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Factors Predicting the Effectiveness of Cognitive-Behavioral Group Therapy in the Treatment of Obsessive–Compulsive Disorder. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2022. [DOI: 10.1007/s10942-022-00456-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, Welton NJ, Baxter H, Kessler D, Churchill R, Lewis G. Pharmacological and Psychotherapeutic Interventions for Management of Obsessive-compulsive Disorder in Adults: A Systematic Review and Network Meta-analysis. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:457-467. [PMID: 35747299 DOI: 10.1176/appi.focus.19402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reprinted under Creative Commons CC-BY license.
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Affiliation(s)
- Petros Skapinakis
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Deborah M Caldwell
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - William Hollingworth
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Peter Bryden
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Naomi A Fineberg
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Paul Salkovskis
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Nicky J Welton
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Helen Baxter
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - David Kessler
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Rachel Churchill
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
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Abstract
It becomes increasingly clear that (non-)invasive neurostimulation is an effective treatment for obsessive-compulsive disorder (OCD). In this chapter we review the available evidence on techniques and targets, clinical results including a meta-analysis, mechanisms of action, and animal research. We focus on deep brain stimulation (DBS), but also cover non-invasive neurostimulation including transcranial magnetic stimulation (TMS). Data shows that most DBS studies target the ventral capsule/ventral striatum (VC/VS), with an overall 76% response rate in treatment-refractory OCD. Also TMS holds clinical promise. Increased insight in the normalizing effects of neurostimulation on cortico-striatal-thalamic-cortical (CSTC) loops - through neuroimaging and animal research - provides novel opportunities to further optimize treatment strategies. Advancing clinical implementation of neurostimulation techniques is essential to ameliorate the lives of the many treatment-refractory OCD patients.
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Intelligence quotient level and treatment of obsessive-compulsive disorders: Meta-analyses. Med Hypotheses 2020; 144:109995. [DOI: 10.1016/j.mehy.2020.109995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 11/22/2022]
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Predictors of response to group cognitive-behavioral therapy in the treatment of obsessive-compulsive disorder. Eur Psychiatry 2020; 24:297-306. [DOI: 10.1016/j.eurpsy.2008.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 12/10/2008] [Accepted: 12/10/2008] [Indexed: 11/20/2022] Open
Abstract
AbstractPurposeTo identify the presence of factors associated with treatment outcome in patients under group cognitive-behavioral therapy (GCBT) for obsessive-compulsive disorder (OCD).Subjects and methodsThis study evaluated 181 patients with OCD that attended a 12-session weekly GCBT program. Response criteria were: ≥35% reduction in Y-BOCS scores and global improvement score of the Clinical Global Impression (CGI) ≤ 2 at post-treatment evaluation. Sociodemographic data, OCD characteristics, and treatment data were studied.ResultsIn the bivariate analysis, the following variables showed statistical significance (p < 0.20) to enter the regression model: being woman (p = 0.074), greater insight (p = 0.017) and better quality of life (QOL) in all domains before treatment (p = 0.053), overall severity of disease according to the CGI (p = 0.007), number of associated comorbidities (p = 0.063), social phobia (p = 0.044), and dysthymia (p = 0.072). In the final regression model, these variables were associated with response to GCBT: female gender (p = 0.021); WHOQOL-BREF psychological domain (p = 0.011); insight (p = 0.042); and global improvement score of the CGI severity-scale before therapy (p = 0.045).ConclusionSpecial attention should be paid to patients with poor insight, increasing the cognitive aspects of the therapy in an attempt to modify the rigidity and fixity of their beliefs. In addition, male patients should be more observed, since they showed lower chance of response to GCBT when compared to women. Patients with more severe global symptoms (CGI) are poorer responders to GCBT, which indicates that not only obsessive-compulsive symptoms (OCS) should be evaluated, since other symptoms, such as depression and anxiety, may affect the treatment; therefore, an attempt to reduce these symptoms, prior to the treatment of OCD, should be considered as an option in some cases.
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Del Casale A, Sorice S, Padovano A, Simmaco M, Ferracuti S, Lamis DA, Rapinesi C, Sani G, Girardi P, Kotzalidis GD, Pompili M. Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Curr Neuropharmacol 2020; 17:710-736. [PMID: 30101713 PMCID: PMC7059159 DOI: 10.2174/1570159x16666180813155017] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) is associated with affective and cognitive symptoms causing personal distress and reduced global functioning. These have considerable societal costs due to healthcare service utilization. Objective: Our aim was to assess the efficacy of pharmacological interventions in OCD and clinical guidelines, providing a comprehensive overview of this field. Methods: We searched the PubMed database for papers dealing with drug treatment of OCD, with a specific focus on clinical guidelines, treatments with antidepressants, antipsychotics, mood stabilizers, off-label medications, and pharmacogenomics. Results: Prolonged administration of selective serotonin reuptake inhibitors (SSRIs) is most effective. Better results can be obtained with a SSRI combined with cognitive behavioral therapy (CBT) or the similarly oriented exposure and response prevention (ERP). Refractory OCD could be treated with different strategies, including a switch to another SSRI or clomipramine, or augmentation with an atypical antipsychotic. The addition of medications other than antipsychotics or intravenous antidepressant administration needs further investigation, as the evidence is inconsistent. Pharmacogenomics and personalization of therapy could reduce treatment resistance. Conclusions: SSRI/clomipramine in combination with CBT/ERP is associated with the optimal response compared to each treatment alone or to other treatments. New strategies for refractory OCD are needed. The role of pharmacogenomics could become preponderant in the coming years.
