1. Ferhat Yaylacı, Handan Özek Erkuran, Murat Eyüboğlu***
Early-term Aripiprazole Augmentation and Clinical Efficacy: A Case Series of Six Adolescents
  Ferhat Yaylacı, Handan Özek Erkuran, Murat Eyüboğlu***
* Department of Child and Adolescent Psychiatry, Karaman State Hospital, Karaman, Turkey
**Department of Child and Adolescent Psychiatry, İzmir Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
*** Department of Child and Adolescent Psychiatry, Mardin State Hospital, Mardin, Turkey
INTRODUCTION:
Obsessive- compulsive disorder (OCD) in children and adolescents is characterized by intrusive thoughts and compulsions that typically cause distress and functional impairment. Guidelines for the treatment of OCD include Cognitive- Behavioral Therapy (CBT) as first line treatment option along with family counseling and psychoeducation. Selective serotonin Reuptake Inhibitors (SSRI) have long been used in the pharmacological treatment of OCD, with much success. Multidrug choices and augmentation strategies have only been proposed for cases that are resistant to treatment. The term “treatment-resistance” reflect persistent and severe continuum of symptoms even though efficient and suggested line of treatment options have been used with indicated dose ranges and time interval. This might reflect unsuccessful response to at least two SSRI use or use of one SSRI and clomipramine along with enough number of CBT sessions. Many drugs have been tried for augmentation, in the face of treatment-resistance. However, these mainly have been conducted with adults and studies that assess augmentation in children and adolescents have been scarce. Some of these have focused on aripiprazole as an option to be used for augmentation. This series comprises the clinical course and treatment process of six adolescents diagnosed with OCD from three different centers in Turkey.
DISCUSSION:
Following grounded hypotheses that OCD might bear an underlying mechanism of dopaminergic dysfunction, many researches have suggested use of antipsychotic medication as augmentation treatment in the course of resistant OCD. Though much more widely studies in adults, there has been an increase on the number of studies conducted with children and adolescents as well that prove beneficial effects, lately. As OCD is a persistent condition and in some cases, a serious cause of disability and morbidity that severely disrupts daily functioning and adding up to this the low treatment compliance to both medical and supportive interventions in some cases and families, early-term aripiprazole augmentation to SSRIs might be a viable option.
CASES:
Formal diagnoses of participating adolescents were made by using DSM-V criteria. All six adolescents met the criteria for OCD as the main psychiatric diagnosis. Ages of the cases ranged between years and 4 were boys while 2 were girls. None of the 6 adolescents had an underlying medical condition, drug use or other psychiatric comorbidities that would interfere with the main clinical diagnosis. Four cases had histories of psychiatric disorders in the family while the remaining two, did not. Most common disorder in the families was OCD, following major depressive disorder and panic disorder. Symptom severity was assessed by Children’s Yale Brown Obsessive Compulsive Scale (CY-BOCS) at the beginning of treatment and at every control appointment. All 6 cases were started on an SSRI monotherapy; 4 cases used fluoxetine while 2 were started on sertraline. Initial CY-BOCS scores of cases ranged between with significant deterioration in daily functioning. Though partial improvement was observed in 7-12 weeks in each case described, due to different underlying reasons that were elaborately described within each case presentation, recommended treatment guidelines were in a way distorted, resulting in an earlier onset of low- dose add-on aripiprazole (2,5- 5 mg/day) in turn, causing relief in symptoms and improvement in clinical picture as well as overall quality of life and functioning, measured by final CY-BOCS scores following augmentation ranging between 6-21 with no major side effects.
CONCLUSIONS:
Though a diversion from accepted treatment guidelines, we believe if replicated by more studies with research samples and control groups, early-term aripiprazole augmentation to SSRIs in OCD might be a useful alternative to be used in selected patients. We hope this case series shall make a contribution to relevant literature and studies designed to improve treatment options and guidelines.