A brief summary of the etiological factors and pharmacological approaches to therapy of obsessive-compulsive disorder is given. Evidence for the serotonergic hypothesis is reviewed. Three case reports of patients with severe OCD who had not responded to traditional chemotherapeutic approaches and electroconvulsive therapy are presented. All three responded to a series of 14 intravenous chlorimipramine infusions with a maximum dose of 350 mgms per infusion. The technique of infusion therapy and possible mechanisms of action are discussed. It is concluded that OCD is no longer accepted as a rare disorder and that effective treatment exists. For patients who do not respond to oral chlorimipramine, the treatment of choice, intravenous chlorimipramine is suggested as a viable alternative.
References
1.
KarnoM, GoldingJ, SorensonS.The epidemiology of obsessive compulsive disorder in five U.S. communities. Arch Gen Psychiatry1988; 45: 1094–1099.
2.
BlandR.Psychiatric Epidemiology. Can J Psychiatry1988; 33(7): 618–625.
3.
SalzmanL, ThalerFH. Obsessive compulsive disorder: a review of the literature. Am J Psychiatry1981; 138: 286–296.
4.
FreudS. (1909) Notes upon a case of obsessional neurosis. Collected papers, Vol. 3. New York: Basic Books, 1959; 293–383.
5.
ThylerBA, ParrishRT, CurtisGC, Ages of onset of DSM-III anxiety disorders. Compr Psychiatry1985; 26: 113–122.
6.
BlackA.The natural history of obsessional neurosis. In: BeechHR, ed. Obsessional states.London: Methuen, 1974.
7.
IngramIM. Obsessional states in mental hospital patients. J Ment Sci1961; 197: 382–402.
8.
ElkinsR, RapoportJ, LipskyA.A childhood obsessive compulsive disorder: a neurobiological perspective. J Am Acad Child Psychiatry1980; 19: 551–554.
9.
NeeL, CaineE, EldridgeR, Gilles de la Tourette syndrome: clinical and family study of 50 cases. Ann Neurol1980; 7(2): 41–49.
BearD, Quantitative analysis of interictal behaviour in temporal lobe epilepsy. Arch Neurol1977; 34: 454–467.
12.
PitmanRK, GreenRC, JenikeMA, Clinical comparison of Tourette's Disorder and obsessive-compulsive disorder. Am J Psychiatry1987; 144: 1166–1171.
13.
PaulsDL, LeckmanJF. The inheritance of Gilles de la Tourette's Syndrome and associated behaviors. N Engl J Med1986; 315: 993–997.
14.
RasmussenSA, TsuangMT. Clinical charcteristics and family history in DSM-III obsessive compulsive disorder. Am J Psychiatry1986; 143: 317–322.
15.
PitmanRK, JenikeMA. Coprolalia in obsessive-compulsive disorder: a missing link. J Nerv Ment Dis1988; 176(5): 311–313.
16.
CummingsJL, FrankelM.Gilles de la Tourette Syndrome and the neurological basis of obsessions and compulsions. Biol Psychiatry1985; 20: 1117–1126.
17.
FlorHenryP, YeudallL, KolesZ, Neuropsychological and power spectral EEG investigations of the obsessive-compulsive syndrome. Biol Psychiatry1979; 14: 119–130.
18.
BeharD, RapoportJ, BergC, Computerized tomography and neuropsychological test measures in adolescents with obsessive compulsive disorder. Am J Psychiatry1984; 141: 363–369.
LuxenbergJS, SwedoSE, FlamentMF, Neuroanatomical abnormalities in obsessive compulsive disorder detected with quantitative X-ray computed tomography. Am J Psychiatry1988; 145: 1089–1093.
21.
BaxterLR, SchwartzJM, MazziottaJC, Cerebral glucose metabolic rates in non-depressed patients with obsessive compulsive disorder. Am J Psychiatry1988; 145: 1560–1563.
22.
TippenJ, HennFA. Modified leukotomy in the treatment of intractable obsessional neurosis. Am J Psychiatry1982; 139: 1601–1603.
23.
TalairachJ, BancandJ, GeierS, The cingulate gyrus and human behaviour. Electroencephalogr Clin Neurophysiol1973: 34: 45–52.
24.
ThorenP, AsbergM, CronholmB, Clomipramine treatment of obsessive disorder: I. A controlled clinical trial: II. Biochemical aspects. Arch Gen Psychiatry1980; 37: 128–129.
25.
MarksIM, SternRS, MawsonD, Clomipramine and exposure for obsessive compulsive rituals. Br J Psychiatry1980; 136: 1–25.
26.
MontgomerySA. Clomipramine in obsessional neurosis: a placebo controlled trial. Pharm Med1980; 1: 189–192.
27.
AnanthJ.Treatment of obsessive-compulsive neurosis with Clomipramine (Anafranil). J Int Med Res1977; (Supple. 5): 38–41.
28.
AsbergM, ThorenP, BertilssonL.Clomipramine treatment of obsessive disorder: biochemical and clinical aspects. Psychopharmacol Bull1982; 18: 13–21.
29.
StroebelC, SzarekB, GlueckB.Use of clomipramine in treatment of obsessive compulsive symptomatology. J Clin Psychopharmacol1984; 4(2): 98–100.
30.