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Affiliation(s)
- Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Serena Sorice
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Alessio Padovano
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Simmaco
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | | | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
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Kotzalidis GD, Del Casale A, Simmaco M, Pancheri L, Brugnoli R, Paolini M, Gualtieri I, Ferracuti S, Savoja V, Cuomo I, De Chiara L, Mosca A, Sani G, Girardi P, Pompili M, Rapinesi C, On Behalf Of The Sapienza Group For The Study Of The Placebo Effect In Psychiatric Disorders. Placebo Effect in Obsessive-Compulsive Disorder (OCD). Placebo Response and Placebo Responders in OCD: The Trend Over Time. Curr Neuropharmacol 2020; 17:741-774. [PMID: 30370851 PMCID: PMC7059157 DOI: 10.2174/1570159x16666181026163922] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/16/2018] [Accepted: 10/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Placebo response appears to be increasing in antidepressant, antipsychotic and various internal medicine trials. A similar trend has been reported for OCD during 1989-1999. Placebo response is generally considered as the extent to which placebo treatment is associated with core symptom improvement. In this analysis, we used Joinpoint regression to assess the time trend of both placebo response and placebo responder rates according to the year of publication with no time restriction in OCD drug trials. METHODS We included drug and/or psychotherapy trials vs. placebo from PubMed, Embase, CINAHL, and PsycINFO retrieved through the search (placebo OR sham) AND (obsessive* OR OCD). We included studies through investigator consensus. We then performed on data of included studies log-linear joinpoint segmented regression models using a p<0.05 cutoff. RESULTS We included 113 studies from 112 published papers. Placebo mean annual response rates in OCD studies significantly increased from 1991 to 2017 with an annual percent change (APC) of 0.66%, while placebo mean annual responder rates also significantly increased from 2010 to 2017, with an APC of 5.45%. Drug mean annual response rates in OCD studies significantly increased from 1987 to 2012 with an APC of 0.72%, while the corresponding responder rates did not show statistically significant APC changes between 1984 and 2017. CONCLUSION We observed a tendency for placebo to increase both measures of response in OCD clinical drug trials through the years that tend to approximate the responses shown by drugs. Changes in the type of study (moving from classical head to head comparisons to add-on studies in treatmentresistant populations) and countries involved in experimentation may partially account for some portion of these results. It appears that placebo effects are becoming more elusive and out of control.
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Affiliation(s)
- Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Antonio Del Casale
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Maurizio Simmaco
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | | | - Roberto Brugnoli
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Marco Paolini
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Ida Gualtieri
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neuroscience, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | | | - Ilaria Cuomo
- ASL Roma 1, Istituto Penitenziario Regina Caeli, Rome, Italy
| | - Lavinia De Chiara
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Alessio Mosca
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Maurizio Pompili
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Chiara Rapinesi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
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Albert U, Di Salvo G, Solia F, Rosso G, Maina G. Combining Drug and Psychological Treatments for Obsessive- Compulsive Disorder: What is the Evidence, When and for Whom. Curr Med Chem 2019; 25:5632-5646. [PMID: 28707590 DOI: 10.2174/0929867324666170712114445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 04/11/2017] [Accepted: 05/30/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Serotonin reuptake inhibitors (SRIs) and cognitive-behavioral psychotherapy (CBT) are first-line treatments for obsessive-compulsive disorder (OCD). Since response is often inadequate, in recent years researchers investigated whether combining CBT and SRIs, either ab initio or sequentially, results in a greater reduction of obsessivecompulsive symptoms. OBJECTIVE The aims of the present paper are to assess if combination treatment seems adding benefits as compared to either monotherapy alone and if sequential strategies may be effective in converting partial or non responders to a first-line treatment into responders. METHOD We reviewed available literature on pharmacological and CBT combination and sequential treatments for adult and pediatric OCD patients and then we conducted a separate analysis for studies concerning these two promising strategies. Search results included openlabel trials and randomized controlled trials (RCTs). RESULTS We identified ten controlled studies assessing the efficacy of combination treatments ab initio versus CBT alone and six evaluating combination strategies ab initio versus medications alone. Eleven studies, only two of which were RCTs, have been published on sequential treatments. The combination ab initio of CBT and SRIs has not been found to be clearly superior to either monotherapy alone in most studies conducted on this topic, except for patients with severe depression who might benefit more from the combination versus only CBT. A sequential administration of CBT after medications has been found useful in promoting remission in patients who partially responded to drugs and in promoting response in resistant patients. CONCLUSION OCD patients with comorbid major depression should receive medication firstly, eventually associated with CBT; for all remaining patients there is clear evidence from the literature of no additive benefits of combining ab initio CBT and medication. Therefore, the routine use of a combination approach in all adult patients affected by OCD is not supported by the literature. The available evidence supports the effectiveness of the sequential addition of CBT to SRIs.
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Affiliation(s)
- Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy, A.O.U. San Luigi Gonzaga of Orbassano, Turin, Italy
| | - Gabriele Di Salvo
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy, A.O.U. San Luigi Gonzaga of Orbassano, Turin, Italy
| | - Francesca Solia
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy, A.O.U. San Luigi Gonzaga of Orbassano, Turin, Italy
| | - Gianluca Rosso
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy, A.O.U. San Luigi Gonzaga of Orbassano, Turin, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy, A.O.U. San Luigi Gonzaga of Orbassano, Turin, Italy
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Rector NA, Richter MA, Katz D, Leybman M. Does the addition of cognitive therapy to exposure and response prevention for obsessive compulsive disorder enhance clinical efficacy? A randomized controlled trial in a community setting. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 58:1-18. [DOI: 10.1111/bjc.12188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Neil A. Rector
- Frederick W. Thompson Anxiety Disorders Centre; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Department of Psychiatry; University of Toronto; Ontario Canada
| | - Margaret A. Richter
- Frederick W. Thompson Anxiety Disorders Centre; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Department of Psychiatry; University of Toronto; Ontario Canada
| | - Danielle Katz
- Frederick W. Thompson Anxiety Disorders Centre; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
