title: Pharmacological treatment strategies in obsessive compulsive disorder: A cross-sectional view in nine international OCD centers.
abstract: OBJECTIVE
  It is unknown what next-step strategies are being used in clinical practice for patients with obsessive-compulsive disorder (OCD) who do not respond to first-line treatment. As part of a cross-sectional study of OCD, treatment and symptom information was collected.
  
  
  METHODS
  Consecutive OCD out-patients in nine international centers were evaluated by self-report measures and clinical/structured interviews. OCD symptom severity was evaluated by the Yale Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impression-Severity Scale (CGI-S). Clinical response to current treatment was evaluated by the CGI-Improvement Scale (CGI-I ≤ 2).
  
  
  RESULTS
  In total, 361 participants reported taking medication; 77.6% were taking a selective serotonin reuptake inhibitor; 50% reported use of at least one augmentation strategy. Antipsychotics were most often prescribed as augmenters (30.3%), followed by benzodiazepines (24.9%) and antidepressants (21.9%). No differences in OCD symptom severity were found between patients taking different classes of augmentation agents.
  
  
  CONCLUSIONS
  Results from this international cross-sectional study indicate that current OCD treatment is in line with evidence-based treatment guidelines. Although augmentation strategies are widely used, no significant differences in OCD symptom severity were found between monotherapy and augmentation or between different therapeutic agents.
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada vanamer@mcmaster.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Van Ameringen
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada MiNDS Neuroscience Graduate Program, McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Simpson
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Beth
authors.initials: B
authors.lastname: Patterson
authors.affiliation: Department of Psychiatry of the Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico of Milano, Milan, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Dell'Osso
authors.affiliation: National Obsessive Compulsive Disorders Treatment Service, Hertfordshire Partnership NHS Foundation Trust, Queen Elizabeth II Hospital, Welwyn Garden City, UK; University of Hertfordshire, Postgraduate Medical School, Hatfield, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Fineberg
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Hollander
authors.affiliation: University Hospital of Neurology and Psychiatry, St. Naum of Sofia, Sofia, Bulgaria.
authors.forename: Luchezar
authors.initials: L
authors.lastname: Hranov
authors.affiliation: University Hospital of Neurology and Psychiatry, St. Naum of Sofia, Sofia, Bulgaria.
authors.forename: Georgi
authors.initials: G
authors.lastname: Hranov
authors.affiliation: MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa.
authors.forename: Christine
authors.initials: C
authors.lastname: Lochner
authors.affiliation: Sişli Etfal Teaching and Research Hospital of Istanbul, Istanbul, Turkey.
authors.forename: Oguz
authors.initials: O
authors.lastname: Karamustafalioglu
authors.affiliation: Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie", University of Pisa, Pisa, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Marazziti
authors.affiliation: IDIBELL-University Hospital of Bellvitage, CIBERSAM University of Barcelona, Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Menchon
authors.affiliation: Center for Genomic Sciences, Universidad Autónoma de la Ciudad de México and Carracci Medical Group, Mexico City, Mexico.
authors.forename: Humberto
authors.initials: H
authors.lastname: Nicolini
authors.affiliation: Institute of Neuroscience, Università di Firenze, Firenze, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pallanti
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.affiliation: Chaim Sheba Medical Center, Department of Psychiatry, Tel Aviv, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zohar
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005060:Europe; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009656:North America; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013019:South Africa; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Obsessive–compulsive disorder; augmentation; effectiveness; international; medication; treatment