Severe Obsessive-compulsive Disorder Research Articles

Integrating precision medicine in the study and clinical treatment of a severely mentally ill person.

Background. In recent years, there has been an explosion in the number of technical and medical diagnostic platforms being developed. This has greatly improved our ability to more accurately, and more comprehensively, explore and characterize human biological systems on the individual level. Large quantities of biomedical data are now being generated and archived in many separate research and clinical activities, but there exists a paucity of studies that integrate the areas of clinical neuropsychiatry, personal genomics and brain-machine interfaces.Methods. A single person with severe mental illness was implanted with the Medtronic Reclaim® Deep Brain Stimulation (DBS) Therapy device for Obsessive Compulsive Disorder (OCD), targeting his nucleus accumbens/anterior limb of the internal capsule. Programming of the device and psychiatric assessments occurred in an outpatient setting for over two years. His genome was sequenced and variants were detected in the Illumina Whole Genome Sequencing Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory.Results. We report here the detailed phenotypic characterization, clinical-grade whole genome sequencing (WGS), and two-year outcome of a man with severe OCD treated with DBS. Since implantation, this man has reported steady improvement, highlighted by a steady decline in his Yale-Brown Obsessive Compulsive Scale (YBOCS) score from ∼38 to a score of ∼25. A rechargeable Activa RC neurostimulator battery has been of major benefit in terms of facilitating a degree of stability and control over the stimulation. His psychiatric symptoms reliably worsen within hours of the battery becoming depleted, thus providing confirmatory evidence for the efficacy of DBS for OCD in this person. WGS revealed that he is a heterozygote for the p.Val66Met variant in BDNF, encoding a member of the nerve growth factor family, and which has been found to predispose carriers to various psychiatric illnesses. He carries the p.Glu429Ala allele in methylenetetrahydrofolate reductase (MTHFR) and the p.Asp7Asn allele in ChAT, encoding choline O-acetyltransferase, with both alleles having been shown to confer an elevated susceptibility to psychoses. We have found thousands of other variants in his genome, including pharmacogenetic and copy number variants. This information has been archived and offered to this person alongside the clinical sequencing data, so that he and others can re-analyze his genome for years to come.Conclusions. To our knowledge, this is the first study in the clinical neurosciences that integrates detailed neuropsychiatric phenotyping, deep brain stimulation for OCD and clinical-grade WGS with management of genetic results in the medical treatment of one person with severe mental illness. We offer this as an example of precision medicine in neuropsychiatry including brain-implantable devices and genomics-guided preventive health care.

Obsessive-Compulsive Symptoms and Characteristics in Individuals With Delayed Sleep Phase Disorder

Research has demonstrated a relationship between circadian disruption and severe obsessive-compulsive disorder (OCD). Misalignment of sleep timing/endogenous biological rhythms with the 24-hour light/dark cycle may result in difficulty dismissing intrusive thoughts, thus increasing vulnerability to disorders characterized by intrusive thoughts, such as OCD. Deficits in inhibition of intrusive thoughts are posited to play a role in OCD. The current study investigated whether individuals with delayed sleep phase disorder (DSPD) report elevated symptoms of OCD and have greater difficulty inhibiting intrusive thoughts than do individuals without DSPD. Community participants with and without DSPD completed questionnaires and performed behavioral tasks designed to elicit intrusive thoughts. The participants with DSPD (n = 27) had elevated OCD symptoms and greater rates of disorders characterized by intrusive thoughts on a structured interview, as compared with the participants without DSPD (n = 19). These results support a link between the timing of sleep and symptoms of OCD. Implications and future directions are discussed.

Early Onset Obsessive Compulsive Disorder with Obsessive Slowness: A Case Report and Demonstration of Management

Obsessive slowness is a rare entity and is conceptualized either as primary psychiatric illness or as part of obsessive compulsive disorder (OCD). Often its outcome is frustrating even with treatment. We report a case of early onset severe OCD with obsessive slowness which showed good response to combined pharmacotherapy and behavioral therapy.

