human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to evaluate the comparative efficacy and tolerability of sertraline and fluoxetine in the treatment of obsessivecompulsive disorder ( OCD ) . Out patients meeting DSM-IV criteria for OCD , with a Yale-Brown Obsessive-Compulsive ( Y-BOCS ) total score ≥ 17 , an NIMH Global Obsessive-Compulsive ( NIMH-OC ) scale score ≥ 7 , and a CGI-Severity score ≥ 4 were r and omized to 24 weeks of double-blind treatment with sertraline ( N = 77 ) or fluoxetine ( N = 73 ) . Primary efficacy measures consisted of the Y-BOCS , the NIMH-OC scale , and the CGI-Severity ( CGI-S ) and Improvement ( CGI-I ) scales . Equivalent and significant ( p < 0.001 ) improvement was found at week 24 in Y-BOCS and NIMH-OC scale scores  for sertraline and fluoxetine . After 12 weeks , 49.2 % of patients on sertraline were rated on the CGI-S scale as being mildly ill or not ill compared to 24.6 % on fluoxetine ( p < 0.01 ) . A Cox analysis found patients on sertraline to have a statistically nonsignificant 42 % greater likelihood of achieving a response by week 12 ( CGI-I , much or very much improved ; 95 % CI , 0.85 , 2.38;p = 0.18 ) . Sertraline treatment also result ed in a higher proportion of remissions  than fluoxetine ( defined as a CGI-I ≤ 2 and a Y-BOCS score ≤ 11 ) , both at week 12 ( 20 % vs. 8 % ; χ2 , 3.95;df 1;p = 0.047 ) and week 24 ( 36 % vs. 22 % ; χ2 , 3.18;df , 1;p = 0.075 ) . Both medications were welltolerated and demonstrated significant efficacy in the treatment of out patients with moderate to severe OCD with the subjects treated with sertraline showing a greater likelihood of remission as well as an earlier improvement on some but not all efficacy Background Although serotonin reuptake inhibitors are effective in the treatment of OCD , many patients fail to respond to these agents . Growing evidence from open-label and placebo-controlled trials suggests a role for augmentation of SRIs with atypical antipsychotics in OCD . Quetiapine is generally well tolerated and previous open-label data has produced mixed results in OCD and additional controlled data is needed . Methods We undertook a double-blind , r and omised , parallel-group , flexible-dose , placebo-controlled study of quetiapine augmentation in subjects who had responded inadequately to open-label treatment with an SRI for 12 weeks . Following informed consent and screening , forty-two subjects were r and omised to either placebo or quetiapine for six weeks . Results There was significant improvement from baseline to endpoint on the Yale-Brown Obsessive-Compulsive Scale in both the quetiapine and placebo groups ( quetiapine , n = 20 , p < 0.0001 ; placebo , n = 21 , p = 0.001 ) with 40 % ( n = 8) of quetiapine and 47.6 % ( n = 10 ) of placebo treated subjects being classified as responders . Quetiapine did not demonstrate a significant benefit over placebo at the end of the six-week treatment period ( p = .636 ) . Similarly quetiapine failed to separate from placebo in the subgroup of subjects ( n = 10 ) with co-morbid tics . Quetiapine was generally well tolerated . Conclusions In this study , quetiapine augmentation was no more effective than placebo augmentation of SRIs . A number of limitations in study design make comparisons with previous studies in this area difficult and probably contributed to our negative findings . Future work in this important clinical area should address these limitations BACKGROUND AND METHODS The adverse effects and potential clinical value of risperidone as augmentation to selective serotonin reuptake inhibitor ( SSRI ) treatment in treatment resistant severe adolescent OCD patients were examined in 17 adolescents ( 15 - 19 years old , 8 males and 9 females ) in an open label trial of risperidone  1 - 2 mg daily . RESULTS After 12 weeks of augmenting treatment , statistically significant improvements were reflected in OCD symptom ratings ( mean total Y-BOCS/CY-BOCS scores after treatment with second SSRI 24.2 + /- 2.6 versus 19.9 + /- 2.9 , p < 0.001 ) and global assessment scores ( mean CGAS , 69.4 + /- 11.4 versus 74.7 + /- 9.6 , p < 0.001 ) . Four patients had moderate improvement of more than 25 % reduction in Y-BOCS scores in OCD symptoms . Further 10 patients had a reduction of 10 - 25 % in total score , indicating slight improvement . One patient ( 6 % ) dropped from clinical OCD to a sub clinical level of OCD ( Y-BOCS total score < 15 ) . No patient was found to have worsened during augmentation treatment . Eight cases had weight gain and sedation was reported in four cases . CONCLUSION These preliminary findings suggest that augmentation with risperidone in dosages up to 2 mg daily might be efficient in adolescents with treatment resistant OCD To examine the efficacy and tolerability of escitalopram in the prevention of relapse in patients with OCD , 468 patients with OCD were treated with open label escitalopram ( 10 mg or 20 mg ) for 16 weeks , after which the 320 responders ( Y-BOCS total score decrease > or = 25 % ) were r and omised to placebo or escitalopram ( at the assigned dose ) for 24 weeks double-blind treatment . The primary analysis ( time to relapse ) showed a significant advantage for escitalopram ( p<0.001 , log-rank test ) . The proportion of patients who relapsed was statistically significantly higher in the placebo group ( 52 % ) than in the escitalopram group ( 23 % ) ( p<0.001 , chi(2)-test ) . The risk of relapse was 2.74 times higher for placebo compared to escitalopram . Escitalopram was well tolerated and improvements in obsessive-compulsive symptoms reported during the open label period were sustained during the double-blind extension of treatment with active drug . These results demonstrate that escitalopram is effective for long-term treatment and relapse prevention in OCD Despite the effectiveness of clomipramine and selective serotonin reuptake inhibitors ( SSRIs ) in the treatment of obsessive-compulsive disorder ( OCD ) , 40 % to 60 % of patients who receive an adequate treatment with these agents have significant persisting symptoms . Newer atypical antipsychotic drugs showed efficacy as augmenting agents in patients with OCD resistant to serotonin reuptake inhibitors ( SRIs ) . The objective of this study was to evaluate the efficacy and safety of amisulpiride augmentation in treatment resistant OCD . A total of 20 patients diagnosed with OCD according to DSM-IV criteria and having a history of resistance to treatment with SRIs were included in the study .  Amisulpiride 200 mg/day was added to ongoing SRI treatment and titrated up to 600 mg/day in flexible doses . The mean amisulpiride dose was 325 + /- 106 mg/day . The patients were assessed with the Yale-Brown obsessive-compulsive scale ( Y-BOCS ) at baseline and at week 12 of amisulpiride treatment . Side effects were monitored by the UKU side effect rating scale . The reduction in Y-BOCS scores between the baseline ( 26.7 + /- 6.3 ) and the end of the treatment ( 12.5 + /- 2.8 ) was statistically significant ( p=0.0001 ) . The most commonly observed side effects included weight gain ( 14 patients , 70 % ) , mild sedation ( 13 patients , 65 % ) and asthenia ( 7 patients , 35 % ) . This study has several limitations and , hence , the results are preliminary and require confirmation in a r and omized controlled trial . In conclusion , this study suggests that amisulpiride may be a promising option as an augmentation strategy in treatment resistant OCD Background : Two thirds of patients with obsessive-compulsive disorder ( OCD ) respond to treatment with selective serotonin reuptake inhibitors ( SSRIs ) . The neurobiological mechanisms of SSRI action and failure to respond to SSRI treatment remain to be eluci date d. Objectives : The aim of this pilot study was to quantify changes in the availability of serotonin transporter ( SERT ) in the course of SSRI treatment and to relate these changes to improvements of clinical symptoms . Methods : Ten patients with OCD were investigated at baseline and 5 of them after 1 year of SSRI treatment with citalopram 60 mg per day using brain single photon emission computed tomography and [123I]β-CIT .  