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Zakrzewski JJ, Doran N, Mayes TL, Twamley EW, Ayers CR. Rates of diagnosis and service utilization in veterans with hoarding disorder. Psychiatry Res 2024; 336:115888. [PMID: 38608540 DOI: 10.1016/j.psychres.2024.115888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
Hoarding Disorder (HD) is a prominent and disabling neuropsychiatric condition defined by the inability to discard objects resulting in impairing levels of clutter. The prevalence rate is 2-6 % and increases with age. The aging Veteran population is a high risk group for impairment associated with HD. Medical and psychiatric comorbidities as well as associated rates of disability and poor quality of life are very common in both HD and the related disorder of OCD. We examined rates of HD and OCD diagnoses at the VA San Diego Healthcare System. Data were obtained from medical records for all Veterans with these diagnoses over 8-years and included information on medical and psychiatric care, homelessness services, and Care Assessment Needs (CAN) scores. Rates of diagnosis for both HD and OCD were well below epidemiological estimates. Veterans with HD were older, had higher rates of medical hospital admissions with longer stays; had more cardiac, neurological, and acquired medical conditions; had more psychiatric comorbidities; had more interactions with the suicide prevent team and homelessness services; and had higher CAN scores than Veterans with OCD. The low rate of diagnosis and high services utilization of Veterans with HD demonstrates an area of unmet need.
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Affiliation(s)
- Jessica J Zakrzewski
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States.
| | - Neal Doran
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Psychology Service, VA San Diego Healthcare System, La Jolla, CA, United States
| | - Tina L Mayes
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Psychology Service, VA San Diego Healthcare System, La Jolla, CA, United States
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, United States
| | - Catherine R Ayers
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Psychology Service, VA San Diego Healthcare System, La Jolla, CA, United States.
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2
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Ponzini GT, Hundt NE, Christie IC, Chen PV, Ecker AH, Lindsay JA, Teng EJ, Storch EA, Myers US, Roussev MS, Fletcher TL. A protocol for a randomized controlled trial of exposure and response prevention for veterans with obsessive compulsive disorder. Contemp Clin Trials 2024; 138:107445. [PMID: 38237674 DOI: 10.1016/j.cct.2024.107445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is effectively treated with exposure and response prevention (ERP), yet very few veterans receive ERP for OCD within the Veterans Health Administration (VHA). Veterans are a clinically complex population, and no prior research has evaluated the effectiveness of ERP in veterans with OCD or comorbid OCD and posttraumatic stress disorder (PTSD). Given the limited accessibility of ERP-trained providers within VHA, assessment of video telehealth (VTH) delivery of ERP is warranted. METHODS A sample of 160 veterans with OCD (80 diagnosed with comorbid PTSD) will be randomly assigned to receive up to 16 sessions of ERP or a stress management training control delivered via VTH. Assessments will occur at baseline, posttreatment, and 6-month follow-up. The primary outcome will evaluate the impact of ERP on participants' functioning, and secondary outcomes will include quality of life and OCD symptoms. At posttreatment, qualitative interviews with veterans, clinicians, and administrators will explore barriers and facilitators to treatment delivery, and the implementation potential of ERP. CONCLUSIONS Results will provide direction for the treatment of OCD and comorbid PTSD in veterans, as well as guidance for future implementation efforts for ERP within VHA. CLINICALTRIALS gov Identifier:NCT05240924.
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Affiliation(s)
- Gabriella T Ponzini
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, 411 W. Chapel Hill St., Durham, NC 27701, USA.
| | - Natalie E Hundt
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX (a virtual center), USA.
| | - Israel C Christie
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Patricia V Chen
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Anthony H Ecker
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX (a virtual center), USA.
| | - Jan A Lindsay
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX (a virtual center), USA.
| | - Ellen J Teng
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Mental Health Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA.
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Ursula S Myers
- Charleston Health Equity and Rural Outreach Innovation Center and Mental Health Service Line, Ralph H. Johnson Health Care System, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 109 Bee St., Charleston, SC 29401, USA.
| | - Milena S Roussev
- VISN 20 Clinical Resource Hub, 500 W. Fort St., Boise, ID 83702, USA.
| | - Terri L Fletcher
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX (a virtual center), USA.