Case Examples of Enhancing Pediatric OCD Treatment With a Smartphone Application

These case examples depict the use of a smartphone application, Mayo Clinic Anxiety Coach, to enhance the treatment of pediatric obsessive-compulsive disorder (OCD). The presented cases highlight the use of Anxiety Coach as a stand-alone intervention for mild OCD symptoms and as an adjunct to treatment for severe OCD complicated by geographical barriers. Each case includes a description of treatment, patient use of the application, objective assessment of clinical symptoms, and a qualitative interview with the families. Both patients responded well to treatment and had a positive experience with Anxiety Coach. The application encouraged the families to complete exposures between sessions and allowed a detailed examination of the patients’ engagement in homework assignments. Potential uses of smartphone applications to address challenges facing treatment of, and research on, OCD are discussed.

Pediatric Obsessive-Compulsive Disorder

Effective treatment for childhood obsessive-compulsive disorder (OCD) is available, including exposure with response prevention and other cognitive-behavioral interventions. However, many children with OCD reside in locations in which few providers have adequate training to implement these procedures correctly. Family accommodation of childhood OCD symptoms further complicates the delivery of existing treatments. The advent of web camera technology has created the opportunity to provide therapy to individuals who otherwise could not access expert care. This case illustrates the treatment of an 8-year-old child with severe OCD who lived in a remote region of the United States. Treatment was administered twice daily for 5 days via web camera. At a 3-month follow-up, the child showed significant improvement in her OCD symptoms and in overall disability. Other symptoms (anxiety and anxiety sensitivity) were reduced, but not at a statistically significant level. The implications for treatment are considered.

Optimization of the Fluvoxamine dose for a poor metabolizer child using TDM: case study

Therapeutic drug monitoring is a good tool for dose optimization and therapy improvement. TDM is needed when problems arise as uncertain drug adherence, intolerability, non-response at therapeutic doses, or drug-drug interactions. It is mainly helpful for children, elderly patients, forensic patients, patients with known or suspected genetically determined pharmacokinetic abnormalities. Our work represents the case of a twelve year old girl that has been treated at the in-patient clinic due to severe obsessive-compulsive disorder. She was treated with fluvoxamine in combination with behavioral therapy und has had a suspected problem with her metabolism state. Method: Fluvoxamine concentration was measured using HPLC method. The obtained values were then evaluated by using the program CONBEST. Results: The dose of fluvoxamine was increased slowly within a month to 200 mg/d. The measured concentration was between 1400 and 1600 ng/ml, which exceeding the therapeutic range (60 – 230 ng/ml). After dose reduction we found that elimination of the drug took place very slowly. Following three-day pausing, the reduction of the dose to 50 mg every second day gave an insignificant decrease in drug concentration. Conclusion: The steady state concentration reached slowly because of the poor metabolism, so the assessment of the current dosage is possible after about two weeks. TDM was helpful for dose optimization and therapy improvement in combination with a behavioral therapy.

Severe obsessive-compulsive disorder (OCD): socio-demographic and clinical features

Aim: the aim of the study is to evaluate the socio-demographic and clinical features with prognostic value in predicting evolution in severe OCD.Materials and methods: patients with a main diagnosis of OCD were recruited according to DSM-IV criteria. Socio-demographic and clinical features were assessed by mean of a semi-structured interview and clinical rating scales (Y-BOCS, HAM-A, HAM-D and SCID-II). Two subgroups were compared according to the severity of symptoms (severe vs mild-moderate).Results: the total sample was made up of 450 OCD subjects aged 34.5±12.1, with a mean age of onset 22.3±9.1; 215 subjects (47.8%) were females. Patients with severe OCD (Y-BOCS ≥ 32) showed a more insidious onset and a more chronic course compared to patients with mild-moderate symptoms. Other predictors of increased OCD severity were washing and hoarding compulsions. Lastly, the severity of the obsessive-compulsive condition was higher when it was associated either with mood disorders or with Axis II disorders (particularly Cluster A).Discussion: our study shows a correlation between severe OCD and severity predictors such as functional impairment and mood disorders. Furthermore washing and hoarding symptoms, lifetime comorbity with mood disorders and Cluster A personality disorders seem to predict OCD severity.

Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up

Background and purposePsychosurgery, such as anterior capsulotomy, is a therapeutic option for treatment-resistant obsessive-compulsive disorder (OCD). In this paper, we present a prospective, long-term follow-up study aimed at evaluating both...

