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Guía De Práctica Clínica def_Toc_1.pdf 1 17/09/2019 1:04:30 Guía de práctica clínica (basada en el método ADAPTE) GPC Tratamiento farmacológico del trastorno obsesivo compulsivo en adultos GPC Tratamiento Tratamiento farmacológico del trastorno obsesivo compulsivo en adultos AUTORES José Manuel Menchón, Julio Bobes, Cecilio Álamo, María Pino Alonso, María Paz García Portilla, Ángela Ibáñez, Eva Real, Manuel Bousoño, María Dolores Saiz González y Jerónimo Saiz Ruiz C M Y CM MY CY CMY K Guía de práctica clínica (basada en el método ADAPTE) Tratamiento farmacológico del trastorno obsesivo compulsivo en adultos Guía de práctica clínica (basada en el método ADAPTE) Tratamiento farmacológico del trastorno obsesivo compulsivo en adultos José M. Menchón, Julio Bobes, Cecilio Álamo, María Pino Alonso, María Paz García-Portilla, Ángela Ibáñez, Eva Real, Manuel Bousoño, María Dolores Saiz-González y Jerónimo Saiz-Ruiz © 2019 Sociedad Española de Psiquiatría C/ Arturo Soria 311, 1º B 28033 Madrid Tel.: + 34 91 383 41 45 e-mail: [email protected] Web: www.sepsiq.org Quedan prohibidos, dentro de los límites establecidos en la ley y bajo las sanciones legalmente previstas, la reproducción total o parcial de esta obra por cualquier medio o procedimiento, ya sea electrónico o mecánico, el tratamiento informático, el alquiler o cualquier otra forma de cesión de la obra sin la autorización previa y por escrito de los titulares del copyright. ISBN: 978-84-15734-15-4 Depósito legal: M-30570-2019 Impreso en España Advertencia del editor La ciencia y las nuevas tecnologías se encuentran en permanente evolución gracias a la investigación, el desarrollo y la innovación. En consecuencia, es responsabilidad de los lectores y los profesionales de la salud la verificación de modo independiente de cualquier información o recomendación publicada en esta obra. Se aconseja que se analicen los últimos datos aportados por los fabricantes de los dispositivos, así como la maquinaria y los fármacos, para la comprobación del uso adecuado de los mismos. La Sociedad Española de Psiquiatría no se hace responsable, ni ninguna persona empleada por esta, de los daños que pudiesen generarse a personas o propiedades como consecuencia del contenido de esta obra. Conflicto de intereses El Dr. Menchón ha recibido becas de investigación de la institución Medtronic, AB Biotics; becas de viaje de Servier y honorarios de Janssen como ponente. El Dr. Bobes ha recibido becas de investigación, ha sido consultor, asesor o ponente en los últimos cinco años de: AB-Biotics, Acadia Pharmaceuticals, Angelini, Casen Recordati, D&A Pharma, Exeltis, Gilead, GSK, Ferrer, Indivior, Janssen-Cilag, Lundbeck, Mundipharma, Otsuka, Pfizer, Reckitt-Benckiser, Roche, Servier, Shire y Schwabe Farma Ibérica; ha obtenido financiación para investigación por parte del Ministerio de Economía y Competitividad —Centro de Investigación Biomédica en Red de área de Salud Mental (CIBERSAM) del Instituto de Salud Carlos III—, Ministerio de Sanidad, Servicios Sociales e Igualdad español-Plan Nacional sobre Drogas y del 7.º Programa Marco de la Unión Europea. El Dr. Álamo ha sido ponente honorario de Adamed, Angelini, Casen-Recordati, Exeltis, Ferrer, Fuinsa, Grunenthal, Indivior, Janssen-Cilag, Juste SAQF, Kyowa Kiry, Lundbeck, Mudipharma, Normon, Novartis, Otsuka, Pfizer, Roche, Rovi, Rubió, Servier y Shire; consultor honorario para: Angelini, Casen-Recordati, Janssen-Cilag y Kyowa Kiry, Mudipharma, Normon. La Dra. García-Portilla es miembro del Consejo asesor de Angelini, European Medicines Agency, Janssen-Cilag; ha recibido becas de investigación del Instituto de Salud Carlos III, Janssen- Cilag y Lundbeck; ha participado en ponencias de: Janssen-Cilag, Lundbeck, Otsuka y Pfizer. La Dra. Ibáñez ha recibido becas y ha sido ponente o asesora para: Bristol-Myers Squibb, Lundbeck, Otsuka Pharmaceutical y Servier. El Dr. Bousoño ha sido ponente honorario para: Lundbeck, Servier, Exeltis, GlaxoSmithKline, Pfizer y Otsuka; ha recibido becas de viaje de: Lundbeck, Servier, Exeltis, GlaxoSmithKline, Pfizer y Otsuka. La Dra. Saiz-González ha participado como conferenciante o experto para: Otsuka, Janssen y Pfizer. El Dr. Saiz-Ruiz ha participado como con- ferenciante o experto para Adamed, Lundbeck, Servier, Neurofarmagen, Otsuka, Indivior, Schwabe y Janssen; ha recibido ayudas para inves- tigación de Agencias Públicas (CIBERSAM, FIS, CAM, Universidad de Alcalá), Fundación Canis Majoris, Lundbeck, Janssen, Medtronic y Ferrer. GRUPO ELABORADOR DE LA GUÍA José Manuel Menchón Magriñá Psiquiatra Servicio de Psiquiatría, Hospital Universitario de Bellvitge, Universidad de Barcelona, L’Hospitalet de Llobregat (Barcelona). Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat (Barcelona). Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid. Julio Bobes García Psiquiatra Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid. Departamento de Medicina-Psiquiatría, Universidad de Oviedo, Oviedo (Asturias). Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo (Asturias). Cecilio Álamo González Farmacólogo clínico Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares (Madrid). M.ª del Pino Alonso Ortega Psiquiatra Servicio de Psiquiatría, Hospital Universitario de Bellvitge, Universidad de Barcelona, L’Hospitalet de Llobregat (Barcelona). Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat (Barcelona). Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid. María Paz García-Portilla Psiquiatra Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid. Departamento de Medicina-Psiquiatría, Universidad de Oviedo, Oviedo (Asturias). Ángela Ibáñez Cuadrado Psiquiatra Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid. Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid. Eva Real Barrero Psiquiatra Servicio de Psiquiatría, Hospital Universitario de Bellvitge, Universidad de Barcelona, L’Hospitalet de Llobregat (Barcelona). Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat (Barcelona). Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid. Manuel Bousoño García Psiquiatra Departamento de Medicina-Psiquiatría, Universidad de Oviedo, Oviedo (Asturias). María Dolores Saiz-González Psiquiatra Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid. Jerónimo Saiz-Ruiz Psiquiatra Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid. Fernando Rico-Villademoros Experto en Metodología de la Investigación Cociente, S. L. (Madrid) ÍNDICE Prólogo ................................................................................................................................................................................................................ 7 Introducción ...................................................................................................................................................................................................... 9 1. ELABORACIÓN DE LA GUÍA: MÉTODO ADAPTE ............................................................................................................................... 11 2. RESULTADOS DEL CONSENSO ............................................................................................................................................................... 19 3. CONCLUSIONES ........................................................................................................................................................................................... 29 4. BIBLIOGRAFÍA ............................................................................................................................................................................................... 31 APÉNDICE 1. Recomendaciones seleccionadas: original (inglés), recomendación en la guía española y motivo de la modificación/comentarios ............................................................................................................................................ 37 APÉNDICE 2. Búsqueda bibliográfica tratamiento farmacológico del trastorno obsesivo-compulsivo ...................... 47 APÉNDICE 3. Búsqueda bibliográfica trastorno obsesivo-compulsivo/embarazo y lactancia ......................................... 153 PRÓLOGO A pesar de la existencia de tratamientos efectivos basados en la evidencia para el tratamiento del trastorno obsesivo- compulsivo (TOC), el abordaje de esta enfermedad sigue siendo subóptimo. Disponer de una guía terapéutica farmacoló- gica del TOC puede ayudar a mejorar el manejo de la enfermedad en nuestro entorno y contribuir a reducir la carga de la enfermedad para el paciente. Con el patrocinio de la Sociedad Española de Psiquiatría, un grupo de expertos ha desarro- llado una guía para el tratamiento farmacológico del TOC a partir de algunas guías existentes siguiendo la metodología de la ADAPTE Collaboration. En este libro se resume el proceso de elaboración de esta guía y las recomendaciones adoptadas por consenso por el grupo elaborador de las guías, que se han agrupado en cinco
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