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Skapinakis P, Caldwell D, Hollingworth W, Bryden P, Fineberg N, Salkovskis P, Welton N, Baxter H, Kessler D, Churchill R, Lewis G. A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive-compulsive disorder in children/adolescents and adults. Health Technol Assess 2018; 20:1-392. [PMID: 27306503 DOI: 10.3310/hta20430] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a relatively common and disabling condition. OBJECTIVES To determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents and adults. DATA SOURCES We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Trials Registers, which includes trials from routine searches of all the major databases. Searches were conducted from inception to 31 December 2014. REVIEW METHODS We undertook a systematic review and network meta-analysis (NMA) of the clinical effectiveness and acceptability of available treatments. Outcomes for effectiveness included mean differences in the total scores of the Yale-Brown Obsessive-Compulsive Scale or its children's version and total dropouts for acceptability. For the cost-effectiveness analysis, we developed a probabilistic model informed by the results of the NMA. All analyses were performed using OpenBUGS version 3.2.3 (members of OpenBUGS Project Management Group; see www.openbugs.net ). RESULTS We included 86 randomised controlled trials (RCTs) in our systematic review. In the NMA we included 71 RCTs (54 in adults and 17 in children and adolescents) for effectiveness and 71 for acceptability (53 in adults and 18 in children and adolescents), comprising 7643 and 7942 randomised patients available for analysis, respectively. In general, the studies were of medium quality. The results of the NMA showed that in adults all selective serotonin reuptake inhibitors (SSRIs) and clomipramine had greater effects than drug placebo. There were no differences between SSRIs, and a trend for clomipramine to be more effective did not reach statistical significance. All active psychological therapies had greater effects than drug placebo. Behavioural therapy (BT) and cognitive therapy (CT) had greater effects than psychological placebo, but cognitive-behavioural therapy (CBT) did not. BT and CT, but not CBT, had greater effects than medications, but there are considerable uncertainty and methodological limitations that should be taken into account. In children and adolescents, CBT and BT had greater effects than drug placebo, but differences compared with psychological placebo did not reach statistical significance. SSRIs as a class showed a trend for superiority over drug placebo, but the difference did not reach statistical significance. However, the superiority of some individual drugs (fluoxetine, sertraline) was marginally statistically significant. Regarding acceptability, all interventions except clomipramine had good tolerability. In adults, CT and BT had the highest probability of being most cost-effective at conventional National Institute for Health and Care Excellence thresholds. In children and adolescents, CBT or CBT combined with a SSRI were more likely to be cost-effective. The results are uncertain and sensitive to assumptions about treatment effect and the exclusion of trials at high risk of bias. LIMITATIONS The majority of psychological trials included patients who were taking medications. There were few studies in children and adolescents. CONCLUSIONS In adults, psychological interventions, clomipramine, SSRIs or combinations of these are all effective, whereas in children and adolescents, psychological interventions, either as monotherapy or combined with specific SSRIs, were more likely to be effective. Future RCTs should improve their design, in particular for psychotherapy or combined interventions. STUDY REGISTRATION The study is registered as PROSPERO CRD42012002441. FUNDING DETAILS The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Peter Bryden
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Naomi Fineberg
- University of Hertfordshire and Hertfordshire Partnerships Mental Health Trust, Hatfield, UK
| | | | - Nicky Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Baxter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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Kamaradova D, Brunovsky M, Prasko J, Horacek J, Hajda M, Grambal A, Latalova K. EEG correlates of induced anxiety in obsessive-compulsive patients: comparison of autobiographical and general anxiety scenarios. Neuropsychiatr Dis Treat 2018; 14:2165-2174. [PMID: 30214206 PMCID: PMC6120576 DOI: 10.2147/ndt.s169172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The underlying symptomatology of obsessive-compulsive disorder (OCD) can be viewed as an impairment in both cognitive and behavioral inhibition, regarding difficult inhibition of obsessions and behavioral compulsions. Converging results from neuroimaging and electroencephalographic (EEG) studies have identified changes in activities throughout the medial frontal and orbital cortex and subcortical structures supporting the cortico-striato-thalamo-cortical circuit model of OCD. This study aimed to elucidate the electrophysiological changes induced by autobiographical and general anxiety scenarios in patients with OCD. METHODS Resting-state eyes-closed EEG data were recorded in 19 OCD patients and 15 healthy controls. Cortical EEG sources were estimated by standardized low-resolution electromagnetic tomography (sLORETA). The changes in the emotional state were induced by two different scenarios: the autobiographical script related to patient's OCD symptoms and the script triggering general anxiety. RESULTS During the resting state, we proved increased delta activity in the frontal, limbic and temporal lobe and the sub-lobar area in OCD patients. In a comparison of neural activities during general anxiety in OCD patients and the control group, we proved an increase in delta (parietal, temporal, occipital, frontal and limbic lobes, and sub-lobal area), theta (temporal, parietal and occipital lobes) and alpha-1 activities (parietal lobe). Finally, we explored the neural activity of OCD patients during exposure to the autobiographic scenario. We proved an increase in beta-3 activity (left frontal lobe). CONCLUSION Our study proved differences in neural activation in OCD patients and healthy controls during imagination of general anxiety. Exposure to the autobiographic OCD scenario leads to activation of left frontal brain areas. The results show the possibility of using specific scenarios in OCD therapy.
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Affiliation(s)
- Dana Kamaradova
- Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic,
| | | | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic,
| | - Jiri Horacek
- National Institute of Mental Health, Klecany, Czech Republic
| | - Miroslav Hajda
- Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic,
| | - Ales Grambal
- Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic,
| | - Klara Latalova
- Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic,
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Kumar A, Sharma MP, Narayanaswamy JC, Kandavel T, Janardhan Reddy YC. Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions. Indian J Psychiatry 2016; 58:366-371. [PMID: 28196991 PMCID: PMC5270259 DOI: 10.4103/0019-5545.196723] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cognitive behavior therapy (CBT) involving exposure and response prevention is the gold standard psychotherapeutic intervention for obsessive-compulsive disorder (OCD). However, applying traditional CBT techniques to treat patients with predominant obsessions (POs) without covert compulsions is fraught with problems because of inaccessibility of mental compulsions. In this context, we examined the efficacy of mindfulness-integrated CBT (MICBT) in patients with POs without prominent overt compulsions. MATERIALS AND METHODS Twenty-seven patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were recruited from the specialty OCD clinic and the behavior therapy services of a tertiary care psychiatric hospital over 14 months. Patients had few or no overt compulsions and were free of medication or on a stable medication regimen for at least 2 months prior to baseline assessment. All patients received 12-16 sessions of MICBT on an outpatient basis. An independent rater (psychiatrist) administered the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the Clinical Global Impression Scale at baseline, mid- and post-treatment, and at 3-month follow-up. RESULTS Of the 27 patients, 18 (67%) achieved remission (55% reduction in the YBOCS severity score) at 3-month follow-up. The average mean percentage reduction of obsessive severity at postintervention and 3-month follow-up was 56 (standard deviation [SD] = 23) and 63 (SD = 21), respectively. CONCLUSIONS Our study demonstrates that MICBT is efficacious in treating patients with POs without prominent overt compulsions. The results of this open-label study are encouraging and suggest that a larger randomized controlled trial examining the effects of MICBT may now be warranted.
