Efficacy of nicotine administration on obsessions and compulsions in OCD: a systematic review
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Annals of General Psychiatry Open Access
REVIEW
Efficacy of nicotine administration on obsessions and compulsions in OCD: a systematic review Daria Piacentino1,2,3, Annalisa Maraone2, Valentina Roselli2, Isabella Berardelli1, Massimo Biondi2, Georgios D. Kotzalidis1* and Massimo Pasquini2
Abstract Background: Preliminary studies have tested nicotine as a novel treatment for OCD patients who respond partially/ incompletely or not at all to first and second-line treatment strategies, with the former represented by SSRIs or clomipramine, and the latter by switching to another SSRI, or augmentation with atypical antipsychotics, and/or combination with/switching to cognitive–behavioural therapy. Some studies found nicotine-induced reduction of obsessive thoughts and/or compulsive behaviour in OCD patients. We aimed to evaluate the efficacy of nicotine administration in OCD patients. Methods: We searched the PubMed, ScienceDirect Scopus, CINHAL, Cochrane, PsycINFO/PsycARTICLES, and EMBASE databases from inception to the present for relevant papers. The ‘Preferred Reporting Items for Systematic Review and Meta-Analyses’ (PRISMA) standards were used. We included all studies focusing on the effects of nicotine administration on OCD patients’ obsessions or compulsions. Studies could be open-label, cross-sectional, randomized controlled trials, case series or case reports. Results: A total of five studies could be included. Nicotine administration may ameliorate behavioural features and recurrent thoughts of severe, treatment-resistant OCD patients; however, in one study it was not associated with OC symptom improvement or cognitive enhancement across various executive function subdomains. Conclusions: Although encouraging, the initial positive response from the use of nicotine in OCD needs testing in large controlled studies. This, however, raises ethical issues related to nicotine administration, due to its addiction potential, which were not addressed in the limited literature we examined. As an alternative, novel treatments with drugs able to mimic only the positive effects of nicotine could be implemented. Keywords: Checking behaviour, Cognitive functions, Nicotine, Obsessive–compulsive disorder, Treatment Introduction OCD is a disabling mental health disorder affecting 1.5–3.0% of the general population [81]. Core features of DSM-5 obsessive–compulsive disorder (OCD) include: *Correspondence: [email protected] 1 NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), School of Medicine and Psychology, Sapienza University, Sant’Andrea Hospital, Rome, Italy Full list of author information is available at the end of the article
(a) obsessions, defined as “recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted”, and (b) compulsions, defined as “repetitive behaviours or mental acts that one feels driven to perform in response to an obsession or according to rules that must be applied rigidly” [12]. Obsessions and compulsions (OC) may occupy a sig
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