Clinical relevance of comorbidity in obsessive compulsive disorder: The Netherlands OCD Association study

BackgroundThis study describes lifetime and current rates of comorbidity, its onset and its consequences in a large clinical sample of patients with obsessive compulsive disorder (OCD). A wide range of risk factors and clinical characteristics were also examined to determine whether pure OCD is different from OCD with current comorbidity. Finally, the temporal sequencing of the disorders was examined. MethodData were obtained from the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. A sample of 382 participants with current OCD (during the past month) was evaluated. ResultsCurrent comorbidity occurred in 55% of patients with OCD, while 78% suffered from lifetime comorbidity. Comorbidity is associated with more severe OCD, anxiety and depressive symptoms and more negative consequences on daily life. Multiple comorbid disorders often precede OCD and influence both its course and severity. Childhood trauma and neuroticism are vulnerability factors for the development of multiple comorbid disorders in OCD. LimitationsIt should be noted that causal inferences about the association between risk factors and OCD are precluded since our results were based on cross-sectional data. Conclusion(Multiple) comorbidity in OCD is clinically relevant since it is associated with a specific pattern of vulnerability, with greater chronicity, with more severe OCD and more negative consequences on daily life. This indicates that the diagnosis and treatment of all comorbid disorders is clinically relevant, and clinicians should be especially aware of multiple disorders in cases of childhood trauma and high levels of neuroticism. Primary OCD has a different developmental and comorbidity pattern compared to secondary OCD.

Cognitive functioning in medication-free obsessive-compulsive patients treated with cognitive-behavioural therapy

So far it is still uncertain whether neuropsychological test results in obsessive-compulsive disorder (OCD) change after CBT and whether neuropsychological and clinical variables predict response to CBT. 60 medication-free patients hospitalised for severe OCD were treated with CBT including exposure and response prevention (ERP). Pre- and Post-treatment patients completed a cognitive test battery covering a broad range of neuropsychological and clinical variables. The Yale Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess symptom severity. A healthy control group matched for age, gender, intelligence and education completed the same neuropsychological test battery, with similar test–retest intervals as the patients. Analyses showed significantly worse cognitive functioning in patients compared to healthy controls before treatment on many measures. After CBT patients had significantly improved test results regarding speed of information processing, verbal fluency, visuo-constructive functions and set shifting ability while controls did not perform better at the second testing. None of the neuropsychological and clinical variables assessed was significantly correlated with treatment outcome. These results indicate that cognitive dysfunctions in OCD are in part state-dependent and reversible after treatment. Moreover, our results suggest that CBT is successful even in those patients who exhibit cognitive dysfunctions and who are severely affected at the beginning of treatment.

Obsessive-Compulsive Behavior as Presenting Symptom of Primary Antiphospholipid Syndrome

This study aimed to improve understanding and treatment of psychiatric symptoms in antiphospholipid syndrome (APS) and to present an approach to the medical management of patients presenting with obsessive-compulsive disorder (OCD) with suspected neurovascular pathology. A 15-year-old boy presented with severe OCD of recent onset. An infarct of the caudate nucleus was identified as the initial presentation of primary APS. This case report includes a selective literature review of the neuropsychiatric correlates of APS. The patient had OCD for 3 months with increasing symptoms resulting in admission for psychiatric reasons. After referral to the emergency department 3 weeks later, an infarct of the caudate nucleus was documented using magnetic resonance images of the brain, and APS was diagnosed based on additional laboratory findings. Anticoagulant treatment (enoxaparin and phenprocoumon) in this patient was effective in reducing obsessive-compulsive symptom severity. OCD may present as a neuropsychiatric manifestation of APS. The present observations are consistent with a thrombotic mechanism for neurologic or psychiatric symptoms in APS. In general, routine medical workup for childhood OCD is not indicated, but a comprehensive psychiatric, medical, and family history taking and physical examination are essential, particularly if OCD is of recent onset. The role of anticoagulant therapy in neuropsychiatric manifestations of APS without the presence of a cerebral infarct requires further research.