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Affiliation(s)
- Ajay Kumar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mahendra P Sharma
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Thennarasu Kandavel
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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13
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Julien D, O'Connor K, Aardema F. The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change. J Affect Disord 2016; 202:187-96. [PMID: 27262641 DOI: 10.1016/j.jad.2016.05.060] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The inference-based approach (IBA) postulates that individuals with obsessive-compulsive disorder (OCD) confuse a possibility with reality (inferential confusion) according to specific inductive reasoning devices and act as if this possibility were true. A new treatment modality, the inference-based therapy (IBT), was developed. The aim of this study was to critically review empirical evidence regarding the etiological model, treatment efficacy, and model of change of IBA. METHODS A search of the literature was conducted using PsycINFO and Medline. RESULTS Thirty-four articles were included in the review. The review reveals that intrusive thoughts of non-clinical and OCD individuals may occur in different contexts. There is support for a specific inductive reasoning style in OCD. Inferential confusion is associated with OCD symptoms. There is good evidence that IBT is an efficacious treatment for OCD, including two randomized controlled trials showing that IBT was as efficacious as cognitive-behavior therapy. There is some but limited evidence that the process of change during treatment is coherent with IBA's assumptions. LIMITATIONS Key premises were investigated in only a few studies. Some of these studies were conducted in non-clinical samples or did not include an anxious control group. CONCLUSIONS IBA's etiological model, treatment modality, and model of change make a significant contribution to OCD.
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Affiliation(s)
- Dominic Julien
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Canada; Département de Psychologie, Université de Montréal, Canada.
| | - Kieron O'Connor
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Canada; Département de Psychiatrie, Université de Montréal, Canada
| | - Frederick Aardema
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Canada; Département de Psychiatrie, Université de Montréal, Canada
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14
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Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, Welton NJ, Baxter H, Kessler D, Churchill R, Lewis G. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry 2016; 3:730-739. [PMID: 27318812 PMCID: PMC4967667 DOI: 10.1016/s2215-0366(16)30069-4] [Citation(s) in RCA: 210] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/06/2016] [Accepted: 04/18/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several interventions are available for management of obsessive-compulsive disorder in adults, but few studies have compared their relative efficacy in a single analysis. We aimed to simultaneously compare all available treatments using both direct and indirect data. METHODS In this systematic review and network meta-analysis, we searched the two controlled trials registers maintained by the Cochrane Collaboration Common Mental Disorders group for trials published up to Feb 16, 2016. We selected randomised controlled trials in which an active psychotherapeutic or pharmacological intervention had been used in adults with obsessive-compulsive disorder. We allowed all comorbidities except for schizophrenia or bipolar disorder. We excluded studies that focused exclusively on treatment-resistant patient populations defined within the same study. We extracted data from published reports. The primary outcome was symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale. We report mean differences with 95% credible intervals compared with placebo. This study is registered with PROSPERO, number CRD42012002441. FINDINGS We identified 1480 articles in our search and included 53 articles (54 trials; 6652 participants) in the network meta-analysis. Behavioural therapy (mean difference -14·48 [95% credible interval -18·61 to -10·23]; 11 trials and 287 patients), cognitive therapy (-13·36 [-18·40 to -8·21]; six trials and 172 patients), behavioural therapy and clomipramine (-12·97 [-19·18 to -6·74]; one trial and 31 patients), cognitive behavioural therapy and fluvoxamine (-7·50 [-13·89 to -1·17]; one trial and six patients), cognitive behavioural therapy (-5·37 [-9·10 to -1·63]; nine trials and 231 patients), clomipramine (-4·72 [-6·85 to -2·60]; 13 trials and 831 patients), and all SSRIs (class effect -3·49 [95% credible interval -5·12 to -1·81]; 37 trials and 3158 patients) had greater effects than did drug placebo. Clomipramine was not better than were SSRIs (-1·23 [-3·41 to 0·94]). Psychotherapeutic interventions had a greater effect than did medications, but a serious limitation was that most psychotherapeutic trials included patients who were taking stable doses of antidepressants (12 [80%] of the 15 psychotherapy trials explicitly allowed antidepressants). INTERPRETATION A range of interventions is effective in the management of obsessive-compulsive disorder, but considerable uncertainty and limitations exist regarding their relative efficacy. Taking all the evidence into account, the combination of psychotherapeutic and psychopharmacological interventions is likely to be more effective than are psychotherapeutic interventions alone, at least in severe obsessive-compulsive disorder. FUNDING National Institute for Health Research.
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Affiliation(s)
- Petros Skapinakis
- Division of Psychiatry, University College London, London, UK; Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece.
| | - Deborah M Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Peter Bryden
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Naomi A Fineberg
- Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK; Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | | | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Baxter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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15
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Mantione M, Nieman DH, Figee M, Denys D. Cognitive-behavioural therapy augments the effects of deep brain stimulation in obsessive-compulsive disorder. Psychol Med 2014; 44:3515-3522. [PMID: 25065708 DOI: 10.1017/s0033291714000956] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a promising new treatment for patients with treatment-refractory obsessive-compulsive disorder (OCD). However, since most DBS patients only show a partial response, the treatment still needs to be improved. In this study we hypothesized that cognitive-behavioural therapy (CBT) could optimize the post-operative management in DBS and we evaluated the efficacy of CBT as augmentation to DBS targeted at the nucleus accumbens. METHOD A total of 16 patients with treatment-refractory OCD were treated with DBS targeted at the nucleus accumbens. After stabilization of decline in OCD symptoms, a standardized 24-week CBT treatment programme was added to DBS in an open-phase trial of 8 months. Changes in obsessive-compulsive, anxiety and depressive symptoms were evaluated using the Yale-Brown Obsessive Compulsive Scale, Hamilton Anxiety Scale and Hamilton Rating Scale for Depression. RESULTS Following the addition of CBT to DBS, a significant decrease in obsessive-compulsive symptoms was observed, but not in anxiety and depressive symptoms. In a subsequent double-blind phase, in which stimulation was discontinued, OCD symptoms returned to baseline (relapse) and anxiety and depressive symptoms worsened (rebound) compared with baseline. CONCLUSIONS The results of this explorative study suggest that a combined treatment of accumbens DBS and CBT may be optimal for improving obsessive-compulsive symptoms in treatment-refractory OCD. However, a subsequent randomized controlled trial is necessary to draw firm conclusions. It seems that DBS results in affective changes that may be required to enable response prevention in CBT. This may indicate that DBS and CBT act as two complementary treatments.
