Cognitive behavioral therapy was more effective than the antipsychotic drug risperidone (Risperdal) for improving responses among people suffering from obsessive-compulsive disorder (OCD), according to MedPage Today.
The study published in JAMA Psychiatry utilized a randomized trial where patients were assigned to a behavioral therapy centered on exposure and ritual prevention for 8 weeks in addition to their ongoing antidepressant drugs.
Results showed reductions in Yale-Brown Obsessive Compulsive Scale scores greater by an adjusted mean of 9.72 points than those randomized to risperidone, according to Helen Blair Simpson, MD, PHD, of Columbia University in New York City, and colleagues. Mean change from baseline in the risperidone group at 8 weeks was not significantly different from that seen in the three-arm trial's placebo group..
Treatment-emergent and overall adverse events were somewhat less common among patients randomized to the cognitive therapy versus risperidone, but both groups had more adverse events than the placebo group.
"Patients with OCD receiving serotonin reuptake inhibitors should be offered [exposure-ritual prevention therapy] before antipsychotics given the behavioral therapy's superior efficacy and less negative adverse event profile," Simpson and colleagues wrote.
The conclusion is effectively a call for practice change, because current American Pyschiatric Association guidelines co-authored by Simpson -- say that antipsychotics may be added in patients not responding adequately to serotonin reuptake inhibitors.
In an interview with MedPage Today, Simpson acknowledged that the study had examined only one antipsychotic drug, but she was nevertheless confident that the results justified a conclusion about all such agents.
She noted that risperidone is generally considered the most effective antipsychotic drug for reducing OCD symptoms, so the finding that it was less effective than the exposure-ritual prevention therapy should be generalizable to the whole class.