SEXUAL OBSESSIONS IN PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER: CLINICAL CHARACTERISTICS AND TREATMENT OUTCOMES

Sexual obsessions are common in adults with obsessive-compulsive disorder (OCD), cause great distress, and are sometimes misinterpreted as indicating risk to others. Little is known about the prevalence, clinical correlates, and prognosis of such symptoms in young people. Three hundred and eighty-three patients referred to a specialist pediatric OCD clinic were administered a series of measures at intake and, for those treated at the clinic, again after treatment. Patients with and without sexual obsessions were compared on socio-demographic and clinical characteristics. Mixed model analyses of variance compared treatment outcomes in both groups. A quarter of patients had sexual obsessions at baseline (age range 8-17); they had slightly more severe OCD symptoms and were more depressed than those without sexual obsessions. Aggressive and religious obsessions, magical thinking, fear of saying certain things, repeating rituals, superstitious games, mental rituals, and the need to tell, ask, or confess were more frequent in participants with sexual obsessions. Crucially, no differences in treatment outcome were found between the groups. Sexual obsessions are common in pediatric OCD, even in very young children. Although they may be associated with particular clinical features, they do not interfere with treatment response. The occurrence of sexual obsessions in children should be recognized and these symptoms understood as ordinary, nonthreatening OCD symptoms, which pose no risk to others. They respond to the standard treatment strategies, so children and families should receive the usual message of optimism regarding the chances of recovery.

An Evaluation of Irreversible Psychosurgical Treatment of Patients With Obsessive-Compulsive Disorder in the Netherlands, 2001–2008

Admissions for irreversible psychosurgical treatment of obsessive-compulsive disorder (OCD) by the Working Group for Indication Psychosurgery in the Netherlands were analyzed, and the postsurgical effects on symptom severity and quality of life were evaluated. The data were extracted from patient records in the period 2001-2008, and there was a postoperative assessment with a semistructured interview. Fourteen patients applied, having severe OCD with mostly one or more comorbid disorders. The mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 32 points. Four of seven patients in whom psychosurgery was deemed useful were operated on. The decrease of the Y-BOCS score from registration to after surgery was 9 points (range, 3-17 points). An improvement in social function was present in three of four patients. In conclusion, psychosurgery can be a valuable treatment option for patients with severe OCD in whom other treatments fail.

Life threatening self starvation; a case report

BackgroundObsessive compulsive disorders are a complex group that can have a variety of manifestations. Many authors now describe an obsessive compulsive spectrum disorder where many other specific diagnostic entities such as trichotillomania, tic disorders and body dysmorphic disorder are considered to be related and linked disorders.Case presentationWe report a case of a twenty two year old Sri Lankan male who presented with life threatening self starvation due to severe obsessive compulsive disorder. The diagnosis was not considered till late due to the atypical presentation of the patient. While his symptoms bordered on a delusional psychosis, a decision was made to treat him as for obsessive compulsive disorder with behavioural therapy which was successful in the end.ConclusionsIn analysis of a patient with severe anorexia, the psychological causes should not be forgotten. In fact, if the feeding pattern of the patient was observed at the beginning, unnecessary investigating and life threatening worsening of the condition could have been avoided.

Treatment of sexual trauma dissolves contamination fear: case report

Background: In patients with co-morbid obsessive–compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), repetitive behavior patterns, rituals, and compulsions may ward off anxiety and often function as a coping strategy to control reminders of traumatic events. Therefore, addressing the traumatic event may be crucial for successful treatment of these symptoms.Objective: In this case report, we describe a patient with comorbid OCD and PTSD who underwent pharmacotherapy and psychotherapy.Methods: Case Report. A 49-year-old Dutch man was treated for severe PTSD and moderately severe OCD resulting from anal rape in his youth by an unknown adult man.Results: The patient was treated with paroxetine (60 mg), followed by nine psychotherapy sessions in which eye movement desensitization and reprocessing (EMDR) and exposure and response prevention (ERP) techniques were applied. During psychotherapy, remission of the PTSD symptoms preceded remission of the OCD symptoms.Conclusions: This study supports the idea of a functional connection between PTSD and OCD. Successfully processing the trauma results in diminished anxiety associated with trauma reminders and subsequently decreases the need for obsessive–compulsive symptoms.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online

Citalopram Pulse-Loading for Severe Treatment-Resistant OCD: A Case Series of Acute Response, One Year Follow-Up and Tolerability

