Drugs, therapy help OCD patients

New drug treatments are offering hope to patients who suffer from autism, compulsive buying and hypochondria, according to one expert in the field.

Once thought to be separate and distinct medical disorders, these diseases are now included within a category called obsessive-compulsive spectrum disorders. And many of these disorders are responding to the same drugs used to treat obsessive-compulsive disorder, said Eric Hollander, M.D., director of the compulsive, impulsive and anxiety disorders program at Mt. Sinai School of Medicine, New York.

"We found over time that there were a number of diagnoses that didn't qualify as obsessive-compulsive disorder, but that certainly shared similar characteristics of the disorder," Hollander said at a press briefing sponsored by the American Medical Association in New York.

"It was natural to wonder if some of the drug and behavioral therapies used for obsessive-compulsive disorder would be useful for these diagnoses. And research published in the last three years is beginning to show that they are."

Body issues

Researchers divide obsessive-compulsive spectrum disorders into three categories.

The first category includes a preoccupation with bodily sensation, body image and weight, such as hypochondria and eating disorders. Another example is body dysmorphic disorder, in which people are obsessed with body appearance.

Of these disorders, researchers have done the most substantial research on body dysmorphic disorder, Hollander said. "There's a large amount of data from open clinical trials where patients seem to respond to serotonin reuptake inhibitors. We also did a trial using fluvoxamine [Solvay's Luvox], and this seemed to work, while some antidepressants did not. A double-blind crossover trial showed that chlomipramine, a serotonin reuptake inhibitor, was effective in treating this disorder, while zipramine, a norepinephrine reuptake inhibitor, was not."

Some studies also involve cognitive-behavioral therapy for patients with body dysmorphic disorder. "Getting people to socialize more and to avoid camouflaging whatever physical defects they're obsessed about are also shown to be successful in helping people to cope with this disorder," he said.

Neurological disorders

The second category of obsessive-compulsive spectrum disorders represents neurological diseases (such as Tourette's Syndrome or other tic-related disorders), Sydenham's Chorea (usually associated with strep infection and resulting in jerky involuntary movements) and autism.

Among these disorders, research has shown that chlomipramine is more effective than desipramine (sold as Hoechst Marion Roussel's Norpramin and as a generic), Hollander said.

For autism, a large-scale controlled study published in the Nov. 13 issue of the Archives of General Psychiatry shows that treatment with fluvoxamine, or Luvox, is helpful.

However, many studies have shown that serotonin reuptake inhibitors are not particularly useful in treating Tour-ette's Syndrome's tic-related behaviors, Hollander said. Still, these drugs are useful in treating these patients' obsessive-compulsive symptoms.

Impulsive behavior

The third category includes disorders that focus on impulsive-style behavior that results in pleasure, such as compulsive shopping or pathological gambling.

Researchers have good data showing that fluvoxamine is effective in reducing the urge to gamble, Hollander said. "We've done some earlier studies with chlomipramine as well, as it has been shown to be effective."

Another study tested fluvoxamine for compulsive shoppers. In an open trial, the drug reduced buying and shopping behavior in about ten weeks.

"Mental health professionals are very interested in the new research on drugs and behavioral therapy used for these disorders, but the learning curve is just beginning," Hollander said. PR