Specific-to-nondisplaceable [123I]β-CIT binding ratios ( V3″ ) were calculated in SERT-rich brainstem , midbrain and thalamus using a magnetic resonance imaging-based region of interest ( ROI ) analysis . Symptom severity was evaluated with the Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) . Results : V3″ differed significantly between pretreatment and follow-up scans in all three brain regions , thalamus , midbrain as well as in brainstem . In thalamic ROI , differ ences in SERT availability and Y-BOCS ratings correlated . In midbrain , a trend toward a significant association was found . In brainstem , no relationship was revealed . Conclusions : Higher occupancy of SERT by citalopram seems to be associated with better clinical response after 1 year of SSRI treatment of patients with OCD BACKGROUND To date , only 1 controlled study has found a drug ( haloperidol ) to be efficacious in augmenting response in patients with obsessive-compulsive disorder ( OCD ) refractory to serotonin reuptake inhibitor ( SRI ) monotherapy ; patients with comorbid chronic tic disorders showed a preferential response . This report describes the first controlled study of risperidone addition in patients with OCD refractory to treatment with SRI alone . METHODS Seventy adult patients with a primary DSM-IV diagnosis of OCD received 12 weeks of treatment with an  SRI . Thirty-six patients were refractory to the SRI  and were r and omized in a double-blind manner to 6 weeks of risperidone ( n = 20 ) or placebo ( n = 16 ) addition . Behavioral ratings , including the Yale-Brown Obsessive Compulsive Scale , were obtained at baseline and throughout the trial . Placebo-treated patients subsequently received an identical open-label trial of risperidone addition . RESULTS For study completers , 9 ( 50 % ) of 18 risperidone-treated patients were responders ( mean daily dose , 2.2 + /-0.7 mg/d ) compared with 0 of 15 in the placebo addition group ( P<. 005 ) . Seven ( 50 % ) of 14 patients who received open-label risperidone addition responded . Risperidone addition was superior to placebo in reducing OCD ( P<.001 ) , depressive ( P<.001 ) , and anxiety ( P = .003 ) symptoms . There was no difference in response between OCD patients with and without comorbid diagnoses of chronic tic disorder or schizotypal personalty disorder . Other than mild , transient sedation , risperidone was well tolerated . CONCLUSION These results suggest that OCD patients with and without comorbid chronic tic disorders or schizotypal personality disorder may respond to the addition of low-dose risperidone to ongoing SRI therapy There is evidence of the clinical efficacy and safety of clomipramine and the newer selective serotonin reuptake inhibitors ( SSRIs ) for the treatment of obsessive-compulsive disorder ( OCD ) . In the present study , we have compared the efficacy and safety of 40 mg/day of fluoxetine and 150 mg/day of clomipramine in patients with OCD , diagnosed according to DSM-IIIR . A total of 55 patients entered this 8-week , double-blind controlled study . Efficacy for both drugs was comparable . The primary efficacy criterion , the Y-BOCS Total score , did not show any significant differences between treatment arms . Response rate was higher with clomipramine , using a 25 % decrease in Y-BOCS Total score as response threshold , but there were no significant differences between treatment arms using a 35 % threshold . Overall safety and tolerability were good for both drugs , being slightly better for fluoxetine The aim of this study was to compare the efficacy , safety , and tolerability of sertraline and clomipramine in the treatment of obsessive-compulsive disorder ( OCD ) . Out patients with DSM-III-R defined OCD for 1 year or longer and scores of > /=20 on the YaleBrown Obsessive Compulsive Scale ( Y-BOCS ) , > /=7 on the National Institute of Mental Health Global Obsessive-Compulsive Scale ( NIMH-OC ) , > /=4 on the Clinical Global Impression Severity of Illness Scale ( CGI-S ) and < /=1 
    Output:
    
agent
