First-line treatment for Obsessive compulsive disorder (OCD) includes selective serotonin reuptake inhibitors (SSRI) and Cognitive-Behavioral Therapy. However, an important proportion of the childhood OCD cases do not respond to their treatments. Augmentation prescriptions are recommended especially for the children with OCD, who do not respond to two different SSRI regimens. In OCD augmentation therapy, mostly the atypical antipsychotics, e.g. risperidone, olanzapine, and quetiapine are used. In this presentation, we aimed to present three pediatric OCD cases,which were resistant to two different SSRI treatments and prescribed aripiprazole for augmentation therapy.
Case 1; 17-year-old male patient had contamination obsessions and cleaning and counting compulsions for the recent one year period. The OCD symptoms did not respond to the şuoxetine 20-60 mg/day and afterwards sertraline 50-200 mg/day therapy. While he was on sertraline 200 mg/day, risperidone were added on and tapered to 4 mg/day. He had partial remission. However, because of the extrapyramidal symptoms and lack of optimal efficacy, risperidone were switched to aripiprazole and tapered to 20 mg/day. In the progress, the patient had almost whole recovery for OCD symptoms in the fourth month of this regimen. Side effects of aripiprazole included “headache, fatigue, and insomnia” and disappeared in the fourth week of treatment.
Case 2; A9-year-old female patient had contamination obsessions and cleaning and checking compulsions for the recent one year period. The OCD symptoms did not respond to the şuoxetine 20-60 mg/day and afterwards sertraline 50-150 mg/day therapy. While he was on sertraline 150 mg/day, aripiprazole were added on and tapered to 15 mg/day. In the progress, the patient had almost whole recovery for OCD symptoms in the sixth month of this regimen. Side effects of aripiprazole included “dizziness and insomnia” and disappeared in the fourth week of treatment.
Case 3; A16-year-old female patient had contamination obsessions and cleaning and checking compulsions. The OCD symptoms did not respond to the sertraline 50-200 mg/day and afterwards paroxetine 20-40 mg/day therapy. While he was on paroxetine 40 mg/day, olanzapine 5 mg/day were added on. The patient did not want to use olanzapine because of sedation. Olanzapine were switched to aripiprazole and tapered to 15 mg/day. In the progress, the patient had almost whole recovery for OCD symptoms in the seventh month of this regimen
Aripiprazole is a partial dopamine agonist and its prescription for childhood psychiatric disorders, e.g. bipolar disorder, autism, and schizophrenia is increasing. Scarce number of case reports was presented on aripiprazole augmentation for child and adolescent OCD. The results of the previous case reports and these three cases suggest that aripiprazole is an effective and safe alternative as augmentation for childhood OCD treatment. To investigate aripiprazole efficacy and safety in childhood OCD, randomized controlled treatment studies are needed.