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3
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Patel TA, Raines AM, Morabito DM, Schmidt NB. Obsessive-compulsive symptoms, perceived burdensomeness, and thwarted belongingness: Associations and implications among US veterans. J Clin Psychol 2024; 80:323-338. [PMID: 37837647 DOI: 10.1002/jclp.23609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/16/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders worldwide, but has gone relatively unnoticed within the US veteran population. Simultaneously, suicide rates continue to remain high within this population despite the high volume of veterans who receive psychiatric care. With recent research demonstrating OCD's unique relationship with suicidality, it is imperative to explore this association and factors that may explain this association within veterans. METHODS The present study investigated OCD symptoms and their relationship with two known risk factors of suicide, perceived burdensomeness (PB) and thwarted belongingness (TB), in two samples of veterans. RESULTS In the first study (N = 100), OCD symptoms were found to be uniquely related to both PB and TB even after covarying for demographics, trauma exposure, and probable depression. In the second study (N = 99), these relationships were replicated longitudinally. OCD symptoms at baseline were found to be indirectly related to suicidal ideation severity at a 1-month follow-up via PB and TB at post-treatment. CONCLUSION This study highlights the importance of assessing and addressing OCD symptoms within veterans due to the unique relationship these symptoms have with suicidal constructs. A deeper understanding of the impact of OCD within the veteran population will inform future prevention and intervention efforts.
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Affiliation(s)
- Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, Los Angeles, USA
- Louisiana State University School of Medicine, New Orleans, Los Angeles, USA
| | - Danielle M Morabito
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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4
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Abstract
Obsessive-compulsive disorder (OCD) is characterized by time-consuming, distressing, or impairing obsessions and compulsions. Obsessions are recurrent, persistent, and intrusive thoughts, urges, or images. Compulsions are repetitive and often ritualized behaviors or mental acts performed to manage obsession-related distress or prevent harm. OCD affects 1% to 3% of the population, typically begins during adolescence or early adulthood, and can have a chronic or deteriorating course in the absence of effective treatment.
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Affiliation(s)
- Matti Cervin
- Department of Clinical Sciences, Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, Lund SE-22241, Sweden.
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5
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The OCI-4: An ultra-brief screening scale for obsessive-compulsive disorder. J Anxiety Disord 2021; 78:102354. [PMID: 33454619 DOI: 10.1016/j.janxdis.2021.102354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 12/18/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a prevalent and burdensome condition that is typically assessed using in-depth interviews or lengthy self-report measures. Accordingly, routine screening in busy non-mental health settings is impractical, and OCD is often under- (or mis-) recognized. We evaluated an ultra-brief version of a widely used self-report measure, the Obsessive-Compulsive Inventory-Revised (OCI-R), which may be employed as a routine screener for OCD. A total of 1087 adults diagnosed with OCD, 1306 unselected adults from the community, and 423 adults with anxiety related disorders completed the OCI-R along with measures of anxiety and mood. Analyses were conducted to reduce the number of items and examine evidence for sensitivity and specificity to OCD clinical status, test-retest reliability, sensitivity to treatment, and convergent and discriminant validity. Four items that optimally assess different dimensions of OCD (washing, checking, ordering, obsessing) were identified. Psychometric evaluation revealed good to excellent test-retest reliability, validity, prediction of clinical OCD status, and sensitivity to treatment. A 4-item version of the OCI-R, called the OCI-4, shows promise as an ultra-brief screening tool for identifying likely OCD in settings where in-depth assessment is impractical. Patients with a positive screen may be referred for further evaluation and appropriate treatment.