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Affiliation(s)
- M Mantione
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - D H Nieman
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - M Figee
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - D Denys
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
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16
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Romanelli RJ, Wu FM, Gamba R, Mojtabai R, Segal JB. Behavioral therapy and serotonin reuptake inhibitor pharmacotherapy in the treatment of obsessive-compulsive disorder: a systematic review and meta-analysis of head-to-head randomized controlled trials. Depress Anxiety 2014; 31:641-52. [PMID: 24390912 DOI: 10.1002/da.22232] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/19/2013] [Accepted: 11/28/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Effective treatments for obsessive-compulsive disorder (OCD) include behavioral therapy (exposure and response/ritual prevention and cognitive behavioral therapy) and serotonin-reuptake inhibitors (SRIs); however, the relative efficacy of these treatments is not well established. We sought to review evidence from head-to-head randomized-controlled trials (RCTs) of behavioral therapy and SRIs in the treatment of OCD. METHODS A systematic search of multiple databases was conducted from first available date to June 30, 2012, for RCTs in the treatment of OCD among outpatients, comparing behavioral therapy and SRIs, alone or combined. Two independent reviewers evaluated studies for eligibility and risk of bias. The main outcome measure was posttreatment mean Yale-Brown Obsessive-Compulsive Scale (YBOCS) score. RESULTS We identified 2,186 unique articles. Fifteen articles were included, describing 13 RCTs. Pooled standardized mean difference (SMD; 95% confidence intervals) in YBOCS score significantly favored behavioral therapy over SRIs (0.37; 0.10, 0.64; P = .007), but not in a subset of trials that used selective SRIs (0.22; -0.02, 0.47; P = .070). Within individual trials, effect sizes significantly favored the combination of behavioral therapy plus an SRI over an SRI, but not behavioral therapy, alone. CONCLUSIONS This review provides evidence that, among outpatients with OCD, behavioral therapy is more effective than SRIs, overall, but not selective SRIs. Furthermore, the combination of behavioral therapy plus an SRI is more effective than an SRI alone. These data may be used to inform the development of evidence-based treatment guidelines; however, more studies are also needed to further evaluate the relative efficacy of these interventions.
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Affiliation(s)
- Robert J Romanelli
- Clinical Outcomes Research, Clinical Integration Department, Sutter Health, San Francisco, California
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Hillebrand T, Niedermeier N. Intensive ambulante Expositionsbehandlung bei schweren Zwängen - zwei Modelle aus der Praxis für die Praxis. VERHALTENSTHERAPIE 2014. [DOI: 10.1159/000366529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Stereotypies that develop spontaneously in nonhuman primates can provide an effective model for repetitive stereotyped behavior in people with neurodevelopmental or obsessive-compulsive disorders. The behaviors are similar in form, are similarly affected by environmental conditions, and are improved with similar treatment methods such as enrichment, training, and drug therapy. However, because of a greater number of commonalities in these factors, nonhuman primates may serve as a better model for stereotyped behavior in individuals with autism or intellectual disability than for compulsions in individuals with obsessive-compulsive disorder. Because animal models may not be exact in all features of the disorder being studied, it is important to investigate the strengths and weaknesses of using a nonhuman primate model for stereotyped behavior in people with psychological disorders.
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Wetterneck CT, Little TE, Rinehart KL, Cervantes ME, Hyde E, Williams M. Latinos with obsessive-compulsive disorder: Mental healthcare utilization and inclusion in clinical trials. J Obsessive Compuls Relat Disord 2012; 1:85-97. [PMID: 29057210 PMCID: PMC5647138 DOI: 10.1016/j.jocrd.2011.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Previous research has documented that ethnic minorities, particularly Latinos, obtain fewer mental health services than Caucasians (Kearney, Draper, & Baron 2005; Sue, Fujino, Hu, Takeuchi, & Zane, 1991). Conceivably, this may be due to a wide array of cultural issues (e.g., negative stigma attached to mental health, and language, socio-economic, and acculturation barriers), symptom disparities across Caucasian and Latino groups, or lack of effective outreach methods by clinicians and researchers. However, research is limited. As a result, Latinos may be insufficiently represented in clinical studies for OCD, making it unclear whether evidence-based treatments demonstrate the same efficacy and effectiveness for Latinos as has been demonstrated for Caucasians. The current study takes an in-depth analysis of 98 efficacy and effectiveness studies for OCD from across the Western hemisphere and reports the rates of Latino inclusion from each sample. Ninety clinical studies in the US and Canada, as well as eight clinical studies in Mexico and Central America were reviewed. Findings showed that only 11 (24%) US and Canadian studies included Latino participants, illustrating an overwhelming underrepresentation of Latinos in clinical studies for OCD. Further explanation of the results and their implications are discussed, along with suggestions for effectively improving access to mental health research and appropriate treatments.
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Affiliation(s)
- Chad T Wetterneck
- University of Houston-Clear Lake, 2700 Bay Area Blvd., Houston, TX 77058, United States
| | - Tannah E Little
- University of Houston-Clear Lake, 2700 Bay Area Blvd., Houston, TX 77058, United States
| | - Kimberly L Rinehart
- University of Houston-Clear Lake, 2700 Bay Area Blvd., Houston, TX 77058, United States
| | - Maritza E Cervantes
- University of Houston-Clear Lake, 2700 Bay Area Blvd., Houston, TX 77058, United States
| | - Emma Hyde
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Monnica Williams
- University of Louisville, Center for Mental Health Disparities, Department of Psychological & Brain Sciences, 2301 South Third St., Louisville, KY 40292, United States
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Besiroglu L, Çetinkaya N, Selvi Y, Atli A. Effects of selective serotonin reuptake inhibitors on thought-action fusion, metacognitions, and thought suppression in obsessive-compulsive disorder. Compr Psychiatry 2011; 52:556-61. [PMID: 21109243 DOI: 10.1016/j.comppsych.2010.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 10/07/2010] [Accepted: 10/11/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed to assess whether cognitive processes change over time in patients with obsessive-compulsive disorder (OCD) receiving selective serotonin reuptake inhibitors without cognitive behavioral therapy and to investigate the factors associated with probable cognitive changes. METHODS During the 16 weeks of the study, 55 patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for OCD received open-label treatment with sertraline (100-200 mg/d) or fluoxetine (40-80 mg/d) and were assessed using the Yale-Brown Obsessive-Compulsive Scale, Beck Depression Inventory (BDI), Thought-Action Fusion Scale (TAFS), Metacognitions Questionnaire (MCQ-30), and White Bear Suppression Inventory (WBSI). RESULTS The Yale-Brown Obsessive-Compulsive Scale (P < .001), BDI (P < .001), TAFS morality (P < .005), MCQ-30 (P < .01), and WBSI (P < .005) scores at follow-up were significantly lower than baseline scores. When we excluded OCD patients with depressive disorder (n = 12), statistical significance in paired comparisons for MCQ and WBSI disappeared. Similarly, when OCD patients with religious obsessions (n = 16) were excluded, paired comparisons for MCQ and TAF morality were not statistically significant. Changes in BDI, TAFS morality, MCQ-30, and WBSI (P < .005) were significantly correlated with changes in severity of obsessions, but not that of compulsions. After controlling for the change in depression severity, significant correlations between changes in obsessive and cognitive scales did not continue to have statistical significance. The BDI changes (P < .05) significantly explained the changes in symptom severity in a linear regression model. CONCLUSIONS Our findings suggest that selective serotonin reuptake inhibitors can change appraisals of obsessive intrusions via their effects on negative emotions.
