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Outcome of Additional Behaviour Therapy Including Treatment Discontinuation for Fluvoxamine Non-Responders with Obsessive-Compulsive Disorder

point of the RCT was 26.0 (range = 22–33), which was considered to be moderate to severe OCD. Mean age and duration of illness were 33.0 years (range = 23–40) and 3.9 years (range = 1–27), respectively. All 8 patients continued to receive fluvoxamine (200 mg/day) and completed an additional 12-week BT using the same manual as patients in the BTP group of the RCT. Individual baseline (start of fluvoxamine) Y-BOCS scores and their decreases from the baseline to the end of the additional BT are shown in figure 1 . There was a highly significant change in the Y-BOCS score after the additional BT (26.0 ] 13.8, t = 4.6, p ! 0.01, paired t test). Of the 8 patients who underwent the additional BT, 7 (ID1, 2, 4, 5, 6, 7, and 8) reached the criteria for ‘responder’. For those 7 responders, a further 12-week programme to discontinue treatments was recommended, which they all entered. In this programme, patients visited us at 0, 2, 4, 6, 8, and 12 weeks. While the dose of fluvoxamine was reduced gradually, the patients undertook 6 supplemental behavioural treatments tailored to the individual patient, with the purpose of improving longterm outcome by encouraging self-help skills. The patients’ condition (e.g. obsessive-compulsive symptoms, depressive mood) was examined with clinical assessment 4 weeks after the start of discontinuation. All patients showed further improvement at the We reported the results of a comparison of the effectiveness of behaviour therapy (BT) and fluvoxamine for patients with obsessive-compulsive disorder (OCD) in a randomised controlled trial (RCT) in Psychotherapy and Psychosomatics [1] . In that study, BT was found to be more effective than fluvoxamine. We subsequently investigated whether (1) patients who remained symptomatic after adequate fluvoxamine treatment benefited from additional BT and (2) the patients who improved could then discontinue fluvoxamine and maintain improvement. Detailed procedures of the RCT were described in our previous report [1] . Briefly, the participants, who were out-patients of the Department of Neuropsychiatry, Kyushu University Hospital in Japan, met DSM-III-R [2] criteria for OCD without any axis I disorder and had total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) [3] scores 1 16. The participants were randomly assigned to one of the following three treatment groups: BTP (BT + pill placebo), FLV (autogenic training + fluvoxamine), or Control (autogenic training + pill placebo). Autogenic training was used as a psychological placebo. Every patient had 12 weekly sessions using treatment manuals created for the RCT. The primary outcome measures were a reduction of the baseline Y-BOCS score and the Clinical Global Impression-Improvement Scale score [CGI-I: from 0 (= very much worse) to 6 (= very much improved)] [4] . Our criteria for ‘responder’ were (a) reduction of Y-BOCS score 6 35% and (b) CGI-I score 6 5 (much improved). The diagnoses, assessments, and treatments were conducted by experienced psychiatrists. Additional BT was given to 8 patients in the fluvoxamine group in the RCT who did not fulfil the criteria for ‘responder’ although they had received fluvoxamine (up to 200 mg/day) for 12 weeks. The mean Y-BOCS score for the 8 patients at the end Published online: August 21, 2008