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6
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Pozza A, Ferretti F, Coluccia A. The Perception of Physical Health Status in Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis. Clin Pract Epidemiol Ment Health 2019; 15:75-93. [PMID: 31819755 PMCID: PMC6882187 DOI: 10.2174/1745017901915010075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 11/22/2022]
Abstract
Background: Physical Health Status is a neglected outcome in clinical practice with Obsessive-Compulsive Disorder (OCD) and a systematic review is lacking. Objective: The current study presents the first systematic review and meta-analysis summarizing the evidence on (a) perceived Physical Health Status, Bodily Pain and Role Limitations due to Physical Problems in patients with OCD compared with controls, (b) age, gender, severity of OCD symptoms, study publication date, study methodological quality as moderators of perceived Physical Health Status. Methods: Case-control studies were included if they (a) compared OCD patients with healthy/general population participants as controls, and (b) used validated self-report instruments. Two reviewers searched electronic databases, contacted corresponding authors, and examined reference lists/conference proceedings/theses. Results: Fourteen studies were included. A large significant negative effect size without publication bias showed that controls reported higher perceived Physical Health Status than patients with OCD. Medium and small effect sizes favouring controls emerged for Role Limitations due to Physical Problems and Bodily Pain, respectively. Higher age, females percentage, and publication date were associated with larger effect sizes; higher OCD severity and methodological quality were associated with smaller effect sizes. Conclusion: Perceived Physical Health should be evaluated and addressed by clinicians during treatment, particularly with older, female and less severe patients. Lifestyle interventions might be implemented.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, viale Bracci 16, 53100 Siena, Italy
| | - Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, viale Bracci 16, 53100 Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, viale Bracci 16, 53100 Siena, Italy
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7
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Franklin CL, Raines AM. The overlap between OCD and PTSD: Examining self-reported symptom differentiation. Psychiatry Res 2019; 280:112508. [PMID: 31401290 DOI: 10.1016/j.psychres.2019.112508] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
The role of stressful precipitating events has long been recognized in the genesis of obsessive-compulsive disorder (OCD). Posttraumatic stress disorder (PTSD) also necessitates the experience of a traumatic event (PTSD criterion A). Research has demonstrated a high degree of comorbidity between these two conditions. However, few studies have examined symptom overlap as a potential cause for this co-occurrence. Thus, the purpose of the present study was to examine symptom endorsement and overlap between OCD and PTSD using a sample of trauma exposed veterans. Veterans were administered self-report assessments, including the Dimensional Obsessive-Compulsive Scale (DOCS) and the PTSD Checklist for DSM-5 (PCL-5), as part of a routine clinical care at a Veteran's Administration hospital. Based on self-report assessment of clinical cut scores, 81% of participants met for probable PTSD and 74% for probable OCD. In addition, a series of chi square analyses revealed frequent overlap of endorsement across items with similar content. There is significant overlap between PTSD and OCD symptoms, and patients may find it difficult to differentiate between them on self-report measures. As such, caution should be used when using self-report solely to assess PTSD and OCD, particularly in traumatized samples.
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Affiliation(s)
- C Laurel Franklin
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA 70119, United States; South Central Mental Illness Research, Education & Clinical Center (MIRECC), New Orleans, LA 70119, United States; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA 70112, United States.
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA 70119, United States; South Central Mental Illness Research, Education & Clinical Center (MIRECC), New Orleans, LA 70119, United States; School of Medicine, Louisiana State University, New Orleans, LA 70112, United States
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8
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Lee LO, Rouse S, Mlinac ME. Home-Based Assessment and Treatment of Obsessive-Compulsive Disorder Symptoms to Reduce Unnecessary Emergency Room Usage in an Older Adult. J Cogn Psychother 2019; 33:82-94. [PMID: 31057214 PMCID: PMC6492924 DOI: 10.1891/0889-8391.33.1.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Lewina O. Lee
- VA Boston Healthcare System
- Boston University School of Medicine
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9
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Aldea MA, Michael K, Alexander K, Kison S. Obsessive-Compulsive Tendencies in a Sample of Veterans With Posttraumatic Stress Disorder. J Cogn Psychother 2019; 33:33-45. [PMID: 32746420 DOI: 10.1891/0889-8391.33.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Obsessive-compulsive disorder (OCD) is considered one of the most debilitating disorders worldwide. Data suggests that trauma may be a significant source of not only posttraumatic stress disorder (PTSD), but also OCD. An epidemiologic study of the general population found the risk for OCD to be increased 10-fold in persons with PTSD. The National Vietnam Veterans Readjustment Study found the prevalence of OCD to be 5.2% in war-zone veterans and other studies highlighted PTSD-OCD comorbidity rates ranging from 41% to 70%. However, the frequency of diagnosed OCD is low among veterans (0.6%), and veterans with OCD receive little mental healthcare after diagnosis (mean: 3.8 sessions). The present study examined obsessive-compulsive (OC) tendencies in a sample of veterans with PTSD seeking treatment in a Veterans Affairs (VA) PTSD program between 2011 and 2013. Of the 318 veterans with PTSD included in the current study, 125 (36%) also reported OC tendencies. Data analyses revealed that participants with PTSD who showed evidence of OC tendencies demonstrated more severe PTSD symptoms, higher anxiety sensitivity, and lower cognitive flexibility than participants with PTSD without comorbid OC tendencies; no differences regarding posttraumatic growth were found between the two groups. This is a preliminary study aiming to assess OC tendencies in a sample of veterans with PTSD and expand on the limited existing literature on OCD-PTSD comorbid presentation among veterans.