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Affiliation(s)
- Lutfullah Besiroglu
- Department of Psychiatry, Faculty of Medicine, Yuzuncu Yil University, Van, 65200, Turkey.
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Jónsson H, Hougaard E, Bennedsen BE. Randomized comparative study of group versus individual cognitive behavioural therapy for obsessive compulsive disorder. Acta Psychiatr Scand 2011; 123:387-97. [PMID: 20946200 DOI: 10.1111/j.1600-0447.2010.01613.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The primary aim of the study was to compare the effectiveness of group and individual cognitive behaviour therapy (CBT) for obsessive compulsive disorder (OCD). METHOD One hundred and ten out-patients with OCD were randomly assigned to 15 sessions of either group CBT or individual CBT. Outcome measures were administered before and after treatment, as well as at 6- and 12-month follow-ups. The study was supplemented by a meta-analysis of accomplished comparative studies of group vs. individual CBT for OCD. RESULTS Large and stable pre-post effect sizes were found for both treatment conditions in the study (d = 1.06-1.24 on the Yale-Brown Obsessive Compulsive Scale). There were no significant between-group differences in outcome at any data point (ds= -0.13 to 0.15). The meta-analysis of four accomplished comparative studies (including the present one) found a between-group mean effect size of (d= 0.15 favouring individual over group CBT at posttreatment (95% confidence interval, -0.12, 0.42). CONCLUSION The results of this study suggest that OCD can be treated effectively with a group format of CBT, thus sparing some therapist resources, although the four accomplished comparative studies do not rule out the possibility of a small superiority of individually conducted CBT.
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Affiliation(s)
- H Jónsson
- Department of Psychology, Aarhus University, Aarhus Clinic for Obsessive Compulsive Disorder, Aarhus University Hospital, Denmark.
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Goljevscek S, Carvalho LA. Current management of obsessive and phobic states. Neuropsychiatr Dis Treat 2011; 7:599-610. [PMID: 22003299 PMCID: PMC3191872 DOI: 10.2147/ndt.s17032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Indexed: 12/05/2022] Open
Abstract
Obsessional states show an average point prevalence of 1%-3% and a lifetime prevalence of 2%-2.5%. Most treatment-seeking patients with obsessions continue to experience significant symptoms after 2 years of prospective follow-up. A significant burden of impairment, distress, and comorbidity characterize the course of the illness, leading to an increased need for a better understanding of the nature and management of this condition. This review aims to give a representation of the current pharmacological and psychotherapeutic strategies used in the treatment of obsessive-compulsive disorder. Antidepressants (clomipramine and selective serotonin reuptake inhibitors) are generally the first-line choice used to handle obsessional states, showing good response rates and long-term positive outcomes. About 40% of patients fail to respond to selective serotonin reuptake inhibitors. So far, additional pharmacological treatment strategies have been shown to be effective, ie, administration of high doses of selective serotonin reuptake inhibitors, as well as combinations of different drugs, such as dopamine antagonists, are considered efficacious and well tolerated strategies in terms of symptom remission and side effects. Psychotherapy also plays an important role in the management of obsessive-compulsive disorder, being effective for a wide range of symptoms, and many studies have assessed its long-term efficacy, especially when added to appropriate pharmacotherapy. In this paper, we also give a description of the clinical and psychological features likely to characterize patients refractory to treatment for this illness, with the aim of highlighting the need for greater attention to more patient-oriented management of the disease.
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Vaccaro LD, Jones MK, Menzies RG, Wootton BM. Danger Ideation Reduction Therapy for Obsessive–Compulsive Checking: Preliminary Findings. Cogn Behav Ther 2010; 39:293-301. [DOI: 10.1080/16506073.2010.512643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Houghton S, Saxon D, Bradburn M, Ricketts T, Hardy G. The effectiveness of routinely delivered cognitive behavioural therapy for obsessive-compulsive disorder: a benchmarking study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2009; 49:473-89. [PMID: 19849894 DOI: 10.1348/014466509x475414] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES There is often difficulty in generalizing the results of randomized controlled trials (RCTs) to routine clinical practice given the rigid design features of such studies. The purpose of this study is to describe the effectiveness of routinely delivered, formulation-based cognitive behavioural therapy (CBT) within a publicly funded clinic for adults with obsessive-compulsive disorder (OCD) and offer a comparison against the outcomes achieved in efficacy studies for the same population. METHOD Practice-based prospective study. Routine data collected from a National Health Service out-patient clinic for adult clients with OCD is benchmarked against the findings of RCTs. The comparison RCTs were identified using a systematic review methodology. RESULTS The mean (95% confidence interval) change in Yale-Brown Obsessive Compulsive Scale score pre- to post-therapy in the Sheffield clinic was 10.2 (7.1 - 13.3), which compares well with changes of 11.4 (10.5 - 12.2) for exposure and response prevention trials, 12.9 (11.2 - 14.7) for cognitive therapy trials, and 10.6 (8.5 - 12.8) for CBT trials. The Sheffield results fell within the benchmarks derived from the included RCTs. CONCLUSION These results indicate that CBT for adults with OCD delivered outside the constraints of a clinical trial is equivalently effective but that this conclusion should be tested further on a larger group of patients.