Background: Treatment resistance is a frequent situation in Obsessive Compulsive Disorder (OCD), occurring in 40-60% of patients. However, in the current literature there are only a few evidence-based options for treatmentresistant patients. Pulse-loading treatment consists in a rapid titration of the pharmacological agent in the first days of treatment. A few studies suggested that this kind of titration with intravenous clomipramine could result in a greater and faster response than with a standard titration in OCD resistant patients. The main aim of this case series was to investigate the effectiveness and tolerability of a citalopram pulse-loading protocol in severe treatment-resistant OCD patients. Methods: We treated 5 severe treatment-resistant OCD patients with intravenous citalopram starting with 40 mg for 3 days and increasing the dose up to 80 mg from the fourth day. The patients continued the treatment with 80 mgof intravenous citalopram for 18 days (a total of 21 days of intravenous treatment), then they switched to oral treatment (80 mg of oral citalopram). We assessed acute and one-year follow-up efficacy and tolerability. Results: During the pulse-loading treatment no patients showed significant adverse events. Two of five patients had a full response and one of these had remission. Furthermore, these two patients did not have any relapse of OC symptoms during the 1-year follow-up. One of five patients had a partial response after 12 weeks and a full response during the 1-year follow-up period after switching from quetiapine to aripiprazole and after a CBT trial. Two of five patients did not respond. No patients showed clinical significant changes of the QTc interval. No patients showed significant changes of the sodium levels. Conclusion: Taking into account the very limited sample size, this case series suggests that this treatment approach deserves further controlled studies.

3029 – Bridging the gap between physio- and psychopathology: the example of deep brain stimulation in human-repetitive behaviours

Deep brain stimulation (DBS) is able to target with precision specific cerebral networks, thus offering hope for severe and treatment refractory illnesses, as well as to investigate in the detail the subcortical bases. In obsessive-compulsive disorder (OCD), DBS is being tested at several nodes of a prefrontal-subcortical circuit, including the subthalamic nucleus (STN). Functional imaging studies of OCD patients have shown abnormal metabolic activity of the orbito-frontal and cingulate cortices, as well as of the anterior part of the striatum. In animal and human studies, these structures have been associated with performance-monitoring and more generally metacognitive processes, thus suggesting that metacognitive dysfunctions might be central to OCD leading to pathological doubt. In this conceptual framework of hyperactive distrust metacognitive mechanism in OCD, checking behaviour can be regarded as an ill-founded metacognitive strategy designed to restore confidence in the outcome of one's actions. Within the basal ganglia network, the STN could act a crucial part in this process regarding its role in the inhibitory control of behaviour. Moreover, anatomy and neuro-computational models of the basal ganglia show that this nucleus is in the position to implement cortical metacognitive control by increasing the threshold for decision. This framework has the advantage of providing a theoretical basis to the promising clinical results obtained for STN-DBS in severe resistant OCD. Bearing in mind this model, it can be postulated that DBS, by its action on STN, positively interferes with the neural mechanism underlying compulsive behaviour.

Beneficial Effect of Subsequent Lesion Procedures After Nonresponse to Initial Cingulotomy for Severe, Treatment-Refractory Obsessive-Compulsive Disorder

Anterior cingulotomy (AC) can be an effective therapy for patients with severe obsessive-compulsive disorder who are refractory to traditional medical therapy. For patients who do not respond to AC, the benefit of additional lesion procedures vs continued medical management remains unknown. To determine whether a second lesion procedure is beneficial after unsuccessful initial AC. In this retrospective cohort study, we reviewed the records of 31 patients who were nonresponders to initial AC. Full response was defined as at least a 35% decrease and partial response as a 25% to 34% decrease in Yale-Brown Obsessive-Compulsive Scale scores. Yale-Brown Obsessive-Compulsive Scale change was compared between patients who underwent additional surgery and those treated nonsurgically. In addition, for patients who underwent additional surgery, we compared the benefit of subcaudate tractotomy with repeat AC (extension of the initial lesion) as the second procedure. Nineteen patients underwent a second surgery and 12 patients continued nonsurgical therapy. Fifty-three percent of patients who received additional surgery were full responders and 21% were partial responders at the most recent follow-up compared with 17% full responders and 25% partial responders among those who continued conventional therapy (P = .02). Of the patients who underwent an additional surgery, there were 64% full and 9% partial responders in the subcaudate tractotomy group compared with 38% full and 38% partial responders in the repeat AC group (P = .04). Second lesion surgery can be a safe and effective therapy for patients who do not respond to initial AC. Subcaudate tractotomy may confer a higher response rate than repeat cingulotomy.

