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A Comparative Study of Aripiprazole, Olanzapine, and L-Methylfolate Augmentation in Treatment Resistant Obsessive-Compulsive Disorder

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Abstract

About half of the patients with Obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) or have a partial improvement in their symptoms. This study aimed to compare the efficiency and safety of aripiprazole, olanzapine, and L-methyl folate in patients with resistant OCD. The study consisted of an open-label prospective phase of 12-weeks to ascertain resistance to SRIs and a second 6-week open-label addition phase for non or, partial responders of the first phase. One-hundred-fifteen patients entered the 16-week open-label phase. Fifty patients (43.47%) responded to the SRIs monotherapy, two patients developed adverse effects and another three were lost to the follow up. Sixty patients (52.2%) were considered treatment-resistant and entered the 6-week open-label aripiprazole, olanzapine, or L-methyl folate addition phase; Patients showed a significant improvement over 6-week study period in olanzapine and aripiprazole group as measured by YBOCS total score (p < 0.001) while there was no change in the L-methyl folate group at the end as compared with baseline (p = 0.150). Clinical Global Impression-Severity decreased from 4.90 to 2.90 in olanzapine and aripiprazole group at the end of 6 weeks while there was no change in the L-methyl folate group. The CGI-I was significant in the olanzapine and aripiprazole group (p < 0.001) while it was insignificant in the L-methyl folate group (p = 0.088). Augmentation of SRIs with olanzapine or aripiprazole could be a promising option for resistant OCD. L-methyl folate though shown to be effective in resistant depression was not effective in treatment resistant OCD.

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Data Availability

The data will be made available from the corresponding author on request.

Abbreviations

OCD:

Obsessive-compulsive disorder

SRIs:

Serotonin reuptake inhibitors

YBOCS:

Yale–brown obsessive-compulsive

CGI-I:

Clinical global impression scale-improvement

CGI-S:

Clinical global impression-severity

BH4:

Tetrahydrobiopterin

CBT:

Cognitive-behavioral therapy

1–5-MTHF:

l-5-methyltetrahydrofolate

CNS:

Central nervous system

mg/d:

milligrams per day

ANOVA:

Analysis of variance

SPSS:

Statistical package for the social sciences

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Acknowledgments

The authors would like to acknowledge the patients who generously participated in the study.

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Authors and Affiliations

  1. Department of Psychiatry, Government Medical College, Srinagar, 190003, India

    Shabir Ahmad Dar & Rayees Ahmad Wani

  2. Department of Social and Preventive Medicine, Government Medical College, Srinagar, India

    Inaamul Haq

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  1. Shabir Ahmad Dar
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Contributions

RAW: the conception, design of the work; drafted the manuscript. SAD: the conception, design of the work; drafted the manuscript. AH: the analysis, interpretation of data. All authors have read and approved the final manuscript.

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Correspondence to Shabir Ahmad Dar.

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Ethics Approval and Consent to Participate

The consent document and the research Protocols were approved by the institutional ethics committee of Govt. Medical College Srinagar (IEC/GMCS/211/17). All participants provided written informed consent.

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Consent for publication was obtained.

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All authors declare that they have no competing interest.

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Dar, S.A., Wani, R.A. & Haq, I. A Comparative Study of Aripiprazole, Olanzapine, and L-Methylfolate Augmentation in Treatment Resistant Obsessive-Compulsive Disorder. Psychiatr Q 92, 1413–1424 (2021). https://doi.org/10.1007/s11126-021-09892-0

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