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Affiliation(s)
- Simon Houghton
- Psychotherapy Department, Sheffield Health and Social Care Trust, UK.
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Cordioli AV. [Cognitive-behavioral therapy in obsessive-compulsive disorder]. BRAZILIAN JOURNAL OF PSYCHIATRY 2009; 30 Suppl 2:s65-72. [PMID: 19039446 DOI: 10.1590/s1516-44462008000600003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the cognitive-behavioral therapy in the treatment of the symptoms of obsessive-compulsive disorder. METHOD Through the revision of text books and articles the origins and fundamentals of cognitive-behavioral therapy in the treatment of the symptoms of obsessive-compulsive disorder are presented. Through the review of randomized clinical trials and meta-analysis in Medline the evidences of effectiveness of cognitive-behavioral therapy in obsessive-compulsive disorder are highlighted. RESULTS AND CONCLUSIONS The cognitive-behavioral therapy is effective in reducing symptoms of obsessive-compulsive disorder by approximately 70% of patients who adhere to treatment. The challenges ahead are to clarify the reasons why many patients do not respond to this kind of treatment and develop new strategies to increase its effectiveness.
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Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention. Behav Res Ther 2009; 47:301-7. [DOI: 10.1016/j.brat.2009.01.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 01/06/2009] [Accepted: 01/07/2009] [Indexed: 11/23/2022]
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O'Connor K. Cognitive and meta-cognitive dimensions of psychoses. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:152-9. [PMID: 19321019 DOI: 10.1177/070674370905400303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper outlines cognitive approaches to understanding and treating positive psychotic symptoms, such as hallucinations, delusions, and dissociations. Recent cognitive accounts of psychosis are reviewed along with the claim that it is not the symptoms themselves but cognitive and meta-cognitive appraisals (attributions and beliefs) about the significance of the symptoms that cause distress and dysfunction. Psychotic symptoms do lie on a continuum with normal experience. Cognitive appraisal dimensions may interact with reasoning styles such as inferential confusion, cognitive slippage, fantasy proneness, and perceptual immersion (styles also normally distributed in the population) and together persuade the person with psychosis to live in fictional narratives as if they were real. Recent clinical studies suggest that addressing beliefs about symptoms modifying inferential styles and normalizing experiences may help symptom management.
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Affiliation(s)
- Kieron O'Connor
- Fernand-Seguin Research Centre, Louis-H Lafontaine Hospital, Montreal, Quebec.
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Bandelow B, Zohar J, Hollander E, Kasper S, Möller HJ, Zohar J, Hollander E, Kasper S, Möller HJ, Bandelow B, Allgulander C, Ayuso-Gutierrez J, Baldwin DS, Buenvicius R, Cassano G, Fineberg N, Gabriels L, Hindmarch I, Kaiya H, Klein DF, Lader M, Lecrubier Y, Lépine JP, Liebowitz MR, Lopez-Ibor JJ, Marazziti D, Miguel EC, Oh KS, Preter M, Rupprecht R, Sato M, Starcevic V, Stein DJ, van Ameringen M, Vega J. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision. World J Biol Psychiatry 2009; 9:248-312. [PMID: 18949648 DOI: 10.1080/15622970802465807] [Citation(s) in RCA: 424] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, World J Biol Psychiatry 3:171), recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo- or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University of Gottingen, Gottingen, Germany.
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Soomro GM, Altman D, Rajagopal S, Oakley-Browne M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database Syst Rev 2008; 2008:CD001765. [PMID: 18253995 PMCID: PMC7025764 DOI: 10.1002/14651858.cd001765.pub3] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obsessive compulsive disorder is a common and disabling disorder. A significant proportion of patients manifest a chronic course. Individual randomised controlled trials (RCTs) have shown that selective serotonin re-uptake inhibitors (SSRIs) are effective in this condition. Previous systematic reviews or meta-analyses summarising the evidence are methodologically problematic or limited in the scope of their analysis. OBJECTIVES To examine the efficacy and adverse effects of serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD) in adults. SEARCH STRATEGY CCDANCTR-Studies and CCDANCTR-References were searched on 12/11/2007. Reference lists were checked. Experts in the field were contacted. SELECTION CRITERIA All RCTs and quasi-RCTs examining the efficacy of SSRIs compared with placebo for OCD in adults were eligible for inclusion. DATA COLLECTION AND ANALYSIS Selection of studies and data extraction were carried out by two review authors independently, and quality assessment of studies was undertaken. Data analysis was conducted using Review Manager software. Summary measures were produced using the weighted mean difference (WMD) for continuous data and relative risk (RR) for dichotomous data, with 95% confidence intervals (CI). SSRIs were examined as an overall group of drugs, and as individual drugs. MAIN RESULTS Seventeen studies were included in the review, involving 3097 participants. Based on all 17 studies, SSRIs as a group were more effective than placebo in reducing the symptoms of OCD between 6 and 13 weeks post-treatment, measured using the Yale-Brown Obsessive Compulsive Scale (YBOCS) (WMD -3.21, 95% CI -3.84 to -2.57). The WMD for individual SSRI drugs were similar and not statistically different. Based on 13 studies (2697 participants), SSRIs were more effective than placebo in achieving clinical response at post-treatment (RR 1.84, 95% CI 1.56 to 2.17). The pooled RR was shown to be similar between individual SSRI drugs. Although reported adverse effects data were more limited, with few exceptions, the overall and individual adverse effects for the different SSRIs were always worse than for placebo and, in the majority of cases, the difference was statistically significant. Nausea, headache and insomnia were always reported amongst the most common adverse effects in trials of each of the drugs. AUTHORS' CONCLUSIONS SSRIs are more effective than placebo for OCD, at least in the short-term, although there are differences between the adverse effects of individual SSRI drugs. The longer term efficacy and tolerability of different SSRI drugs for OCD has yet to be established.
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Affiliation(s)
- G M Soomro
- St. George's Hospital Medical School, Department of Psychiatry, University of London, Cranmer Terrace, London, UK SW17 0RE.