AnanthJ.Clomipramine: an antiobsessive drug. Can J Psychiatry1986; 31(3): 253–258.
31.
SternRS, MarksIM, MawsonD, Clomipramine and exposure for compulsive rituals: II. Plasma levels, side effects and outcome. Br J Psychiatry1980; 126: 161–166.
32.
MavissakalianMR, MichelsonL.Tricyclic antidepressants in obsessive compulsive disorder: antiobsessional or antidepressant agents?J Nerv Ment Dis1983; 171: 301–306.
33.
DeVeaugh-GeissJ, LandauP, KatzR.Preliminary results from a multi-center trial of clomipramine (Anafranil) in obsessive compulsive disorder. Presented at the annual NCDEU meeting, Key Biscayne, Fl., May 30-June 3, 1988.
TraskmanL, AsbergM, BerlitssonL, Plasma levels of clomipramine and its desmethyl metabolite during treatment of depression. Clin Pharmacol Ther1979; 26: 600–610.
36.
Yaryura-TobiasJA, BerbrianRJ, NezirogluFA, Obsessive compulsive disorders as a serotonergic deficit. Res Commun Psychol Psychiatr Behav1977; 2: 279–286.
37.
FlamentMF, RapaportJL, MurphyDL, Biochemical changes during clomipramine treatment of obsessive compulsive disorder. Arch Gen Psychiatry1987; 44: 219–225.
38.
ZoharJ, InselTR, Zohar-KadouchRC. Seretonergic respon-sivity in obsessive compulsive disorder. Arch Gen Psychiatry1988; 45: 167–172.
39.
ZakJP, MillerJA, SheehanDV, The potential role of serotonin reuptake inhibitors in the treatment of obsessive compulsive disorder. J Clin Psychiatry1988; 49(8 Suppl): 23–29.
40.
HollanderE, FayM, CohenB, Serotonergic and norandrenergic sensitivity in obsessive compulsive disorder: behavioral findings. Am J Psychiatry1988; 145: 1015–1017.
41.
WamsleyJK, ByerleyWF, McCabeRT, Receptor alterations associated with serotonergic agents: an autoradiographic analysis. J Clin Psychiatry1987; 48: 19–25.
42.
CacciaS, FongMH, GaratliniS, Plasma concentrations of trazadone and 1-(3-chlorophenyl) piperazine in man after a single oral dose of trazadone. J Pharm Pharmacol1982; 34: 605–606.
43.
GrimshawL.The outcome of obsessional disorder, a follow-up study of 100 cases. Br J Psychiatry1965; 111: 1051–1056.
MeyerV, LevyR.Treatment of obsessive compulsive neurosis. Proc R Soc Med1971; 64: 1115–1116.
46.
FoaEB, StetekeeG, MilbyJB. Differential effects of exposure and response prevention in obsessive compulsive washers. J Consult Psychol1980; 48: 71–79.
47.
MarksI, O'SullivanG.Drugs and psychological treatments for agoraphobia/panic and obsessive compulsive disorders: a review. Br J Psychiatry1988; 153: 650–658.
PatoMT, Zohar-KodouchR, ZoharJ, Return of symptoms after discontinuation of clomipramine in patients with obsessive compulsive disorder. Am J Psychiatry1988; 145: 1521–1525.
50.
KahnRS, WestenbergHG, JoliesJ.Zimelidine treatment of obsessive compulsive disorder: biological and neuropsychological aspects. Acta Psychiatr Scand1984; 69: 259–261.
51.
PrasadAJ. Obsessive compulsive disorder and trazodone. Am J Psychiatry1984; 141: 612–613.
52.
FontaineR, ChouinardG.An open clinical trial of fluoxetine in the treatment of obsessive compulsive disorder. J Clin Psychopharmacol1986; 6: 98–101.
MellmanLA, GormanTM. Successful treatment of obsessive compulsive disorder with E.C.T. J Clin Psychiatry1983; 4: 131–132.
58.
WarnekeL.The use of intravenous chlorimipramine in the treatment of obsessive compulsive disorder. Can J Psychiatry1984; 29(2): 135–141.
59.
WarnekeL.Intravenous chlorimipramine in the treatment of obsessional disorder in adolescence: a case report. J Clin Psychiatry1985; 46: 100–103.
60.
Lopez-IborJJ. Intravenous perfusions of monochlorimipramine: technique and results. Proceedings of Sixth International Congress of the C.I.W.P., Amsterdam. Excerpt: Medica Foundation, 1969.
61.
PollockBG, PerrelJM, ShostakM.Rapid achievement of antidepressant effect with intravenous chlorimipramine. (Letter to Ed.) N Engl J Med1985; 312(19): 1130.
62.
KisslingW, MollerHJ, LauterH, Double-blind comparison of intravenous versus oral maprotiline: antidepressant activity, plasma levels, side effects. Pharmacopsychiatry1985; 15: 96–97.
63.
PollockBG, PerrelJM, NathanS, Acute antidepressant effect following pulse loading with intravenous and oral chlorimipramine. Arch Gen Psychiatry1989; 46: 29–35.
64.
SethyVH, DayJS, CooperMM. Rapid changes in central beta-adrenergic receptors after chronic intravenous infusion of antidepressants. Res Commun Chem Pathol Pharmacol1986; 54: 35–46.
