CoChat
Sign Up
Cited by 248Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychoanalysis and Psychopathology Research

Cognitive-Behavioral Therapy vs Risperidone for Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder: A Randomized Clinical Trial

Open access
Simpson, Helen Blair, Foa, Edna B., Liebowitz, Michael R., Huppert, Jonathan D., Cahill, Shawn, Maher, Michael J., McLean, Carmen P., Bender, James +11 more·2013·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2013.1932PMC PMC3955365
Open this paper in CoChat — free account

Abstract

IMPORTANCE: Obsessive-compulsive disorder (OCD) is one of the world's most disabling illnesses according to the World Health Organization. Serotonin reuptake inhibitors (SRIs) are the only medications approved by the Food and Drug Administration to treat OCD, but few patients achieve minimal symptoms from an SRI alone. In such cases, practice guidelines recommend adding antipsychotics or cognitive-behavioral therapy consisting of exposure and ritual prevention (EX/RP). OBJECTIVE: To compare the effects of these 2 SRI augmentation strategies vs pill placebo for the first time, to our knowledge, in adults with OCD. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial (conducted January 2007-August 2012) at 2 academic outpatient research clinics that specialize in OCD and anxiety disorders. Patients (aged 18-70 years) were eligible if they had OCD of at least moderate severity despite a therapeutic SRI dose for at least 12 weeks prior to entry. Of 163 who were eligible, 100 were randomized (risperidone, n = 40; EX/RP, n = 40; and placebo, n = 20), and 86 completed the trial. INTERVENTIONS: While continuing their SRI at the same dose, patients were randomized to the addition of 8 weeks of risperidone (up to 4 mg/d), EX/RP (17 sessions delivered twice weekly), or pill placebo. Independent assessments were conducted every 4 weeks. MAIN OUTCOME AND MEASURE: The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to measure OCD severity. RESULTS: Patients randomized to EX/RP had significantly greater reduction in week 8 Y-BOCS scores based on mixed-effects models (vs risperidone: mean [SE], -9.72 [1.38]; P < .001 vs placebo: mean [SE], -10.10 [1.68]; P < .001). Patients receiving risperidone did not significantly differ from those receiving placebo (mean [SE], -0.38 [1.72]; P = .83). More patients receiving EX/RP responded (Y-BOCS score decrease ≥25%: 80% for EX/RP, 23% for risperidone, and 15% for placebo; P < .001). More patients receiving EX/RP achieved minimal symptoms (Y-BOCS score ≤12: 43% for EX/RP, 13% for risperidone, and 5% for placebo; P = .001). Adding EX/RP was also superior to risperidone and placebo in improving insight, functioning, and quality of life. CONCLUSIONS AND RELEVANCE: Adding EX/RP to SRIs was superior to both risperidone and pill placebo. Patients with OCD receiving SRIs who continue to have clinically significant symptoms should be offered EX/RP before antipsychotics given its superior efficacy and less negative adverse effect profile. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00389493.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2013.1932

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [14]First MB Spitzer RL Gibbon M Williams JB Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition New York Biometrics Research Department, New York State Psychiatric Institute 1996

Cited by

Sorted by citations

Related

Authors
Simpson, H. B., Foa, E. B., Liebowitz, M. R., Huppert, J. D., Cahill, S., Maher, M. J., McLean, C. P., Bender, J., Marcus, S. M., Williams, M. T., Weaver, J., Vermes, D., Van Meter, P. E., Rodriguez, C. I., Powers, M., Pinto, A., Imms, P., Hahn, C.-G., & Campeas, R.
Affiliations
  • New York State Psychiatric Institute (US)
  • University of Pennsylvania (US)
  • Columbia University (US)
  • Hebrew University of Jerusalem (IL)
  • University of Wisconsin–Milwaukee (US)
  • University of Louisville (US)
Corresponding author
Simpson, Helen Blair
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2013-11-01
Volume
70
Issue
11
Pages
1190
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2013.1932
PMC
PMC3955365
OpenAlex
W2167904835
Cited by
248
References
44
Citations by year
2026: 10 · 2025: 16 · 2024: 15 · 2023: 19 · 2022: 19 · 2021: 14 · 2020: 17 · 2019: 21 · 2018: 22 · 2017: 22 · 2016: 26 · 2015: 22 · 2014: 19 · 2013: 5 · 2012: 1
FWCI
26.70
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K24MH091555, R10MH045404, R01MH045404, R01MH-45404, K23MH092434, R01MH045436)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
obsessive-compulsive disorder, serotonin reuptake inhibitors, risperidone, cognitive behavioral therapy, exposure and response prevention, augmentation therapy, antipsychotic augmentation, placebo comparison, Yale-Brown Obsessive Compulsive Scale, treatment response, treatment-resistant OCD, relapse prevention
MeSH terms
Adolescent, Adult, Aged, Combined Modality Therapy, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Antipsychotic Agents, Cognitive Behavioral Therapy, Single-Blind Method, Selective Serotonin Reuptake Inhibitors, Risperidone

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review