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Clomipramine in obsessive-compulsive disorder

  • R.J. Katz
    Correspondence
    Address reprint requests to Dr. R. J. Katz, New Drug Development-CNS Section, Pharmaceuticals Division, CIBA-GEIGY Corporation, 556 Morris Ave.-Dev 3042, Summit, NJ 07901.
    Footnotes
    Affiliations
    From the New Drug Development Department-CNS Section, Pharmaceuticals Division, CIBA-GEIGY Corporation, Summit, NJ, USA
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  • J. DeVeaugh-Geiss
    Footnotes
    Affiliations
    From the New Drug Development Department-CNS Section, Pharmaceuticals Division, CIBA-GEIGY Corporation, Summit, NJ, USA
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  • P. Landau
    Footnotes
    Affiliations
    From the New Drug Development Department-CNS Section, Pharmaceuticals Division, CIBA-GEIGY Corporation, Summit, NJ, USA
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  • Author Footnotes
    ∗ Twelve sites participated in this multicenter investigation. We are grateful to the following principal investigators: H. Akiskal, J. Ananth, W. Betts, B. Diamond, A. Feiger, E. Foa, D. Fogelson, R. Hoehn-Saric, P. Ninan, R. Noyes, A. Ringold, and K. Shear. Dr. Steven Freitag and Ms. Helen Lau offered invaluable statistical support and Mss. S. Sullivan, J. Cedrone, and A. Cooper ably assisted in clinically monitoring the progress of the trial throughout.
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      Abstract

      The effects of clomipramine hydrochloride (CMI) versus placebo upon DSM-III-defined obsessive-compulsive disorder (OCD) were assessed in a 10-week double-blind multi-center trial and in a corresponding 1-year double-blind extension study. The NIMH global O-C scale, a 15-point ordinal severity scale, incorporating categorical features specific to OCD, was used to evaluate the severity of obsessive compulsive symptoms over the course of treatment, and a physician's rating of global therapeutic effect was used to assess overall change from baseline. In the core study, patients receiving placebo demonstrated minor and nonsystematic changes, whereas patients who received CMI had clinically and statistically significant reductions in the global severity of their disorder. Findings from the extension study were consistent with continuing efficacy for CMI, whereas corresponding data for patients receiving long-term placebo were difficult to interpret. Based upon shifts in categorical severity, symptoms for over half those patients who received CMI were rendered subclinical or within a range of normal functioning. In contast, less than 5% of patients receiving placebo had their symptoms reduced to a subclinical level. Generally, both treatments were well tolerated. Previous studies have indicated therapeutic potential for CMI in obsessive compulsive disorder. These findings confirm and extend previous observations.
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