Exposure and Response Prevention in Virtual Reality for Patients with Contamination-Related Obsessive-Compulsive Disorder: a Case Series

Exposure therapy in virtual reality is successful in treating anxiety disorders. Studies on exposure and response prevention in virtual reality (VERP) in obsessive-compulsive disorder (OCD) are rare, and it is unclear whether distress associated with other emotions than anxiety (e.g., disgust) can be evoked. The present study aimed to investigate whether distress can be induced during VERP in patients with contamination-related OCD (C-OCD) and a primary feeling of disgust. We treated eight female patients with C-OCD with the primary emotion of disgust over six weeks with VERP and assessed their OC symptoms before and after the intervention period with the Y-BOCS. We measured subjective units of distress (SUD), heart rate and skin conductivity (arousal), sense of presence, and simulator sickness during four consecutive exposure sessions. VERP was able to induce distress and arousal. The qualitative feedback was heterogeneous and sense of presence moderate. Patients' OC symptoms reduced over the treatment period with medium to large effect sizes, but only two patients were considered responders; two patients discontinued treatment due to lack of treatment success. Although VERP was able to induce distress and arousal associated with disgust and evoked a moderate sense of presence, the low rate of symptom reduction diminishes the positive results. Possible reasons for the heterogeneous results and implications are discussed. Trial registration: German Registry for Clinical Studies (DRKS00016929), 10.04.2019.

Symptomkategorien der Zwangsstörung–spezifisch oder generalisiert?

Theoretischer Hintergrund: Die meisten diagnostischen Instrumente stellen bei Zwangsstörung, bzw. den Symptomkategorien Zwangsgedanken und -handlungen, in erster Linie den Schweregrad und nicht deren Generalisierung fest. Fragestellung: Sind Zwangsgedanken bzw. -handlungen situationsspezifisch oder generalisiert auf viele Bereiche? Methode: 142 Patienten mit Zwangsstörung und 21 gesunde Kontrollprobanden erhielten eine deutsche Version des VOCI, das Zwangssymptome in einer Anzahl von Situationen erfragt und die Subskalen der Y-BOCS, die den Schweregrad von Zwangshandlungen und –gedanken erheben. Patienten wurden mit den Kontrollprobanden hinsichtlich der Skalen verglichen. In der Gruppe der Patienten wurden die VOCI Items einer Faktorenanalyse unterzogen und die Faktorenscores mit dem Y-BOCS korreliert. Ergebnisse: Die Patienten unterschieden sich signifikant von den Kontrollprobanden hinsichtlich beider Zwangsfragebogen. Das 6-Faktorenmodell des deutschen VOCI entsprach dem der Originalfassung. Die Y-BOCS Subskalen waren nur moderat mit den entsprechenden VOCI Faktoren korreliert. Unter Patienten mit hoher Ausprägung der Y-BOCS befanden sich solche mit hohen (generalisierten), aber auch mit niedrigen (spezifischen) VOCI Faktorscores. Schlussfolgerungen: Die Ergebnisse lassen auf individuelle Unterschiede hinsichtlich der Spezifität oder Generalisierung der Symptomkategorien unter Zwangspatienten schließen.

Children with very early onset obsessive-compulsive disorder: clinical features and treatment outcome

BACKGROUND

There is emerging evidence that early onset obsessive-compulsive disorder (OCD) may be a phenomenologically distinct subtype of the disorder. Previous research has shown that individuals who report an early onset display greater severity and persistence of symptoms, and they may be less responsive to treatment. To date, this question has been investigated solely in adult samples. The present study represents the first investigation into the effect of age at onset of OCD on clinical characteristics and response to treatment in a paediatric sample.

METHOD

A total of 365 young people referred to a specialist OCD clinic were included in the study. Clinical records were used to examine potential differences in key clinical characteristics between those who had a very early onset of the disorder (before 10 years) and those who had a late onset (10 years or later). Group differences in treatment responsiveness were also examined within a subgroup that received cognitive behaviour therapy (CBT) alone or CBT plus medication (n = 109).

RESULTS

The very early onset group were characterised by a longer duration of illness, higher rates of comorbid tics, more frequent ordering and repeating compulsions and greater parent-reported psychosocial difficulties. There were no differences in treatment response between the groups, and when age at onset was examined as a continuous variable, it did not correlate with treatment response.

CONCLUSIONS

Very early onset OCD may be associated with different symptoms and comorbidities compared with late onset OCD. However, these differences do not appear to impact on responsiveness to developmentally tailored CBT alone or in combination with medication. These findings further indicate the value in early detection and treatment of OCD in childhood.

[Obsessive-compulsive disorder--clinical picture, diagnosis, and therapy]

This article reviews the present state of knowledge concerning obsessive-compulsive disorder (OCD) with respect to its classification, epidemiology, pathogenesis, and therapy. Epidemiological evidence has indicated that OCD may be one of the most prevalent and disabling psychiatric disorders. There is also a high comorbidity with depression and anxiety disorders. OCD is characterized by repetitive, intrusive thoughts and images, and/or by repetitive, ritualistic physical or mental acts performed to reduce the attended anxiety. OCD is relatively common, affecting 1-3% of both adult and paediatric samples. OCD is clinically a heterogeneous condition in that two different patients with clear OCD can display completely distinct symptom patterns. Furthermore, neurobiological and psychological models concerning OCD as well as the present state of therapy are presented in detail.

Predicting Therapy Outcome in Patients with Early and Late Obsessive-Compulsive Disorder (EOCD and LOCD)

Background: Increasing attention has been given to subtyping OCD with respect to different clinical profiles, response to drug treatments, comorbidity and age of onset. There are a number of studies looking at predictors of treatment outcome in OCD, but so far not for OCD subtypes. Method: Prediction of outcome after cognitive-behavioural therapy was evaluated in 63 inpatients with early obsessive-compulsive disorder (EOCD ≤ 12 years of age) and 191 patients with late obsessive-compulsive disorder (LOCD > 15 years of age). Results: For EOCD patients factors predicting a good outcome included high motivation and high initial Y-BOCS scores. Factors associated with a bad outcome were higher age at assessment, a longer duration of psychiatric inpatient treatment before assessment and a low level of social functioning (BSS). For LOCD patients living in a stable relationship, high motivation and completing treatment predicted a favourable therapy outcome, while a low level of psychological functioning (BSS) and a longer duration of inpatient psychiatric treatment before assessment were associated with an undesirable therapy outcome. Conclusions: Subtyping OCD patients according to age of onset seems to be a promising avenue towards improving and developing more specified treatment programs.