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10
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Raines AM, Franklin CL, Carroll MN. Obsessive-Compulsive Symptom Dimensions and Insomnia: Associations Among a Treatment-Seeking Veteran Sample. J Cogn Psychother 2019; 33:46-57. [PMID: 32746421 DOI: 10.1891/0889-8391.33.1.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sleep disturbances are a prevalent and pernicious correlate of most emotional disorders. A growing body of literature has recently found evidence for an association between sleep disturbances and obsessive-compulsive disorder (OCD). Though informative, this link has yet to be explored in a veteran population. Further, the degree to which this relationship is accounted for by relevant third variables is limited. The current study investigated the relationship between self-reported insomnia and OCD symptoms after controlling for probable depression and posttraumatic stress disorder (PTSD) using an unselected sample of veterans (N = 57). Most of the sample reported clinically significant OCD (61%) and insomnia symptoms (58%). Results revealed associations between insomnia and OCD unacceptable thoughts/neutralizing compulsions, but not contamination obsessions/washing compulsions, responsibility for harm obsessions/checking compulsions, or symmetry obsessions/ordering compulsions. Findings highlight the need for more research on OCD and sleep problems and clinical work focused on sleep for patients reporting increased OCD symptoms, particularly veterans.
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Affiliation(s)
- Amanda M Raines
- South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana.,Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana.,Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - C Laurel Franklin
- South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana.,Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana.,Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Michele N Carroll
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana
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11
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McIngvale E, Van Kirk N, Amspoker AB, Stanley MA, Fletcher TL. Prevalence and Treatment of Obsessive-Compulsive Disorder in Veterans and Active-Duty Service Members: A Systematic Review. J Cogn Psychother 2019; 33:11-22. [PMID: 32746418 DOI: 10.1891/0889-8391.33.1.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence and treatment of obsessive-compulsive disorder (OCD) in veterans and active-duty military remains unclear. We systematically reviewed literature on OCD diagnosis and treatment in U.S. Veterans and active-duty military to obtain a prevalence estimate, describe treatment approaches for OCD in veterans, and evaluate use of Exposure and Response Prevention (ERP). Eight terms were used to identify studies in PubMed, PsychINFO and SCOPUS up to March 13, 2018; additional articles were identified from reference lists of 19 included studies, 16 addressing prevalence, and 3 addressing treatment. OCD prevalence is lower in studies employing electronic medical records databases than in studies using OCD assessments, suggesting underrecognition of OCD in clinical settings. Higher prevalence was seen with OCD screening tools than with diagnostic interviews. Lower OCD prevalence was seen in active-duty individuals than in veterans. Two case studies showed a decrease in OCD symptoms following ERP. Additional studies with larger samples and controlled designs examining ERP are needed.
