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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

SO479

Augmentation pharmacotherapy for obsessive-compulsive symptoms in bipolar disorder: a systematic review of randomized controlled trials

AUGMENTATION PHARMACOTHERAPY FOR OBSESSIVE–COMPULSIVE SYMPTOMS IN BIPOLAR DISORDER: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

Although response rates were higher in the active treatment arm than with placebo in all five randomized controlled trials examining augmentation treatment for obsessive-compulsive symptoms in bipolar disorder, the evidence remains limited and unreplicated.

The aim was to systematically review randomized controlled trials evaluating pharmacological augmentation strategies for obsessive-compulsive symptoms (OCS) in bipolar disorder (BD). PubMed and Embase were searched for randomized, double-blind, placebo-controlled augmentation trials; the primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), with response defined as a reduction in Y-BOCS score exceeding 34% to 35%. Five randomized controlled trials were identified: topiramate (manic, 17/16, with background lithium, olanzapine, and clonazepam treatment, 16 weeks), memantine (manic, 19/19, 16 weeks), aripiprazole (manic, 23/23, with background lithium and clonazepam treatment, 8 weeks), quetiapine (euthymic, 24/23, 8 weeks), and risperidone (euthymic, 21/21, with background lithium treatment, 12 weeks). Response rates with active treatment versus placebo were 52.9% (9/17) versus 12.5% (2/16) for topiramate, 78.9% (15/19) versus 36.8% (7/19) for memantine, 91.3% (21/23) versus 4.3% (1/23) for aripiprazole, 50% (12/24) versus 5% (1/23) for quetiapine, and 95.2% (20/21) versus 47.6% (10/21) for risperidone. Regarding the direction of the evidence, memantine produced lower Y-BOCS scores and higher response rates from week 4 onward; aripiprazole reduced Y-BOCS scores and increased response rates, but improvement in mania did not differ between groups; quetiapine produced greater improvement in euthymic patients; and risperidone was associated with lower Y-BOCS scores and higher response rates. For topiramate, although the response rate favored the drug, the mean reduction in Y-BOCS scores was numerically greater in the placebo group. The authors note that heterogeneity between manic and euthymic samples complicates interpretation, that improvements in OCS may partly reflect concurrent mood stabilization, and that discordant outcomes and reporting inconsistencies in several studies limit confidence. In conclusion, pharmacological augmentation, particularly with antipsychotic strategies, shows promising signals for OCS in bipolar disorder, but the evidence remains limited and unreplicated.

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