title: Exposure and response prevention helps adults with obsessive-compulsive disorder who do not respond to pharmacological augmentation strategies.
abstract: OBJECTIVE
  Serotonin reuptake inhibitors (SRIs) are a first-line treatment for obsessive-compulsive disorder (OCD). Yet, most patients with OCD who are taking SRIs do not show excellent response. Recent studies show that augmenting SRIs with risperidone benefits a minority of patients. We evaluated the effectiveness of exposure and response prevention (EX/RP) among nonresponders to SRI augmentation with 8 weeks of risperidone or placebo.
  
  
  METHODS
  The study was conducted from January 2007 to August 2012. Nonresponders to SRI augmentation with risperidone or pill placebo (N = 32) in a randomized controlled trial for adults meeting DSM-IV-TR criteria for OCD were offered up to 17 twice-weekly EX/RP sessions. Independent evaluators, blind to treatment, evaluated patients at crossover baseline (week 8), midway through crossover treatment (week 12), post-EX/RP treatment (week 16), and follow-up (weeks 20, 24, 28, and 32). The primary outcome was OCD severity, measured with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Secondary outcomes were depression, quality of life, insight, and social functioning.
  
  
  RESULTS
  Between crossover baseline and follow-up, nonresponders to SRI augmentation with risperidone or placebo who received EX/RP showed significant reductions in OCD symptoms and depression, as well as significant increases in insight, quality of life, and social functioning (all P < .001).
  
  
  CONCLUSIONS
  Exposure and response prevention is an effective treatment for patients who have failed to respond to SRI augmentation with risperidone or placebo. This study adds to the body of evidence supporting the use of EX/RP with patients who continue to report clinically significant OCD symptoms after multiple pharmacologic trials.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00389493.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, 3535 Market St, 6th Floor, Philadelphia, PA 19104 mcleanca@mail.med.upenn.edu.
authors.forename: Carmen P
authors.initials: CP
authors.lastname: McLean
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Zandberg
authors.forename: Page E
authors.initials: PE
authors.lastname: Van Meter
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Carpenter
authors.forename: Helen Blair
authors.initials: HB
authors.lastname: Simpson
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004357:Drug Synergism; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D018967:Risperidone / Q000008:administration & dosage / Q000494:pharmacology*; D012702:Serotonin Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D012720:Severity of Illness Index
chemical_list: D018967:Risperidone; D012702:Serotonin Antagonists; D017367:Selective Serotonin Reuptake Inhibitors