A 20-year-old man has had OCD since age 11 and a lifelong history of chronic motor tics. He has failed two adequate SSRI trials at maximum doses. Which augmentation agent has the best evidence in his particular profile?
- A Risperidone ✓
- B Buspirone
- C Lithium
- D Venlafaxine
Correct answer: A. Risperidone
Explanation
Tic-related OCD, captured by the DSM-5 specifier, shows a preferential response to low-dose antipsychotic augmentation such as risperidone or aripiprazole, with effect sizes larger than in non-tic OCD. Lithium and buspirone lack consistent evidence as OCD augmenting agents. Venlafaxine is itself a first-line antidepressant alternative rather than an augmenting drug, and adding it to an SSRI risks serotonin toxicity. The childhood onset and lifelong tics are the discriminating clues pointing to antipsychotic augmentation.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.