Brexpiprazole augmentation in patients with a resistant obsessive compulsive disorder with psychotic features: an observational study in a psychiatric rehabilitation center

Introduction The relationship between obsessive-compulsive disorder and psychotic disorders has been frequently observed. Subject to diagnostic and therapeutic controversies, this association is a challenge for clinicians. Several scientific studies have observed a frequency of approximately 12% of this association in patients affected by schizophrenia. The efficacy of augmentation of SGAs with antidepressants in treatment-resistant OCD is demonstrated. Several studies have shown the efficacy of some dopamine receptor partial agonists (DRPAs) (aripiprazole and cariprazine) in augmentation with SSRIs in zOCD-psychotic features treatment-resistant. Brexpiprazole is a DRPAs with serotoninergic 5-HT1A agonism and 5-HT2A receptor antagonist. Objectives To evaluate the efficacy of brexpiprazole in augmentation with SSRIs in OCD patients with psychotic features resistant to pharmacological treatment. Methods Eleven patients (6 females, 5 males; mean total age (42.818 yrs ±12.679)) were recruited into our observational study. Affected by Obsessive Compulsive Disorder with psychotic features (based on the DSM-5-TR criteria). All patients were assessed using the SCID-5-CV. Levels of insight were assigned using DSM-5-TR specifiers. A detailed interview was conducted containing information on the demographic profile of the patients. All patients were administered the following rating scales: BPRS, Y-BOCS, GAF, CGI-S, at baseline (T0), after one month (T1), two months (T2), six months (T3), and one year (T4). All patients were administered bexpiprazole, replacing other SGAs associated with SSRIs (see Table 1). Results Table 2 and the graphic show the results obtained with our study. A statistically significant reduction of the mean total score was observed in the BPRS, Y-BOCS scales, an increase in the mean total score with the GAF. An improvement in the mean total score was also observed with the CIG-S. In all the scales used, the ANOVA results indicate that at least two of the repeated measures differed significantly. The preliminary data also indicate adequate safety and effectiveness. Image 1: Image 2: Image 3: Conclusions Our small observational study aimed to evaluate the efficacy of brexpiprazole in a group of patients affected by OCD with psychotic features. Despite the small sample analyzed, the results of our study point towards a possible use of brexpiprazole in this group of patients affected by OCD with psychotic features during normal routine clinical practice. Disclosure of Interest None Declared