The use of psychotropic agents for the symptoms of obsessive-compulsive disorder

Hoarding and Animal Hoarding: Psychodynamic and Transitional Aspects

Hoarding is a disorder that has only recently begun to be understood by researchers and clinicians. This disorder has been examined from a biopsychosocial perspective and has features that overlap with obsessive-compulsive disorder as well as some unique characteristics. Hoarding disorder is widespread and maybe related to the evolution of collecting and storing resources among humans and other animals. While there have been a number of non-analytic theories related to hoarding and its treatment, psychoanalytic thinkers have rarely described the disorder or explored its underlying psychodynamics. Beginning with Freud, it is possible to understand hoarding in relationship to the vicissitudes of the anal stage of development. However, loss of a loved object, especially loss of the mother, can play an important role in the development of hoarding behavior in adults. The hoarding of inanimate items, examined from a developmental object-relations perspective, appears to involve transitional phenomena. Animal hoarding also involves transitional phenomena, but animals, which can serve as animated transitional objects, also have a repetition compulsion function. These psychodynamic characteristics are relevant for establishing a working transference with the analyst or therapist, in order to promote positive therapeutic outcomes.

Treatments used for obsessive-compulsive disorder-An international perspective

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.

International prescribing practices in obsessive-compulsive disorder (OCD)

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.

Patient-reported outcomes in obsessive-compulsive disorder

The purpose of the article was to provide an overview of patient-reported outcomes (PROs) and related measures that have been examined in the context of obsessive-compulsive disorder (OCD). The current review focused on patient-reported outcome measures (PROMs) that evaluated three broad outcome domains: functioning, health-related quality of life (HRQoL), and OCD-related symptoms. The present review ultimately included a total of 155 unique articles and 22 PROMs. An examination of the PROs revealed that OCD patients tend to suffer from significant functional disability, and report lower HRQoL than controls. OCD patients report greater symptom severity than patients with other mental disorders and evidence indicates that PROMs are sensitive to change and may be even better than clinician-rated measures at predicting treatment outcomes. Nonetheless, it should be noted that the measures reviewed lacked patient input in their development. Future research on PROMs must involve patient perspectives and include rigorous psychometric evaluation of these measures.