title: Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review and meta-analysis.
abstract: BACKGROUND
  In 2006, the National Institute of Clinical and Health Excellence (NICE) guidelines for Obsessive Compulsive Disorder (OCD) recommended anti-psychotics as a class for SSRI treatment resistant OCD. The article aims to systematically review and conduct a meta-analysis on the clinical effectiveness of atypical anti-psychotics augmenting an SSRI.
  
  
  METHODS
  Studies that were double-blind randomized controlled trials of an atypical antipsychotic against a placebo, for a minimum of 4 weeks, in adults with OCD, were included. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores were the primary outcome measure. Inclusion criteria included Y-BOCS score of 16 or more and at least one adequate trial of a SSRI or clomipramine for at least 8 weeks prior to randomization. Data sources included Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews (CDSR), trial registries and pharmaceutical databases and manufacturers up to September 2013. Forest-plots were drawn to display differences between drug and placebo on the Y-BOCS.
  
  
  RESULTS
  Two studies found aripiprazole to be effective in the short-term. There was a small effect-size for risperidone or anti-psychotics in general in the short-term. We found no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo.
  
  
  CONCLUSIONS
  Risperidone and aripiprazole can be used cautiously at a low dose as an augmentation agent in non-responders to SSRIs and CBT but should be monitored at 4 weeks to determine efficacy.
authors.affiliation: The Institute of Psychiatry, King's College London and South London and Maudsley NHS Foundation Trust, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. david.veale@kcl.ac.uk.|Centre for Anxiety Disorders and Trauma, The Maudsley Hospital, 99 Denmark Hill, London, SE5 8AZ, UK. david.veale@kcl.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Veale
authors.affiliation: The Institute of Psychiatry, King's College London and South London and Maudsley NHS Foundation Trust, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. sarah.k.miles@kcl.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Miles
authors.affiliation: Kings College London Medical School, Denmark Hill, London, SE5 9RS, UK. nicola.smallcombe@kcl.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Smallcombe
authors.affiliation: The Institute of Psychiatry, King's College London and South London and Maudsley NHS Foundation Trust, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. haben.ghezai@kcl.ac.uk.
authors.forename: Haben
authors.initials: H
authors.lastname: Ghezai
authors.affiliation: London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. ben.goldacre@lshtm.ac.uk.
authors.forename: Ben
authors.initials: B
authors.lastname: Goldacre
authors.affiliation: The Institute of Psychiatry, King's College London and South London and Maudsley NHS Foundation Trust, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. john.hodsoll@kcl.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Hodsoll
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000627:therapeutic use; D002997:Clomipramine / Q000627:therapeutic use; D003987:Dibenzothiazepines / Q000627:therapeutic use; D004311:Double-Blind Method; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy*; D000077152:Olanzapine; D010879:Piperazines / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018967:Risperidone / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D000068180:Aripiprazole; D001569:Benzodiazepines; D002997:Clomipramine; D003987:Dibenzothiazepines; D000077152:Olanzapine; D010879:Piperazines; D000069348:Quetiapine Fumarate; D015363:Quinolones; D018967:Risperidone; D017367:Selective Serotonin Reuptake Inhibitors