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Zisler EM, Meule A, Endres D, Schennach R, Jelinek L, Voderholzer U. Effects of inpatient, residential, and day-patient treatment on obsessive-compulsive symptoms in persons with obsessive-compulsive disorder: A systematic review and meta-analysis. J Psychiatr Res 2024; 176:182-197. [PMID: 38875774 DOI: 10.1016/j.jpsychires.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Patients with severe or treatment-refractory obsessive-compulsive disorder (OCD) often need an extensive treatment which cannot be provided by outpatient care. Therefore, we aimed to estimate the effects and their moderators of inpatient, residential, or day-patient treatment on obsessive-compulsive symptoms in patients with OCD. METHODS PubMed, PsycINFO, and Web of Science were systematically screened according to the PRISMA guidelines. Studies were selected if they were conducted in an inpatient, residential, or day-patient treatment setting, were using a number of pre-defined instruments for assessing OCD symptom severity, and had a sample size of at least 20 patients. RESULTS We identified 43 eligible studies in which inpatient, residential, or day-patient treatment was administered. The means and standard deviations at admission, discharge, and-if available-at follow-up were extracted. All treatment programs included cognitive-behavioral treatment with exposure and response prevention. Only one study reported to not have used psychopharmacological medication. Obsessive-compulsive symptoms decreased from admission to discharge with large effect sizes (g = -1.59, 95%CI [-1.76; -1.41]) and did not change from discharge to follow-up (g = 0.06, 95%CI [-0.09; 0.21]). Length of stay, age, sex, and region did not explain heterogeneity across the studies but instrument used did: effects were larger for clinician-rated interviews than for self-report measures. CONCLUSIONS Persons with OCD can achieve considerable symptom reductions when undertaking inpatient, residential, or day-patient treatment and effects are-on average-maintained after discharge.
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Affiliation(s)
- Eva M Zisler
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany.
| | - Adrian Meule
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | | | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Segal SC, Carmona NE. A systematic review of sleep problems in children and adolescents with obsessive compulsive disorder. J Anxiety Disord 2022; 90:102591. [PMID: 35728382 DOI: 10.1016/j.janxdis.2022.102591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 05/15/2022] [Accepted: 06/04/2022] [Indexed: 11/28/2022]
Abstract
There is growing interest in the relationship between obsessive-compulsive disorder (OCD) and sleep problems in youth, including the development of a theoretical model proposing how these disorders maintain each other. The model suggests that OCD symptoms are proposed to interfere with sleep duration (e.g., via increased arousal and delayed bedtime), which compounds OCD symptom severity during the daytime and into the evening, feeding back into the model. Whether the recent influx of research on sleep problems in youth with OCD supports this model is unknown. The primary aim of this systematic review was to characterize sleep problems in youth with OCD and evaluate whether current research supports previous theoretical inferences. Findings across 20 studies revealed a high prevalence of sleep problems among youth with OCD and support a bidirectional relationship. Studies largely did not assess hypothesized relationships proposed by the model; support for the model is therefore preliminary. A secondary aim was to assess the impacts of comorbidity and developmental stage. Findings suggest that in childhood, comorbid anxiety disorders may initially predate sleep problems, but they become mutually maintained over time; the role of comorbid depression appears to increase with age. Limitations, future directions, and clinical implications are discussed.
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Affiliation(s)
- Shira C Segal
- Toronto Metropolitan University, Department of Psychology, 350 Victoria St, Toronto, ON M5B 2K3, Canada.
| | - Nicole E Carmona
- Toronto Metropolitan University, Department of Psychology, 350 Victoria St, Toronto, ON M5B 2K3, Canada.
