Buprenorphine responders had all shown some improvement in their depressive symptoms with either SSRIs or clomipramine. The underlying mechanism of opiate-mediated improvement in OCD is probably unknown. A number of earlier studies have suggested the potential importance of the opioid system in OCD and its treatment [Shapira et al. 1997; Warneke, 1997; Goldsmith et al. 1999] and naloxone has

been shown to rapidly worsen OCD symptoms [Insel and Pickar, 1983; Keuler et al. 1996]. Studies in mice suggest that agonist-induced head-twitch behaviour mediated through 5-HT2A Inhibitors,research,lifescience,medical receptors is antagonized by both SSRIs and atypical opiates and that combination treatment with both classes of agents is more effective than either treatment alone, suggesting a convergence between the serotonergic and opiate systems Inhibitors,research,lifescience,medical [Rojas-Corrales et al. 2007]. Consistent with this

is the finding that the partial agonist effect of buprenorphine at the µ-opioid receptor releases central nervous system serotonin and dopamine [Urraca et al. 2004]. These inferences are supported by the observation that patients who did not respond to buprenorphine had not improved with antidepressants active on the serotonin pathways. We believe that further treatment trials of buprenorphine augmentation of Inhibitors,research,lifescience,medical antidepressant treatment in patients with severe OCD are warranted. Footnotes Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflict of interest statement: The authors declare no conflicts of interest in preparing this article. Contributor Information Malcolm Inhibitors,research,lifescience,medical B. Liddell, Adult Community Mental Health Services, DHHS NW Tasmania, 1 Parkside, Burnie, Tasmania 7320, Australia. Victor Aziz, Mental Health Unit, The Royal Glamorgan

Hospital, Llantrisant, Rhondda Cynon Taff, UK. Patrick Briggs, Mental Health Unit, The Royal Glamorgan Hospital, Inhibitors,research,lifescience,medical Llantrisant, Rhondda Cynon Taff, UK. Nimalee Kanakkehewa, Mental Health Unit, The Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taff, UK. Omar Rawi, Mental Health Unit, The Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taff, UK.
Motor abnormalities are frequently described in patients receiving antipsychotic treatment. However, patients with schizophrenia also also display neurological motor abnormalities prior to the initiation of any psychotropic medication [McCreadie et al. 2005; Honer et al. 2005; Koning et al. 2010]. Honer and colleagues reported that 44.9% of antipsychotic-naïve patients with schizophrenia (and related disorders) had signs and symptoms consistent with basal ganglia dysfunction and 28.1% had at least mild signs of an extrapyramidal disorder, most commonly hypokinesia. Thus, it has been proposed that the abnormal movements occurring with schizophrenia are markers of the neurodysfunction implicated in the pathogenesis of schizophrenia [Pappa and Temsirolimus purchase Dazzan, 2009].