depressed and inefficient. Aims: As the previous treatment with an SSRI (paroxetine) after 3 months at the maximum tolerated dose (40mg/day) gave only a partial therapeutic response, we augmented the treatment with aripriprazole at a dose of 5mg/day. Review of the literature indicates that adding aripiprazole to an SSRIs could be a valid strategy for treatment-resistant OCD patients or those with only a partial therapeutic response. Aripiprazole is associated with a lower risk of weight gain, sedation, and increase in prolactin compared to other antipsychotics. Method: The following instruments were applied before and two weeks after aripriprazole augmentation: The Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II) and the Obsessive-Compulsive Inventory-Revised (OCI-R). We also followed patients for possible side-effects. Results: Scores on the applied instruments were as follows: before the augmentation with aripriprazole: BAI=10; BDI-II=28, OCI-R= 21; after augmentation with aripriprazole: BAI =3, BDI-II =10, OCI-R=8. Conclusions: Aripriprazole augmentation in a dose of 5mg/day was effective in reduction of obsessive-compulsive symptoms in a patient with partial therapeutic response to paroxetine, as well as in generalized anxiety and depression, with rapid onset of improvement (after 2 weeks of initiation) and good tolerability.Objective: Despite the efficacy of SSRIs and clomipramine, 40%60% of patients with obsessive-compulsive disorder do not respond adequately to the first line of treatment. This was the case of our patient, a 34-year old female, who demonstrated pronounced magical thinking and an obsessive fear that something terrible would happen to family members. She sought to reduce the impact of these thoughts with mental and motor compulsions (counting, repeating thoughts, bringing things into order and symmetry). Obsessive thoughts and compulsions took up several hours a day, making her exhausted, depressed and inefficient. Aims: As the previous treatment with an SSRI (paroxetine) after 3 months at the maximum tolerated dose (40mg/day) gave only a partial therapeutic response, we augmented the treatment with aripriprazole at a dose of 5mg/day. Review of the literature indicates that adding aripiprazole to an SSRIs could be a valid strategy for treatment-resistant OCD patients or those with only a partial therapeutic response. Aripiprazole is associated with a lower risk of weight gain, sedation, and increase in prolactin compared to other antipsychotics. Method: The following instruments were applied before and two weeks after aripriprazole augmentation: The Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II) and the Obsessive-Compulsive Inventory-Revised (OCI-R). We also followed patients for possible side-effects. Results: Scores on the applied instruments were as follows: before the augmentation with aripriprazole: BAI=10; BDI-II=28, OCI-R= 21; after augmentation with aripriprazole: BAI =3, BDI-II =10, OCI-R=8. Conclusions: Aripriprazole augmentation in a dose of 5mg/day was effective in reduction of obsessive-compulsive symptoms in a patient with partial therapeutic response to paroxetine, as well as in generalized anxiety and depression, with rapid onset of improvement (after 2 weeks of initiation) and good tolerability.