Bipolar Disorder With Comorbid Cluster B Personality Disorder Features: Impact on Suicidality
J Clin Psychiatry 2005;66(3):339-345
© Copyright 2016 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Background: Obsessive-compulsive disorder
(OCD) often responds inadequately to serotonin reuptake
inhibitors (SRIs). A case series reported substantial response to
once-weekly oral morphine. We conducted a placebo-controlled,
double-blind trial to investigate whether once-weekly oral
morphine is effective in SRI-resistant OCD.
Method: Subjects with DSM-IV-defined OCD
for >= 3 years who had failed >= 2 adequate SRI trials and
had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of
>= 20 were recruited. Current medications were continued.
Subjects were randomly assigned to random-order, 2-week blocks of
once-weekly morphine, lorazepam, and placebo. Week 2 dosage was
increased, decreased, or maintained depending on response and
Results: We enrolled 23 subjects, who had failed
2 to 6 SRI trials. The median screening Y-BOCS score was 29. The
median Y-BOCS score after morphine (highest dose) was 25 (median
decrease = 13%). Seven subjects (30%) were responders (Y-BOCS
decreases >= 25%). The median Y-BOCS score after lorazepam
(highest dose) was 27 (median decrease = 6%). Four subjects (17%)
responded to lorazepam; 1 was a morphine responder. The median
Y-BOCS score after placebo (highest dose) was 27 (median decrease
= 7%), and no subject responded. Responses differed significantly
among the 3 conditions (Friedman 2-way analysis of variance, chi r2 = 13.92, df = 2, p = .01). Wilcoxon matched-pairs signed-rank
tests (T = 56.5, p = .05) showed significance for morphine versus
placebo but not lorazepam versus placebo.
Conclusion: Our results support the
hypothesis that once-weekly oral morphine can reduce symptoms in
some treatment-resistant OCD patients. The mechanism of action is
unknown. Further studies of mu-agonists and glutamate antagonists