CONCLUSIONS The effects of treatment with clomipramine and selective serotonin reuptake inhibitors ( SSRIs : fluvoxamine , sertraline , fluoxetine , citalopram , and escitalopram ) proved to be similar , except for the lower adherence rate in case of clomipramine because of its side effects .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to evaluate the comparative efficacy and tolerability of sertraline and fluoxetine in the treatment of obsessivecompulsive disorder ( OCD ) . Out patients meeting DSM-IV criteria for OCD , with a Yale-Brown Obsessive-Compulsive ( Y-BOCS ) total score ≥ 17 , an NIMH Global Obsessive-Compulsive ( NIMH-OC ) scale score ≥ 7 , and a CGI-Severity score ≥ 4 were r and omized to 24 weeks of double-blind treatment with sertraline ( N = 77 ) or fluoxetine ( N = 73 ) . Primary efficacy measures consisted of the Y-BOCS , the NIMH-OC scale , and the CGI-Severity ( CGI-S ) and Improvement ( CGI-I ) scales . Equivalent and significant ( p < 0.001 ) improvement was found at week 24 in Y-BOCS and NIMH-OC scale scores  for sertraline and fluoxetine . After 12 weeks , 49.2 % of patients on sertraline were rated on the CGI-S scale as being mildly ill or not ill compared to 24.6 % on fluoxetine ( p < 0.01 ) . A Cox analysis found patients on sertraline to have a statistically nonsignificant 42 % greater likelihood of achieving a response by week 12 ( CGI-I , much or very much improved ; 95 % CI , 0.85 , 2.38;p = 0.18 ) . Sertraline treatment also result ed in a higher proportion of remissions  than fluoxetine ( defined as a CGI-I ≤ 2 and a Y-BOCS score ≤ 11 ) , both at week 12 ( 20 % vs. 8 % ; χ2 , 3.95;df 1;p = 0.047 ) and week 24 ( 36 % vs. 22 % ; χ2 , 3.18;df , 1;p = 0.075 ) . Both medications were welltolerated and demonstrated significant efficacy in the treatment of out patients with moderate to severe OCD with the subjects treated with sertraline showing a greater likelihood of remission as well as an earlier improvement on some but not all efficacy Background Although serotonin reuptake inhibitors are effective in the treatment of OCD , many patients fail to respond to these agents . Growing evidence from open-label and placebo-controlled trials suggests a role for augmentation of SRIs with atypical antipsychotics in OCD . Quetiapine is generally well tolerated and previous open-label data has produced mixed results in OCD and additional controlled data is needed . Methods We undertook a double-blind , r and omised , parallel-group , flexible-dose , placebo-controlled study of quetiapine augmentation in subjects who had responded inadequately to open-label treatment with an SRI for 12 weeks . Following informed consent and screening , forty-two subjects were r and omised to either placebo or quetiapine for six weeks . Results There was significant improvement from baseline to endpoint on the Yale-Brown Obsessive-Compulsive Scale in both the quetiapine and placebo groups ( quetiapine , n = 20 , p < 0.0001 ; placebo , n = 21 , p = 0.001 ) with 40 % ( n = 8) of quetiapine and 47.6 % ( n = 10 ) of placebo treated subjects being classified as responders . Quetiapine did not demonstrate a significant benefit over placebo at the end of the six-week treatment period ( p = .636 ) . Similarly quetiapine failed to separate from placebo in the subgroup of subjects ( n = 10 ) with co-morbid tics . Quetiapine was generally well tolerated . Conclusions In this study , quetiapine augmentation was no more effective than placebo augmentation of SRIs . A number of limitations in study design make comparisons with previous studies in this area difficult and probably contributed to our negative findings . Future work in this important clinical area should address these limitations BACKGROUND AND METHODS The adverse effects and potential clinical value of risperidone as augmentation to selective serotonin reuptake inhibitor ( SSRI ) treatment in treatment resistant severe adolescent OCD patients were examined in 17 adolescents ( 15 - 19 years old , 8 males and 9 females ) in an open label trial of risperidone  1 - 2 mg daily . RESULTS After 12 weeks of augmenting treatment , statistically significant improvements were reflected in OCD symptom ratings ( mean total Y-BOCS/CY-BOCS scores after treatment