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Affiliation(s)
- Elizabeth McIngvale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Nathaniel Van Kirk
- OCD Institute, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Amber B Amspoker
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Melinda A Stanley
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Terri L Fletcher
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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12
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Fletcher TL. Obsessive-Compulsive Disorder in Veterans: An Introduction to the Special Issue. J Cogn Psychother 2019; 33:4-7. [PMID: 32746416 DOI: 10.1891/0889-8391.33.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Raines AM, Carroll MN, Mathes BM, Franklin CL, Allan NP, Constans JI. Examining the Relationships Between Perfectionism and Obsessive-Compulsive Symptom Dimensions Among Rural Veterans. J Cogn Psychother 2019; 33:58-70. [DOI: 10.1891/0889-8391.33.1.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perfectionism, a trait-like individual difference variable reflecting the tendency to set extremely high standards along with critical evaluations of one's own behavior, has long been regarded as a risk and maintenance factor for obsessive-compulsive disorder (OCD). However, research exploring the relationship between these constructs is mixed. One explanation for these equivocal findings is the heterogeneous nature of OCD. Indeed, there is increasing evidence for distinct symptom dimensions that are more homogenous than the broad OCD phenotype. The current study examined the associations between self-reported perfectionism and OCD symptom dimensions controlling for probable depression status. The sample included 67 rural veterans. Results revealed a unique association between perfectionism and the unacceptable thoughts dimension of OCD. These findings are consistent with a growing body of literature demonstrating that OCD symptom dimensions have unique underlying dysfunctional beliefs.
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14
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Ecker AH, Stanley MA, Smith TL, Teng EJ, Fletcher TL, Van Kirk N, Amspoker AB, Walder A, McIngvale E, Lindsay JA. Co-Occurrence of Obsessive-Compulsive Disorder and Substance Use Disorders Among U.S. Veterans: Prevalence and Mental Health Utilization. J Cogn Psychother 2019; 33:23-32. [PMID: 32746419 DOI: 10.1891/0889-8391.33.1.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Obsessive-compulsive disorder (OCD) and substance-use disorders (SUDs) co-occur at high rates, which is related to poorer psychosocial outcomes. Prior work suggests that, among veterans in the Veterans Health Administration (VHA), OCD is underdiagnosed and undertreated, which can compound negative effects of OCD and SUD co-occurrence. This study identified patterns of OCD and specific SUD co-occurrence and their effect on mental health and substance-use screening measures and mental healthcare utilization. Using VHA administrative data, we identified veterans with an OCD diagnosis from 2010 to 2016 (N = 38,157); 36.70% also had a SUD diagnosis. Specific SUD rates are alcohol-use disorder, 17.17%; cannabis-use disorder, 5.53%; opioid-use disorder, 3.60%; amphetamine-use disorder, 1.49%; cocaine-use disorder, 3.37%; and tobacco-use disorder, 26.50%. Veterans with co-occurring OCD and SUD used more mental health services throughout the data capture period. Findings suggest that OCD and SUD co-occur at high rates within the VHA, and that this is associated with more burden to the healthcare system. Targeted screening and treatment efforts may help address the needs of this population.
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Affiliation(s)
- Anthony H Ecker
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Melinda A Stanley
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Tracey L Smith
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Ellen J Teng
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Terri L Fletcher
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Nathaniel Van Kirk
- Office of Clinical Assessment and Research (OCAR) at the OCD Institute, McLean Hospital, Belmont, Massachusetts
| | - Amber B Amspoker
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Annette Walder
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Elizabeth McIngvale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.,Diana R. Garland School of Social Work, Waco, Texas
| | - Jan A Lindsay
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
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Van Kirk N, Fletcher TL, Wanner JL, Hundt N, Teng EJ. Implications of comorbid OCD on PTSD treatment: A case study. Bull Menninger Clin 2018; 82:344-359. [DOI: 10.1521/bumc.2018.82.4.344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Given the high degree of diagnostic overlap and limited empirical literature surrounding the comorbidity between posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), appropriately conceptualizing the relationship between the comorbid symptoms and their impact on the treatment process can be challenging. This is especially true when the symptoms of the two disorders become functionally connected, with each symptom set maintaining the other. This article details the case of a veteran with comorbid PTSD and OCD who sought intensive trauma-focused treatment within the U.S. Veterans Health Administration. The dynamic relationship between his PTSD and OCD symptoms is described, along with its impact on trauma-focused treatment and the ability to maintain treatment gains. A novel attempt to integrate empirically based treatment strategies for OCD into intensive PTSD treatment, targeting both sets of symptoms simultaneously, is presented, along with implications for conceptualization and treatment of this comorbidity.
