Childhood and adolescence disorders Aripiprazole agumentation in treatment-resistant obsessive compulsive disorder in child and adolescent: case series

Objective: Pediatric obsessive compulsive disorder (OCD) is a common and debilitating disorder, which can cause substantial impairment in academic, social, and family functioning. Adjunctive medications are frequently used in ordinary clinical settings, as augmenting strategies for unsatisfactory response to SRI monotherapy, and/or to manage comorbid mental disorders. Aripiprazole is a newer antipsychotic with a more specific mode of action, as a partial dopamine agonist, which acts as an antagonist at D2 dopamine receptors in hyperdopaminergic conditions, and displays agonist properties under hypodopaminergic conditions. The aim of this study was to assess efficacy of aripiprazole augmentation of serotonin reuptake inhibitor (SRI) treatment in child and adolescents with obsessive compulsive disorder (OCD) who did not respond to initial trials with SRI and augmentation with other atypical antipsychotics.

Methods: The case series of 6 patients (4 females and 2 males; age range, 12 to 16 years) with OCD diagnosed based on a for School-age Children-Present and Lifetime Version (K-SADS-PL) Kiddie-Schedule for Affective Disorders and Schizophrenia and according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, were included. Aripiprazole was initiated at a starting dose of 2.5 or 5 mg daily and optimal dosages ranged from 5 to 15 mg daily. In this process clinical evaluation of patients; grade of obsessions and compulsions “Yale-Brown Obsessive Compulsive Scale” (Y-BOCS), the side effects of drugs ‘Extrapyramidal Symptom Rating Scale’ (ESRS), the severity of the disease, “Clinical Global Impression Scale / Violence” (CGI-S), the degree of improvement during follow-up “Clinical Global Impression Scale / recovery” (CGI-I), level of functionality “Global Assessment Scale” (GAS) are used.

Results: Aripiprazole was significantly better-tolerated and more effective

Conclusion: All patients appeared to benefit from aripiprazole. Neither extrapyramidal side effects nor agitation was observed in any case. Aripiprazole was well tolerated and effective in our cases and appears to be a safe and efficacious alternative in the child and adolescents.