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Brakoulias V, Starcevic V, Albert U, Arumugham SS, Bailey BE, Belloch A, Borda T, Dell'Osso L, Elias JA, Falkenstein MJ, Ferrao YA, Fontenelle LF, Jelinek L, Kalogeraki L, Kay B, Laurito LD, Lochner C, Maina G, Marazziti D, Martin A, Matsunaga H, Miguel EC, Morgado P, Mourikis I, Pasquini M, Perez Rivera R, Potluri S, Reddy JYC, Riemann BC, do Rosario MC, Shavitt RG, Stein DJ, Viswasam K, Wang Z, Fineberg NA. Treatments used for obsessive-compulsive disorder-An international perspective. Hum Psychopharmacol 2019; 34:e2686. [PMID: 30628745 DOI: 10.1002/hup.2686] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.
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Affiliation(s)
- Vlasios Brakoulias
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith, NSW, Australia
| | - Vladan Starcevic
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith, NSW, Australia
| | - Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Brenda E Bailey
- Department of Psychiatry, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders, I'TOC, Faculty of Psychology, Universidad de Valencia, Valencia, Spain
| | - Tania Borda
- Department of Psychiatry, Bio-Behavioral Institute BA, Buenos Aires, Argentina.,Department of Psychology, Argentinian Catholic University (UCA), Buenos Aires, Argentina
| | - Liliana Dell'Osso
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Pisa, Italy
| | - Jason A Elias
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Martha J Falkenstein
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Ygor A Ferrao
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Leonardo F Fontenelle
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria
| | - Lena Jelinek
- Department of Psychology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Leto Kalogeraki
- Behavioral Therapy Department/Outpatient Clinic for OCD and Related Disorders, Division of Psychiatry I, National and Kapodistrian University of Athens, Athens, Greece
| | - Brian Kay
- Department of Psychiatry, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Luana D Laurito
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria
| | - Christine Lochner
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Giuseppe Maina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Pisa, Italy
| | - Andrew Martin
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Euripedes C Miguel
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,Department of Psychiatry, ICVS-3Bs-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Department of Psychiatry, Hospital de Braga, Braga, Portugal
| | - Irakis Mourikis
- Behavioral Therapy Department/Outpatient Clinic for OCD and Related Disorders, Division of Psychiatry I, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Sriramya Potluri
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Janardhan Y C Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Brian C Riemann
- Department of Psychiatry, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | | | - Roseli G Shavitt
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Dan J Stein
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Kirupumani Viswasam
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith, NSW, Australia
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Psychiatry, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Naomi A Fineberg
- Department of Psychiatry, Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Hatfield, UK
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Brakoulias V, Starcevic V, Belloch A, Dell'Osso L, Ferrão YA, Fontenelle LF, Lochner C, Marazziti D, Martin A, Matsunaga H, Miguel EC, Reddy YCJ, do Rosário MC, Shavitt RG, Sundar AS, Stein DJ, Viswasam K. International prescribing practices in obsessive-compulsive disorder (OCD). Hum Psychopharmacol 2016; 31:319-24. [PMID: 27271200 DOI: 10.1002/hup.2541] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/21/2016] [Accepted: 05/03/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To assess rates of psychotropic medication use in patients with obsessive-compulsive disorder (OCD) in seven different countries on five continents and to compare these with international treatment guidelines. METHODS Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their patients with OCD and on their incidence of psychotropic use. Consistency of summary statistics across countries was evaluated. RESULTS The data came from Brazil (n = 955), Italy (n = 750), South Africa (n = 555), Japan (n = 382), Australia (n = 213), India (n = 202) and Spain (n = 82). The majority (77.9%; n = 2445) of the total sample of 3139 participants received a psychotropic medication. Consistent with international guidelines, selective serotonin reuptake inhibitors (SSRIs) were most commonly used (73.5%, n = 1796), but their use ranged from 59% in Australia to 96% in Japan. Clomipramine use varied from 5% in Japan and South Africa to 26% in India and Italy. Atypical antipsychotic use ranged from 12% in South Africa to 50% in Japan. CONCLUSIONS Pharmacotherapy for OCD varied significantly across sites. Prospective studies are required to determine the cultural, pharmacoeconomic and pharmacogenomic factors that may play a role in the variation in prescribing practices internationally and whether these variations influence treatment outcomes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Vlasios Brakoulias
- Department of Psychiatry, The University of Sydney and Nepean Hospital, Sydney Medical School-Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
| | - Vladan Starcevic
- Department of Psychiatry, The University of Sydney and Nepean Hospital, Sydney Medical School-Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders, I'TOC, Faculty of Psychology, Universidad de Valencia, Spain
| | - Liliana Dell'Osso
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Italy
| | - Ygor A Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Leonardo F Fontenelle
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, Brazil.,D'Or Institute for Research and Education; Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - Christine Lochner
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Italy
| | - Andrew Martin
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Euripedes C Miguel
- Department and Institute of Psychiatry, University of São Paulo School of Medicine, Brazil
| | - Y C Janardhan Reddy
- Department of Psychiatry National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Maria C do Rosário
- Child and Adolescent Psychiatry Unit (UPIA) at the Department of Psychiatry, Federal University of São Paulo, Brazil
| | - Roseli G Shavitt
- Department and Institute of Psychiatry, University of São Paulo School of Medicine, Brazil
| | - Arumugham Shyam Sundar
- Department of Psychiatry National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Dan Joseph Stein
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Kirupamani Viswasam
- Department of Psychiatry, The University of Sydney and Nepean Hospital, Sydney Medical School-Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
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