with second SSRI 24.2 + /- 2.6 versus 19.9 + /- 2.9 , p < 0.001 ) and global assessment scores ( mean CGAS , 69.4 + /- 11.4 versus 74.7 + /- 9.6 , p < 0.001 ) . Four patients had moderate improvement of more than 25 % reduction in Y-BOCS scores in OCD symptoms . Further 10 patients had a reduction of 10 - 25 % in total score , indicating slight improvement . One patient ( 6 % ) dropped from clinical OCD to a sub clinical level of OCD ( Y-BOCS total score < 15 ) . No patient was found to have worsened during augmentation treatment . Eight cases had weight gain and sedation was reported in four cases . CONCLUSION These preliminary findings suggest that augmentation with risperidone in dosages up to 2 mg daily might be efficient in adolescents with treatment resistant OCD To examine the efficacy and tolerability of escitalopram in the prevention of relapse in patients with OCD , 468 patients with OCD were treated with open label escitalopram ( 10 mg or 20 mg ) for 16 weeks , after which the 320 responders ( Y-BOCS total score decrease > or = 25 % ) were r and omised to placebo or escitalopram ( at the assigned dose ) for 24 weeks double-blind treatment . The primary analysis ( time to relapse ) showed a significant advantage for escitalopram ( p<0.001 , log-rank test ) . The proportion of patients who relapsed was statistically significantly higher in the placebo group ( 52 % ) than in the escitalopram group ( 23 % ) ( p<0.001 , chi(2)-test ) . The risk of relapse was 2.74 times higher for placebo compared to escitalopram . Escitalopram was well tolerated and improvements in obsessive-compulsive symptoms reported during the open label period were sustained during the double-blind extension of treatment with active drug . These results demonstrate that escitalopram is effective for long-term treatment and relapse prevention in OCD Despite the effectiveness of clomipramine and selective serotonin reuptake inhibitors ( SSRIs ) in the treatment of obsessive-compulsive disorder ( OCD ) , 40 % to 60 % of patients who receive an adequate treatment with these agents have significant persisting symptoms . Newer atypical antipsychotic drugs showed efficacy as augmenting agents in patients with OCD resistant to serotonin reuptake inhibitors ( SRIs ) . The objective of this study was to evaluate the efficacy and safety of amisulpiride augmentation in treatment resistant OCD . A total of 20 patients diagnosed with OCD according to DSM-IV criteria and having a history of resistance to treatment with SRIs were included in the study .  Amisulpiride 200 mg/day was added to ongoing SRI treatment and titrated up to 600 mg/day in flexible doses . The mean amisulpiride dose was 325 + /- 106 mg/day . The patients were assessed with the Yale-Brown obsessive-compulsive scale ( Y-BOCS ) at baseline and at week 12 of amisulpiride treatment . Side effects were monitored by the UKU side effect rating scale . The reduction in Y-BOCS scores between the baseline ( 26.7 + /- 6.3 ) and the end of the treatment ( 12.5 + /- 2.8 ) was statistically significant ( p=0.0001 ) . The most commonly observed side effects included weight gain ( 14 patients , 70 % ) , mild sedation ( 13 patients , 65 % ) and asthenia ( 7 patients , 35 % ) . This study has several limitations and , hence , the results are preliminary and require confirmation in a r and omized controlled trial . In conclusion , this study suggests that amisulpiride may be a promising option as an augmentation strategy in treatment resistant OCD Background : Two thirds of patients with obsessive-compulsive disorder ( OCD ) respond to treatment with selective serotonin reuptake inhibitors ( SSRIs ) . The neurobiological mechanisms of SSRI action and failure to respond to SSRI treatment remain to be eluci date d. Objectives : The aim of this pilot study was to quantify changes in the availability of serotonin transporter ( SERT ) in the course of SSRI treatment and to relate these changes to improvements of clinical symptoms . Methods : Ten patients with OCD were investigated at baseline and 5 of them after 1 year of SSRI treatment with citalopram 60 mg per day using brain single photon emission computed tomography and [123I]β-CIT .  