Memantine add-on in moderate to severe obsessive-compulsive disorder: Randomized double-blind placebo-controlled study

There is a growing body of evidence for the efficacy of memantine augmentation in patients with obsessive-compulsive disorder (OCD). However, to date, no double-blind study has addressed this issue. The objective of the present randomized double-blind placebo-controlled study was to evaluate efficacy and tolerability of memantine add-on treatment in patients with moderate to severe OCD. Forty-two patients with the diagnosis of OCD based on DSM-IV-TR who had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of ≥21 were randomly assigned to memantine (10 mg/day for the first week, and 20 mg/day for the rest of the trial) or placebo in addition to fluvoxamine for eight weeks. Patients were assessed using Y-BOCS every two weeks. Thirty-eight patients completed the study. Repeated measure ANOVA showed significant effect for time × treatment interaction in total scale [F (2.096, 75.470) = 5.280, P = 0.006] and obsession [F (2.340, 94.547) = 5.716, P = 0.002] and near significant effect for compulsion subscales [F (2.005, 79.179) = 2.841, P = 0.065]. By week eight, all patients in the memantine group and six (32%) patients in the placebo group [P value of Fisher's exact test <0.001] met the criteria for partial and complete response. At the end of the trial, 17 (89%) patients in the memantine group compared with six (32%) patients in the placebo group achieved remission (χ2(1) = 13.328, P < 0.001). Frequency of side-effects was not significantly different between the two groups. In summary, we showed that memantine add-on to fluvoxamine significantly improved short-term outcomes in patients with moderate to severe OCD.

Granisetron Adjunct to Fluvoxamine for Moderate to Severe Obsessive-Compulsive Disorder

Several small studies have shown beneficial effects of ondansetron, a serotonin 5-HT(3) receptor antagonist, in the treatment of obsessive-compulsive disorder (OCD). The efficacy of other 5-HT(3) receptor antagonists in patients with OCD is still unclear. Granisetron does not alter cytochrome P450 activity and might have a lower risk of drug interactions, a longer duration of action and a better tolerability profile than other 5-HT(3) receptor antagonists. The objective of this study was to assess the efficacy and tolerability of granisetron augmentation of fluvoxamine in patients with OCD. This was a two-centre, randomized, double-blind, placebo-controlled, parallel-group study conducted from November 2011 to March 2012. The study setting was outpatient clinics of two large referral centres. Study participants were men and women, aged 18-60 years, who met the diagnostic criteria of OCD based on the DSM-IV-TR and who had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of at least 21. Participants were randomly assigned to granisetron (Kytril(®); SmithKline Beecham, Philadelphia, PA, USA) 1 mg every 12 hours or placebo every 12 hours in addition to fluvoxamine for 8 weeks. Patients were assessed using the Y-BOCS at baseline, second, fourth, sixth and eighth weeks. The primary outcome measure was the difference in the score change of Y-BOCS total score from baseline to week 8 between the two groups. We also compared changes in the obsession and compulsion subscales of the Y-BOCS, and frequencies of partial response (≥25% reduction in Y-BOCS score), complete response (≥35% reduction in Y-BOCS score) and remission (Y-BOCS score ≤16) between the two groups. Of the 42 included patients, 39 (20 in the placebo group, 19 in the granisetron group) completed the study. Significant time X treatment interaction was observed for total Y-BOCS (F [2.097, 79.678] = 4.941, p = 0.009), obsession (F [2.337, 88.799] = 4.938, p = 0.006) and compulsion (F [2.050, 77.899] = 4.674, p = 0.012) subscales. By week 8, complete response and remission were achieved by 20 (100%) and 18 (90%) patients in the granisetron group and by 7 (35%) patients in the placebo group (p-value of Fisher's exact test <0.001, risk ratio (RR) [95% CI] = 3.857 [2.039, 7.297]). There was no significant difference in the tolerability between the two regimens. Granisetron is an efficacious adjunct for the short-term treatment of patients with moderate to severe OCD and is well tolerated. IRCT201202041556N32.