Risperidone or Cognitive-Behavioral Therapy for Improving Medication Treatment for Obsessive-compulsive Disorder

NCT ID: NCT00389493

Last Updated: 2014-04-25

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-10-31

Study Completion Date

2012-12-31

Brief Summary

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This study will compare the short- and long-term effectiveness of two common therapies in improving serotonin reuptake inhibitor treatment in people with obsessive-compulsive disorder.

Detailed Description

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Obsessive-compulsive disorder (OCD) is a common psychiatric illness. People with OCD experience unwelcome thoughts, known as obsessions, and feel compelled to perform repetitive behaviors, or compulsions. Impairment due to OCD symptoms ranges from mild to severe, and sometimes can be disabling. The only medications proven effective for OCD are serotonin reuptake inhibitors (SRIs), but even with SRI treatment, most patients continue to experience significant OCD symptoms, impaired functioning, and diminished quality of life. Cognitive-behavioral therapy (CBT), a talking therapy that focuses on altering a person's thoughts and behaviors, and the medication risperidone have both been commonly used for augmenting SRI treatment for OCD. This study will compare the short- and long-term effectiveness of exposure and ritual prevention (EX/RP), a type of CBT, and risperidone in augmenting SRI treatment in people with OCD.

Participants in this double-blind study will be randomly assigned to receive EX/RP, risperidone, or placebo in conjunction with their regular SRI medication. All participants will remain on their regular SRI at a stable dose. During the first 2 months of the study, participants assigned to EX/RP will attend therapy sessions twice per week. In EX/RP, participants will be exposed to feared objects or ideas, and will be encouraged not to carry out a compulsive response. Participants assigned to risperidone or placebo will meet with a psychiatrist once every 1 to 2 weeks. At the end of 8 weeks, all participants' OCD symptom severity will be assessed. During this time, participants who have responded to treatment will continue receiving the same treatment for an additional 24 weeks. Participants assigned to EX/RP will meet with a therapist no more than 15 times total, and participants receiving risperidone or placebo will meet with a psychiatrist once every 4 weeks. Outcomes will be reassessed at study completion.

Ortho McNeil Janssen Scientific Affairs, LLC are providing medication and placebos for this study.

For information on a related study, please follow this link:

http://clinicaltrials.gov/show/NCT00045903

Conditions

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Obsessive-Compulsive Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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1

Participants will receive treatment with risperidone

Group Type ACTIVE_COMPARATOR

Risperidone

Intervention Type DRUG

Dosage of 0.5 mg to 4.0 mg per day as tolerated

2

Participants will receive exposure and ritual prevention therapy (EX/RP)

Group Type ACTIVE_COMPARATOR

Exposure/ritual prevention therapy (EX/RP)

Intervention Type BEHAVIORAL

EX/RP is a form of cognitive behavioral therapy. Participants assigned to EX/RP will attend therapy sessions twice per week. In EX/RP, participants will be exposed to feared objects or ideas, and will be encouraged not to carry out a compulsive response.

3

Participants will receive treatment with the placebo

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Placebo capsules will be identical in appearance to those of risperidone.

Interventions

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Risperidone

Dosage of 0.5 mg to 4.0 mg per day as tolerated

Intervention Type DRUG

Exposure/ritual prevention therapy (EX/RP)

EX/RP is a form of cognitive behavioral therapy. Participants assigned to EX/RP will attend therapy sessions twice per week. In EX/RP, participants will be exposed to feared objects or ideas, and will be encouraged not to carry out a compulsive response.

Intervention Type BEHAVIORAL

Placebo

Placebo capsules will be identical in appearance to those of risperidone.

Intervention Type DRUG

Other Intervention Names

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Risperdal EX/RP PBO

Eligibility Criteria

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Inclusion Criteria

* Primary diagnosis of OCD
* Currently on a stable and adequate dose of an SRI
* Sufficient severity of symptoms to warrant additional augmentation treatment

Exclusion Criteria

* Medical or psychiatric conditions that would make participation in the study unsafe
* Currently receiving psychotherapy elsewhere at the time of study entry
* Previously (within 12 weeks prior to study entry) attended 8 or more sessions of EX/RP within a 2-month period or received at least 4 weeks of antipsychotic augmentation while on an adequate SRI dose
* Currently being treated with an SRI for the first time and has not yet responded, but has not tried another SRI
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

New York State Psychiatric Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Blair Simpson, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

New York State Psychiatric Institute

Edna Foa, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pennsylvania

Locations

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New York State Psychiatric Institute

New York, New York, United States

Site Status

University of Pennsylvania Center for the Treatment and Study of Anxiety

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Simpson HB, Foa EB, Liebowitz MR, Huppert JD, Cahill S, Maher MJ, McLean CP, Bender J Jr, Marcus SM, Williams MT, Weaver J, Vermes D, Van Meter PE, Rodriguez CI, Powers M, Pinto A, Imms P, Hahn CG, Campeas R. Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiatry. 2013 Nov;70(11):1190-9. doi: 10.1001/jamapsychiatry.2013.1932.

Reference Type RESULT
PMID: 24026523 (View on PubMed)

McLean CP, Zandberg LJ, Van Meter PE, Carpenter JK, Simpson HB, Foa EB. Exposure and response prevention helps adults with obsessive-compulsive disorder who do not respond to pharmacological augmentation strategies. J Clin Psychiatry. 2015 Dec;76(12):1653-7. doi: 10.4088/JCP.14m09513.

Reference Type DERIVED
PMID: 26613263 (View on PubMed)

Foa EB, Simpson HB, Rosenfield D, Liebowitz MR, Cahill SP, Huppert JD, Bender J Jr, McLean CP, Maher MJ, Campeas R, Hahn CG, Imms P, Pinto A, Powers MB, Rodriguez CI, Van Meter PE, Vermes D, Williams MT. Six-month outcomes from a randomized trial augmenting serotonin reuptake inhibitors with exposure and response prevention or risperidone in adults with obsessive-compulsive disorder. J Clin Psychiatry. 2015 Apr;76(4):440-6. doi: 10.4088/JCP.14m09044.

Reference Type DERIVED
PMID: 25375780 (View on PubMed)

Farris SG, McLean CP, Van Meter PE, Simpson HB, Foa EB. Treatment response, symptom remission, and wellness in obsessive-compulsive disorder. J Clin Psychiatry. 2013 Jul;74(7):685-90. doi: 10.4088/JCP.12m07789.

Reference Type DERIVED
PMID: 23945445 (View on PubMed)

Related Links

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http://www.columbia-ocd.org/

Click here for the Columbia University Obsessive-Compulsive Disorder Research Clinic website

http://www.med.upenn.edu/ctsa/

Click here for the University of Pennsylvania Center for the Treatment and Study of Anxiety website

http://www.clinicaltrials.gov/show/NCT00045903

Click here to view the ClinicalTrials.gov record of this trial's parent study

Other Identifiers

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R01MH045436-02

Identifier Type: NIH

Identifier Source: secondary_id

View Link

DSIR 83-ATAS

Identifier Type: -

Identifier Source: secondary_id

R01MH045436

Identifier Type: NIH

Identifier Source: secondary_id

View Link

R01MH045404

Identifier Type: NIH

Identifier Source: secondary_id

View Link

#5188/#6258R

Identifier Type: -

Identifier Source: org_study_id

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