Specific-to-nondisplaceable [123I]β-CIT binding ratios ( V3″ ) were calculated in SERT-rich brainstem , midbrain and thalamus using a magnetic resonance imaging-based region of interest ( ROI ) analysis . Symptom severity was evaluated with the Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) . Results : V3″ differed significantly between pretreatment and follow-up scans in all three brain regions , thalamus , midbrain as well as in brainstem . In thalamic ROI , differ ences in SERT availability and Y-BOCS ratings correlated . In midbrain , a trend toward a significant association was found . In brainstem , no relationship was revealed . Conclusions : Higher occupancy of SERT by citalopram seems to be associated with better clinical response after 1 year of SSRI treatment of patients with OCD BACKGROUND To date , only 1 controlled study has found a drug ( haloperidol ) to be efficacious in augmenting response in patients with obsessive-compulsive disorder ( OCD ) refractory to serotonin reuptake inhibitor ( SRI ) monotherapy ; patients with comorbid chronic tic disorders showed a preferential response . This report describes the first controlled study of risperidone addition in patients with OCD refractory to treatment with SRI alone . METHODS Seventy adult patients with a primary DSM-IV diagnosis of OCD received 12 weeks of treatment with an  SRI . Thirty-six patients were refractory to the SRI  and were r and omized in a double-blind manner to 6 weeks of risperidone ( n = 20 ) or placebo ( n = 16 ) addition . Behavioral ratings , including the Yale-Brown Obsessive Compulsive Scale , were obtained at baseline and throughout the trial . Placebo-treated patients subsequently received an identical open-label trial of risperidone addition . RESULTS For study completers , 9 ( 50 % ) of 18 risperidone-treated patients were responders ( mean daily dose , 2.2 + /-0.7 mg/d ) compared with 0 of 15 in the placebo addition group ( P<. 005 ) . Seven ( 50 % ) of 14 patients who received open-label risperidone addition responded . Risperidone addition was superior to placebo in reducing OCD ( P<.001 ) , depressive ( P<.001 ) , and anxiety ( P = .003 ) symptoms . There was no difference in response between OCD patients with and without comorbid diagnoses of chronic tic disorder or schizotypal personalty disorder . Other than mild , transient sedation , risperidone was well tolerated . CONCLUSION These results suggest that OCD patients with and without comorbid chronic tic disorders or schizotypal personality disorder may respond to the addition of low-dose risperidone to ongoing SRI therapy There is evidence of the clinical efficacy and safety of clomipramine and the newer selective serotonin reuptake inhibitors ( SSRIs ) for the treatment of obsessive-compulsive disorder ( OCD ) . In the present study , we have compared the efficacy and safety of 40 mg/day of fluoxetine and 150 mg/day of clomipramine in patients with OCD , diagnosed according to DSM-IIIR . A total of 55 patients entered this 8-week , double-blind controlled study . Efficacy for both drugs was comparable . The primary efficacy criterion , the Y-BOCS Total score , did not show any significant differences between treatment arms . Response rate was higher with clomipramine , using a 25 % decrease in Y-BOCS Total score as response threshold , but there were no significant differences between treatment arms using a 35 % threshold . Overall safety and tolerability were good for both drugs , being slightly better for fluoxetine The aim of this study was to compare the efficacy , safety , and tolerability of sertraline and clomipramine in the treatment of obsessive-compulsive disorder ( OCD ) . Out patients with DSM-III-R defined OCD for 1 year or longer and scores of > /=20 on the YaleBrown Obsessive Compulsive Scale ( Y-BOCS ) , > /=7 on the National Institute of Mental Health Global Obsessive-Compulsive Scale ( NIMH-OC ) , > /=4 on the Clinical Global Impression Severity of Illness Scale ( CGI-S ) and < /=1 
    Output:
    