Bipolar Disorder With Comorbid Cluster B Personality Disorder Features: Impact on Suicidality
J Clin Psychiatry 2005;66(3):339-345
© Copyright 2015 Physicians Postgraduate Press, Inc.
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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