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Affiliation(s)
- Nathaniel Van Kirk
- Office of Clinical Assessment and Research, OCD Institute, McLean Hospital/Harvard Medical School, Boston, Massachusetts
| | - Terri L. Fletcher
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. De-Bakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center
| | - Jill L. Wanner
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. De-Bakey VA Medical Center, Houston, Texas
| | - Natalie Hundt
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. De-Bakey VA Medical Center, Houston, Texas
| | - Ellen J. Teng
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. De-Bakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center
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16
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Knowles KA, Sripada RK, Defever M, Rauch SAM. Comorbid mood and anxiety disorders and severity of posttraumatic stress disorder symptoms in treatment-seeking veterans. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2018; 11:451-458. [PMID: 29963890 DOI: 10.1037/tra0000383] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Comorbidity is the rule and not the exception among veterans with posttraumatic stress disorder (PTSD). Examining comorbidities in a veteran population allows us to better understand veterans' symptoms and recognize when mental health treatment may need to be tailored to other co-occurring issues. This article evaluates comorbid mood and anxiety disorders and PTSD symptom severity in a large sample of veterans from multiple eras of service, including the recent wars in Iraq and Afghanistan. METHOD The current study used data from veterans who sought treatment for PTSD at a VA PTSD Clinical Team from 2005 to 2013. Veterans were assessed for PTSD, mood, and anxiety disorders using a structured clinical interview and completed self-report symptom measures as part of the PTSD clinic intake procedure. A total of 2,460 veterans were evaluated, and 867 met diagnostic criteria for PTSD. RESULTS Veterans with PTSD were significantly more likely than those without PTSD to be diagnosed with social anxiety disorder and obsessive-compulsive disorder, but significantly less likely to be diagnosed with depression. In addition, veterans who had at least one comorbid diagnosis in addition to PTSD reported significantly higher PTSD symptom severity than veterans with PTSD alone. PTSD symptom severity also varied by era of service. CONCLUSION These results suggest that among veterans seeking treatment for PTSD, comorbid mood and anxiety disorders may be associated with greater severity of PTSD symptoms. Future work is needed to determine the impact of specific comorbidities on trauma-focused treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Gros DF, Szafranski DD, Shead SD. A real world dissemination and implementation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders. J Anxiety Disord 2017; 46:72-77. [PMID: 27158076 DOI: 10.1016/j.janxdis.2016.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/03/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Abstract
Dissemination and implementation of evidence-based psychotherapies is challenging in real world clinical settings. Transdiagnostic Behavior Therapy (TBT) for affective disorders was developed with dissemination and implementation in clinical settings in mind. The present study investigated a voluntary local dissemination and implementation effort, involving 28 providers participating in a four-hour training on TBT. Providers completed immediate (n=22) and six-month follow-up (n=12) training assessments and were encouraged to collect data on their TBT patients (delivery fidelity was not investigated). Findings demonstrated that providers endorsed learning of and interest in using TBT after the training. At six-months, 50% of providers reported using TBT with their patients and their perceived effectiveness of TBT to be very good to excellent. Submitted patient outcome data evidenced medium to large effect sizes. Together, these findings provide preliminary support for the effectiveness of a real world dissemination and implementation of TBT.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
| | - Derek D Szafranski
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Sarah D Shead
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States
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18
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Pasquini M, Piacentino D, Berardelli I, Roselli V, Maraone A, Tarsitani L, Biondi M. Fatigue Experiences Among OCD Outpatients. Psychiatr Q 2015; 86:615-24. [PMID: 25814268 DOI: 10.1007/s11126-015-9357-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with OCD are impaired in multiple domains of functioning and quality of life. While associated psychopathology complaints and neuropsychological deficits were reported, the subjective experience of general fatigue and mental fatigue was scarcely investigated. In this single-center case-control study we compared 50 non-depressed OCD outpatients consecutively recruited and 50 panic disorder (PD) outpatients, to determine whether they experienced fatigue differently. Assessment consisted of structured clinical interview for DSM-IV criteria by using the SCID-I and the SCID-II. Symptom severity was assessed using the Yale-Brown Obsessive-Compulsive Scale, the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, the Clinical Global Impressions Scale, severity and the Global Assessment of Functioning Scale. Fatigue was assessed by using the Multidimensional Fatigue Inventory (MFI). Regarding MFI physical fatigue, an OR of 0.196 (95 % CI 0.080-0.478) was found, suggesting that its presence is associated with lower odds of OCD compared to PD. The same can be said for MFI mental fatigue, as an OR of 0.138 (95 % CI 0.049-0.326) was found, suggesting that its presence is associated with lower odds of OCD. Notably, OCD patients with OCDP co-morbidity reported higher scores of mental fatigue. In this study fatigue, including mental fatigue, seems not to be a prominent experience among adult non-depressed OCD patients.