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Böhm K, Förstner U, Külz A, Voderholzer U. Versorgungsrealität der Zwangsstörungen: Werden Expositionsverfahren eingesetzt? VERHALTENSTHERAPIE 2008. [DOI: 10.1159/000115956] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Anxiety disorders usually are chronic or recurrent disorders characterized by stress sensitivity and a fluctuating course. Both psychopharmacologic and cognitive-behavioral treatments are well-established, evidence-based treatments for panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Exposure-based behavioral treatment is well established as evidence-based treatment for specific phobias. Primary care physicians can make a significant impact on patients' lives by identifying and educating about anxiety disorders, directing patients to appropriate self-help resources, choosing evidence-based drug treatment when indicated, and making referrals for specialist care.
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Affiliation(s)
- Steven L Shearer
- Residency Training Program in Family Medicine, Department of Family Medicine, Franklin Square Hospital Center, Baltimore, MD 21237, USA.
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Kempe PT, van Oppen P, de Haan E, Twisk JWR, Sluis A, Smit JH, van Dyck R, van Balkom AJLM. Predictors of course in obsessive-compulsive disorder: logistic regression versus Cox regression for recurrent events. Acta Psychiatr Scand 2007; 116:201-10. [PMID: 17655562 DOI: 10.1111/j.1600-0447.2007.00997.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Two methods for predicting remissions in obsessive-compulsive disorder (OCD) treatment are evaluated. Y-BOCS measurements of 88 patients with a primary OCD (DSM-III-R) diagnosis were performed over a 16-week treatment period, and during three follow-ups. METHOD Remission at any measurement was defined as a Y-BOCS score lower than thirteen combined with a reduction of seven points when compared with baseline. Logistic regression models were compared with a Cox regression for recurrent events model. RESULTS Logistic regression yielded different models at different evaluation times. The recurrent events model remained stable when fewer measurements were used. Higher baseline levels of neuroticism and more severe OCD symptoms were associated with a lower chance of remission, early age of onset and more depressive symptoms with a higher chance. CONCLUSION Choice of outcome time affects logistic regression prediction models. Recurrent events analysis uses all information on remissions and relapses. Short- and long-term predictors for OCD remission show overlap.
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Affiliation(s)
- P T Kempe
- Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Center, GGZ Buitenamstel, The Netherlands
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Prazeres AM, Souza WFD, Fontenelle LF. Terapias de base cognitivo-comportamental do transtorno obsessivo-compulsivo: revisão sistemática da última década. REVISTA BRASILEIRA DE PSIQUIATRIA 2007; 29:262-70. [PMID: 17713699 DOI: 10.1590/s1516-44462006005000046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 02/26/2007] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Revisar de forma sistemática os estudos controlados e meta-análises que envolveram tratamento cognitivo ou comportamental do transtorno obsessivo-compulsivo publicados na última década. MÉTODO: Análise sistemática de ensaios clínicos randomizados e meta-análises indexados no Medline e PsycInfo. RESULTADOS: Os estudos avaliados confirmam que a exposição e prevenção de resposta e a terapia cognitiva são eficazes no tratamento do transtorno obsessivo-compulsivo de crianças, adolescentes e adultos. Em adultos, o uso concomitante de inibidores da recaptação da serotonina e exposição e prevenção de resposta ou terapia cognitiva não foi associado a um efeito adicional na resposta ao tratamento. No transtorno obsessivo-compulsivo infantil, o uso combinado de inibidores da recaptação da serotonina e exposição e prevenção de resposta foi superior aos dois tratamentos isoladamente. A exposição e prevenção de resposta associada à terapia cognitiva resultou em benefícios significativos em pacientes com predominância de pensamentos obsessivos e sua modalidade em grupo também produziu redução significativa dos sintomas obsessivos e compulsivos. CONCLUSÃO: Atualmente, as terapias de base cognitivo-comportamental são as mais adequadas para o tratamento do transtorno obsessivo-compulsivo; porém, mais estudos envolvendo follow-up em longo prazo, tratamento em grupo e uso concomitante de medicação são necessários.
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Affiliation(s)
- Angélica Marques Prazeres
- Programa de Pesquisa em Ansiedade e Depressão, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Julien D, O'Connor KP, Aardema F. Intrusive thoughts, obsessions, and appraisals in obsessive–compulsive disorder: A critical review. Clin Psychol Rev 2007; 27:366-83. [PMID: 17240502 DOI: 10.1016/j.cpr.2006.12.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 11/17/2006] [Accepted: 12/01/2006] [Indexed: 11/28/2022]
Abstract
This article reviews empirical findings on two key premises of the appraisal model of obsessive-compulsive disorder (OCD): (a) non-clinical populations experience intrusive thoughts (ITs) that are similar in form and in content to obsessions; and (b) ITs develop into obsessions because they are appraised according to dysfunctional beliefs. There is support for the universality of ITs. However, the samples used are not representative of the general population. IT measures do not relate systematically or exclusively to OCD symptom measures, and are not specific enough to exclude other types of intrusive thoughts such as negative automatic thoughts or worries, nor are they representative of all types of obsessions. When general distress is controlled, there is so far no evidence that participants with OCD endorse obsessive belief domains more strongly than anxious participants, and inconclusive evidence that OCD and non-clinical samples differ on the belief domains. Some OCD symptom subtypes are associated with belief domains. Currently, there is no coherent model to offer strong predictions about the specificity of the empirically derived belief domains in OCD symptom subtypes. Cognitive therapy based on the appraisal model is an effective treatment for OCD, although it does not add to the treatment efficacy of behaviour therapy. It is unclear how appraisals turn ITs into obsessions. Implications for future research are discussed.
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Affiliation(s)
- Dominic Julien
- Centre de recherche Fernand-Seguin, Université de Montréal, Montreal, Quebec, Canada H1N 3V2.
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Abstract
PURPOSE OF REVIEW Both pharmacotherapy and cognitive-behavioural therapy are effective treatments for anxiety disorders. The present editorial reviews the current status of combination treatments with a focus on randomized controlled trials, meta-analyses and reviews that have been published in the past 3 years. RECENT FINDINGS Recent studies on treatments combining pharmacotherapy and cognitive-behavioural therapy for anxiety disorders have found little benefit for combination therapies versus monotherapies. New investigations have explored the potential benefits of sequential treatments versus the concomitant ones as well as the use of cognitive enhancers as adjuncts to psychotherapy. SUMMARY Uncertainty exists as to whether the combination of cognitive-behavioural therapy and pharmacotherapy in the treatment of anxiety disorders is associated with greater overall efficacy than with either treatment when given alone. New ways for combining the two types of treatments are being investigated.
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Affiliation(s)
- Charles B Pull
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg.
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