Murat Eren ÖZEN, Aysun KALENDEROĞLU, Mustafa ÇELİK, Mehmet Hamdi ÖRÜM, Çiçek HOCAOĞLU

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

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.

Anahtar Kelimeler:

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

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

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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