Obsesif Kompulsif Bozukluk Güçlendirme Tedavisinde Aripiprazol, Klomipramin ve Buspironun Etkinliği: Retrospektif Bir Araştırma

Year 2019, Volume: 5 Issue: 1, 1293 - 1302, 15.04.2019

Murat Eren Özen , Aysun Kalenderoğlu , Mustafa Çelik Mehmet Hamdi Örüm , Çiçek Hocaoğlu

https://doi.org/10.30569/adiyamansaglik.477617

Cited By: 2

Abstract

Amaç: Obsesif Kompulsif Bozukluk (OKB) kronik
seyirli ve yeti yitimine yol açabilen bir ruhsal bozukluktur. Tedavi konusunda
da bazı güçlükler yaşanmakta olup, bilinen tedavi yöntemleri ile hastaların
küçük bir yüzdesi asemptomatik hale gelmektedir. OKB tanılı hastaların
tedavi seçenekleri arasında öncelikli olarak seçici serotonin geri alım
inhibitörleri (SSGI) yer almaktadır. Ancak, çoğu zaman OKB tedavisinde tek
başına SSGI ilaçlar yeterli olmayıp, mevcut tedavinin güçlendirilmesi ya da
farklı bir antidepresan ilacın eklenmesi tercih edilmektedir. Bu çalışmada SSGI
ilaç tedavisine yeterli yanıt alınamayan OKB tanılı hastaların mevcut
tedavilerinin aripiprazol, buspiron ve klomipramin ile güçlendirme etkinliğini
geriye dönük dosya tarayarak incelemeyi amaçladık.

Yöntem: Çalışmamızda, OKB tanısıyla izlenmekte olan ve SSGI’lere yeterli yanıt
alınamadığı için tedavilerine aripiprazol,  klomipramin ve buspiron
ilaçları eklenen hastaların dosyaları geriye dönük olarak incelenmiştir. Dosya
kayıtlarından SSGI tedavisinden kısmi
yanıt alınan hastaların mevcut tedavisinin aripiprazol (n: 96), buspiron
(n: 38) ile güçlendirildiği ve klomipramin (n:76) eklendiği saptandı. Hastaların
takibinde rutinde kullanılan Yale-Brown Obsesyon Kompülsiyon Değerlendirme
Ölçeği (YBOKÖ),  Klinik Global İzlenim Ölçeği
(KGİÖ) ve Hamilton Aksiyete Ölçeği (HAÖ) puanları arşivdeki dosyaları
incelenerek kayıt edilmiştir.

Bulgular: OKB tanılı hastalara
verilen aripiprazol, klomipramin ve buspiron ilaçlarının etkinliği KGİ, YBOKÖ
ve HAÖ tedavi öncesi ve sonrası değerlere göre bu üç ilacın da etkinliği ile
ilgili istatistiksel olarak oldukça anlamlı fark elde edilmiştir (p<0.001).
Her üç ilaç kendi arasında karşılaştırıldığında ise aripiprazolun, klomipramin
ve buspirondan daha etkin olduğu saptanmıştır. Aripiprazolün tedavi öncesi ve sonrası
değerlerine bakıldığında KGİÖ ortalama puanı 5.71±0.58’den 2.98±0.75’e, YBOKÖ
ortalama puanı 31.96±2,43’ten 11.77±4.06’ya ve HAÖ ortalama puanı ise
36.58±5.02’den 12.81±4.49’a düştüğü gözlemlenmiştir.

Sonuç: Geriye dönük çalışmamızda, aripiprazol, klomipramin, buspiron OKB
ekleme tedavisinde etkin bulunmuştur. Çalışmamız bilindiği kadarıyla,
aripiprazol,  klomipramin ve buspironun SSGI tedavisine eklenmesi ile
ilgili sonuçları karşılaştıran ilk çalışmadır. Obsesif kompulsif bozukluk etiyolojik
olarak farklılık gösterebildiğinden farklı tedavi yaklaşımlarını gerekli
kılmaktadır. Bu nedenle, çalışmamızda farklı etki mekanizmasına sahip ilaç
kombinasyonları denenmiştir. Literatürde buspironun OKB tedavisinde veya SSGI’ne
ekleme yöntemi kısıtlı sayıda çalışmada görülmektedir. Bu nedenle, buspiron ile
tedavi edilmiş geniş hasta grubu olan bir çalışma olması çalışmamızın önemini
artırmaktadır.

Keywords

Aripiprazol, klomipramin, buspiron, obsesif-kompulsif bozukluk, ekleme

Efficacy of Aripiprazole, Clomipramine, and Buspirone in Obsessive Compulsive Disorder Augmentation Therapy: A Retrospective Study

Abstract

Aim: Obsessive Compulsive Disorder (OCD) is a chronic disorder
that can lead to disability. There are some difficulties in treatment, and a
small percentage of patients become asymptomatic with known treatment methods.
Among the treatment options of patients with OCD, selective serotonin reuptake
inhibitors (SSRI) are primarily involved. However, most of the time, SSRI drugs
alone are not sufficient in the treatment of OCD, it is preferred to
strengthen the current treatment or to add a different antidepressant drug. In
this study, we aimed to investigate the efficacy of aripiprazole,
buspirone and clomipramine in patients with OCD who were unable to
respond adequately to SSRI drug therapy.

Method: In our study, the files of the patients who were followed
with the diagnosis of OCD and who were added aripiprazole,
clomipramine and buspirone drugs to their treatment because of insufficient
response to SSRIs were examined retrospectively. It was determined that the
current treatment of patients who received partial response from SSRI
treatment was augmened with aripiprazole (n: 96), buspirone (n: 38)
and clomipramine (n: 76) was added. Yale-Brown Obsessive Compulsive Evaluation
Scale (YBOCS), Clinical Global Impression Scale (CGI) and Hamilton Anxiety
Scale (HAS) scores were used to evaluate the patients in the follow-up.

Results: The efficacy of aripiprazole, clomipramine and buspirone
medications given to patients with OCD was statistically significant (p
<0.001). Aripiprazole was found to be slightly more effective than
clomipramine and buspirone. When the pre- and post-treatment values of
aripiprazole were evaluated, it was observed that the mean score of CGI
declined from 5.71 ± 0.58 to 2.98 ± 0.75, YBOCS scores declined from 31.96 ±
2.43 to 11.77 ± 4.06 and HAS score declined from 36.58 ± 5.02 to 12.81 ± 4.49.

Conclusion: In our
retrospective study, aripiprazole, clomipramine and buspirone were found to be effective in the treatment of OCD. As
far as we know, our study is the first study to compare the results of aripiprazole,
clomipramine and buspirone in
addition to the treatment of SSRI. Therefore, in our study drug combinations
with different mechanism of
action have been tried. In the literature, the method of augmentation of
buspirone in OCD or SSRI is limited in a limited number of studies. Therefore,
a study with a large group of patients treated with buspirone increases the
importance of our study.

Keywords

Aripiprazole, clomipramine, buspirone, obsessive-compulsive disorder, augmentation

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