Behavior clomipramine

The ritualistic, repetitive behaviors in autism are often seen as parallel to some of the behaviors seen in OCD spectrum disorders. Because of this, CMI was initially compared with both DMI and placebo in the treatment of children with autism. Clomipramine showed superior efficacy to both DMI and to placebo (Gordon et... 

Berney, T, Kolvin, I., Bhate, R.F., Carsioe, R.F, Jeans, J. Kay, B. and Scarth, L. (1981) School phobia a therapeutic trial with clomipramine and short—term outcome. Br J Psychiatry 138 110—118. Bernstein, C.A., Borchardt, C.M., Perwein, A.R., et al. (2000) Imip-ramine plus cognitive-behavioral therapy in in the treatment of school refusal./ Am Acad Child Adolesc Psychiatry 39 276—283. Bernstein, C.A., Crosby, R.D. Perwein, A.R., and Borchardt, C.M. 

DeHann, E., Hoogduin, K.A.L., Buitelaar, J.K., and Keijsers, G.P.J. (1998) Behavior therapy versus clomipramine for the treatment of OCD in children and adolescents. / Am Acad Child Adolesc Psychiatry 37 1022-1029. 

FIGURE 39.2 Treatment algorithm for pediatric obsessive-compulsive disorder (OCD). In adjusting cognitive behavior therapy (CBT), increase frequency or intensity, or alter the setting or format, e.g., have it be home based or day treatment. CMI, clomipramine DMI, desipramine NT, nortriptyline SSRI, selective serotonin reuptake inhibitor (fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram). 

In the MR population, OCD can be manifested as adherence to specific routines, performance of rituals, or stereotypies. If the person is not able to fulfill these routines and rituals, he or she may become agitated, upset, and uncooperative. The diagnosis of OCD in children with MR is based more on behavioral observations than on a description of internal factors. Treatment is recommended if these behaviors interfere with the person s ability to function and learn. In the Expert Consensus survey (Rush and Frances, 2000) treatment with an SSRI was recommended. Clomipramine, a TCA, may also be considered. Bodfish and Madison... 

File, S.E. and Tucker, J.C. (1984) Prenatal treatment with clomipramine effects on the behavior of male and female adolescent rats. Psychopharmacology 82 221—224. 

It is anticipated that the findings from a National Institute of Mental Health [NIMH)-sponsored study being conducted by investigators at the Medical College of Pennsylvania and Columbia University will shed light on the comparative efficacy of clomipramine plus behavior therapy, clomipramine alone, and behavior therapy alone. Apart from considerations of short-term treatment efficacy, other advantages to the combination of an SRI and behavior therapy may be found. For example, clinical experience suggests that concomitant behavior therapy may decrease the likelihood of... 

Cox BJ, Swinson RP, Morrison B, Lee PS Clomipramine, fluoxetine and behavior therapy in the treatment of obsessive-compulsive disorder a meta-analysis. J Behav Ther Exp Psychiatry 24 2, 149-153, 1993a... 

During all phases of treatment, education, supportive therapy, and, at times, more specific types of psychotherapy are essential for a satisfactory outcome. For example, interpersonal therapy can complement adequate maintenance antidepressant treatment, possibly diminishing the frequency of episodes (see the section Role of Psychosocial Therapies in Chapter 7), and cognitive-behavioral techniques in combination with antiobsessive agents (e.g., clomipramine) can improve the quality of life for patients with obsessive-compulsive disorder, minimizing time spent on disabling rituals (see the section Obsessive-Compulsive Disorder in Chapter 13). 

Although many schizophrenic patients demonstrate obsessive-compulsive symptoms, this problem has received little systematic investigation. There are conflicting case reports of patients with obsessive-compulsive symptoms who failed to benefit when given an antiobsessional drug in addition to an antipsychotic, and other cases in which this strategy was beneficial (176). There are also reports of certain repetitive behaviors that mimic OCD that are benefited by the addition of clomipramine (177,178 and 179). Schulz has proposed the term schizo-obsessive to describe this clinical presentation ( 180). 

Concurrent with the introduction of clomipramine in 1966, Meyer (239) first reported on the benefit of behavioral therapy for OCD. Thus, while studies were finding the... 

Pulman J, Yassa R, Ananth J. Clomipramine treatment of repetitive behavior. Can J Psychiatry 1984 29 254-255. 

That situation has changed with the development of clomipramine and the SSRIs, which appear to have unique efficacy in treating OCD when compared with other types of psychotropics (see Chapter 13, Obsessive-Compulsive Disorder ). In addition, more effective behavioral approaches have been developed, which, in combination with medication, can substantially ameliorate this condition. 

OCD is known to respond to serotonergic antidepressants. It is characterized by repetitive anxiety-provoking thoughts (obsessions) or repetitive behaviors aimed at reducing anxiety (compulsions). Clomipramine and several of the SSRIs are approved for the treatment of OCD, and they are moderately effective. Behavior therapy is usually combined with the antidepressant for additional benefits. 

FIGURE 9—2. Various treatments can be given in combination for obsessive-compulsive disorder (OCD) (i.e., OCD combos). The basis of all combination treatments is a serotonin selective reuptake inhibitor (SSRI) or clomipramine. Added to this basis may be a serotonin 1A partial agonist, a serotonin 2A antagonist, lithium, a benzodiazepine or a sedative-hypnotic, a conventional antipsychotic or an atypical antipsychotic, or behavioral psychotherapy. 

The magnitude of behavioral abnormalities produced by neonatal treatment with RSD drug depends on the dose of the drug. Vogel et al. reported that abnormalities of six sexual variables are found to be dependent on the neonatal treatment dose of clomipramine (CLI). The 30 mg/kg/day dose caused deficiencies in some, but not all, sexual behavior measures higher doses caused deficiencies in all measures of sexual behavior (49). There is also a dose-response characteristic... 

Feng P and Ma Y. Clomipramine suppresses postnatal REM sleep without increasing wakefulness implications for the production of depressive behavior. Sleep 2002 25 177-184. 

Feng P, Ma Y, Vogel GW. The critical window of brain development from susceptive to insusceptive effects of clomipramine neonatal treatment on sexual behavior. Dev Brain Res 2001 129 107-110. 

Velazquez-Moctezuma J, Aguilar-Garcia A, Diaz-Ruiz O. Behavioral effects of neonatal treatment with clomipramine, scopolamine, and idazoxan in male rats. Pharm Biochem Behav 1993 46 215-217. 

Prathiba J, Kumar KB, Karanth KS. Effects of neonatal clomipramine on cholinergic receptor sensitivity and passive avoidance behavior in adult rats. J Neural Trans Gen Sec 1995 100 93-99. 

Hilakivi LA, Sinclair JD, Hilakivi IT. Effects of neonatal treatment with clomipramine on adult ethanol related behavior in the rat. Brain Res 1984 317 129-132. 

Differential reinforcement of low rate (DRL) responding in a Skinnerbox has been used in different studies as a test for teratogenic effects on behavior. Prenatal treatment of rats vith haloperidol resulted in normal baseline level of lever pressing in a Skinnerbox for a water reward. However, like after postnatal haloperidol treatment, an increase in the number of sessions to criterion for DRL responding was observed in these animals (ref. 41). Simple acquisition of the bar-press response for water reward was shown to be affected by prenatal treatment vith chlorpromazine, but not by prenatal amphetamine treatment (ref. 137). The response rate, but not response accuracy, in a left-right alternation learning test in a Skinnerbox was increased after neonatal clomipramine treatment ref. 34). 

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