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Affiliation(s)
- Massimo Pasquini
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy.
| | - Daria Piacentino
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Isabella Berardelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Valentina Roselli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Annalisa Maraone
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Massimo Biondi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
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Becerra MB, Becerra BJ, Safdar N. A nationwide assessment of asthma-mental health nexus among veterans. J Asthma 2015; 53:164-9. [PMID: 26549507 DOI: 10.3109/02770903.2015.1086785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In this study, we evaluated the association between both current and lifetime asthma to that of mental illness among veterans in the USA. METHODS We utilized the 2005-2013 National Survey on Drug Use and Health data, a national population-based survey in the USA. Mental illness was defined as past year major depressive episode and doctor diagnosis of depression. Survey-weighted univariate and multivariable regression analyses were utilized. A total of 20,581 veterans were included in the study. RESULTS A 4.00% and 7.50% prevalence of current and lifetime asthma were noted among veterans, respectively. A significantly higher prevalence of major depressive episode was noted among veterans with current asthma (8.23%), as compared to those without (4.68%), with a similar trend noted among those with lifetime asthma versus those without (7.84% vs. 4.58%). Doctor diagnosis of depression among veterans was higher among those with current asthma (11.83% vs. 5.86%) and lifetime asthma (10.32% vs. 5.76%), as compared to those without asthma. Upon adjusting for confounders, current asthma was significantly associated with past year major depressive episode [adjusted odds ratio (aOR) = 1.65) and depression diagnosis (aOR = 1.88). Similarly, veterans with lifetime asthma, as compared to those without, had higher odds of past year major depressive episode (aOR = 1.56) and depression diagnosis (aOR = 1.66). CONCLUSION The asthma/mental health nexus is significant among the US veterans. Such results warrant the need for integrated care to address mental health burden among veterans with asthma.
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Affiliation(s)
| | - Benjamin J Becerra
- b School of Allied Health Professions, Loma Linda University , Loma Linda , CA , USA , and
| | - Nasia Safdar
- c School of Medicine, University of Wisconsin , Madison , WI , USA
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20
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Gros DF. Design challenges in transdiagnostic psychotherapy research: Comparing Transdiagnostic Behavior Therapy (TBT) to existing evidence-based psychotherapy in veterans with affective disorders. Contemp Clin Trials 2015; 43:114-9. [PMID: 26003434 PMCID: PMC10074285 DOI: 10.1016/j.cct.2015.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/14/2015] [Accepted: 05/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND To address the limitations of disorder-specific approaches, newer transdiagnostic approaches to psychotherapy have been developed to provide a single treatment that is capable of addressing several, related disorders. However, the recruitment of multiple diagnoses presents many challenges to the traditional design of psychotherapy randomized controlled trials (RCTs). OBJECTIVE The goal of the manuscript is to present the challenges and rationale for designing a RCT for transdiagnostic treatment to inform and aid in the development of future investigations. METHODS A recently funded and ongoing RCT for Transdiagnostic Behavior Therapy (TBT) is used as an example to discuss the related design challenges. The TBT study involves the recruitment of 96 veteran participants with any of the following eight principal diagnoses: posttraumatic stress disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, generalized anxiety disorder, specific phobia, major depressive disorder, or persistent depressive disorder. Within the TBT study, participants will complete a semi-structured diagnostic interview and a series of transdiagnostic self-report measures to determine eligibility and assess baseline symptomatology. Qualifying participants will be randomized to TBT or control psychotherapy. Additional assessments will be completed at post-treatment and 6-month follow-up. CONCLUSIONS Due to the transdiagnostic nature of the sample, adjustments to the recruitment and randomization procedures, selection of measures, selection of control psychotherapy, and analysis plan were required. These adjustments have implications to future trials on transdiagnostic psychotherapy protocols as well as future research in line with the transdiagnostic focus of the National Institute of Mental Health's Research Domain Criteria (RDoC) funding strategy.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
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21
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Gros DF. Development and initial evaluation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders. Psychiatry Res 2014; 220:275-82. [PMID: 25193379 DOI: 10.1016/j.psychres.2014.08.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 08/05/2014] [Accepted: 08/10/2014] [Indexed: 11/25/2022]
Abstract
Considerable attention has focused on the growing need for evidence-based psychotherapy for veterans with affective disorders within the Department of Veteran Affairs. Despite, and possibly due to, the large number of evidence-based protocols available, several obstacles remain in their widespread delivery within Veterans Affairs Medical Centers. In part as an effort to address these concerns, newer transdiagnostic approaches to psychotherapy have been developed to provide a single treatment that is capable of addressing several, related disorders. The goal of the present investigation was to develop and evaluate a transdiagnostic psychotherapy, Transdiagnostic Behavior Therapy (TBT), in veterans with affective disorders. Study 1 provided initial support for transdiagnostic presentation of evidence-based psychotherapy components in veterans with principal diagnoses of affective disorders (n=15). These findings were used to inform the development of the TBT protocol. In Study 2, an initial evaluation of TBT was completed in a second sample of veterans with principal diagnoses of affective disorders (n=29). The findings of Study 2 demonstrated significant improvements in symptoms of depression, anxiety, stress, posttraumatic stress, and related impairment across participants with various principal diagnoses. Together, the investigation provided preliminary support for effectiveness of TBT in veterans with affective disorders.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
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22
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Patel SR, Humensky JL, Olfson M, Simpson HB, Myers R, Dixon LB. Treatment of obsessive-compulsive disorder in a nationwide survey of office-based physician practice. Psychiatr Serv 2014; 65:681-4. [PMID: 24585056 PMCID: PMC4051852 DOI: 10.1176/appi.ps.201300192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined treatment of obsessive-compulsive disorder (OCD) in office-based practice. METHODS Data from the 2003– 2010 National Ambulatory Medical Care Survey, a nationally representative survey of visits to U.S. office-based physicians, were used to examine outpatient visits involving treatment of adults with OCD. RESULTS Among the 316 visits with a diagnosis of OCD, most were to a physician seen previously by the patient (96%), usually a psychiatrist (86%), and most patients (56%) had seen the physician at least six times in the previous year. Most visits included psychotropic medications (84%), most commonly a serotonin reuptake inhibitor (SRI) (69%). Visits less commonly included psychotherapy (39%). CONCLUSIONS OCD was predominantly treated by psychiatrists using SRIs, despite the prevalence of OCD in primary care and SRI prescribing practices in that setting. Given the potential shift in OCD treatment patterns after health care reform, research on OCD treatment in primary care is warranted.
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Affiliation(s)
- Sapana R Patel
- Columbia University, Psychiatry, 1051 Riverside Drive, Unit 69, New York, New York, 10017
| | - Jennifer L Humensky
- New York State Psychiatric Institute - Center of Excellence in Cultural Competence, New York
| | - Mark Olfson
- New York State Psychiatric Institute - Department of Psychiatry, New York, New York
| | - Helen Blair Simpson
- Columbia University - Psychiatry, Anxiety Disorders Clinic, New York State Psychiatric Institute, New York
| | - Robert Myers
- New York State Office of Mental Health, New York, New York
| | - Lisa B. Dixon
- Columbia University/NYSPI, Dept of Psychiatry, New York
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