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Nadeem NJ, Chan E, Drummond L. A Naturalistic Study of the Maintenance of Gains Made With Treatment of Patients With Profound Treatment-Refractory Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:673390. [PMID: 34354609 PMCID: PMC8329362 DOI: 10.3389/fpsyt.2021.673390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) generally responds to first-line treatment but patients often relapse. The United Kingdom National OCD Inpatient Service treats patients who have failed to respond to at least two trials of SRI, augmented with a dopamine blocker and two trials of ERP. Despite this, they have profound treatment-refractory OCD and require 24-h nursing care due to severe OCD. We examined patients' Y-BOCS score on admission, discharge and at each follow-up from all patients discharged over 5 years (02/01/2014-31/12/18). Data were analysed using SPSS. Paired student t-tests were used to assess improvement from admission to discharge and each follow-up. Over 5 years, 130 adult patients were treated: 79 male and 51 female with an average age of 42.3 years (20-82; sd14.4). Their ethnic backgrounds were; 115 Caucasian, 11 South Asian, 1 Chinese, and 3 Unspecified. On admission, the average Y-BOCS total score was 36.9 (30-40; sd2.6). At discharge, patients had improved on average by 36% (Y-BOCS reduction to 23.4 = moderate OCD). Similar reduction in Y-BOCS continued throughout the year with an average Y-BOCS of 22.9 at 1 month (n = 69); 23 at 3 months (n = 70); 21.3 at 6 months (n = 78) and 21.9 at 1 year (n = 77). Twenty-seven patients did not attend any follow-up appointment whilst others attended at least one appointment with the majority attending more than 3. Using student t-test, improvements at discharge, 1, 3, 6, and 12 months post-treatment showed a highly significant improvement (p < 0.001). Gains made following inpatient treatment for treatment-refractory OCD were generally maintained until 1 year post-treatment.
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Affiliation(s)
- Nighat Jahan Nadeem
- South West London and St George's Mental Health NHS Trust, London, United Kingdom
| | - Emily Chan
- St George's University of London, London, United Kingdom
| | - Lynne Drummond
- South West London and St George's Mental Health NHS Trust, London, United Kingdom
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Drummond LM, Pillay A, Kolb PJ, Benson S, Fogg R, Jones-Thomas E, Rani S. Community model in treating obsessive–compulsive and body dysmorphic disorders. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.107.017509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodIn November 2005, the National Institute for Health and Clinical Excellence published guidelines for the treatment of obsessive–compulsive disorder (OCD) and body dysmorphic disorder. These guidelines incorporated a stepped care approach with different interventions advised throughout the patient pathway. South West London and St George's Mental Health NHS Trust devised a system of expert clinicians with special expertise in OCD/body dysmorphic disorder to help deliver this model of care. To aid the delivery of service it was decided to operationalise the definitions of severity of OCD/body dysmorphic disorder at each of the stepped-care levels. Examples are given as to how this has been applied in practice. Outcome is presented in terms of clinical hours in the first year of operation.ResultsIn total, 108 patients were referred to the service in the first year. Many of these patients were treated by offering advice and support and joint working with the community mental health team and psychotherapy in primary care teams who had referred. Sixty-eight patients were treated by a member of the specialist service alone and 57 of these suffered from severe OCD. Outcome data from these 57 patients is presented using an intention-to-treat paradigm. They showed a clinically and statistically significant reduction in OCD symptoms after 24 weeks of cognitive–behavioural therapy comprising graded exposure and self-imposed response prevention. the mean Yale–Brown Obsessive Compulsive Scale score dropped from 28 (severe OCD) to 19 (considerable OCD). Depressive symptoms on the Beck Depression Inventory also decreased by an average 24% over the same period.Clinical ImplicationsThe feasibility of extending this model of service organisation to other areas and other diagnoses is discussed.
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Drummond LM, Fineberg NA, Heyman I, Veale D, Jessop E. Use of specialist services for obsessive–compulsive and body dysmorphic disorders across England. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.112.040667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodIn April 2007, the National Specialist Commissioning Team of the Department of Health commissioned a group of services to provide treatment to patients with the most severe and profound obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). We decided to examine the usage of these services across England 4–5 years after the start of the new funding arrangements. This survey used data about patients treated in the financial year 2011–2012.ResultsDespite the services offering intensive home-based as well as residential and in-patient services, there was a greater proportion of referrals from London, the South East of England and counties closer to London.Clinical implicationsIt is important that all patients, regardless of where they live, have access to highly specialist services for OCD and BDD. We discuss potential ways of improving this access but we hope this paper will act as a discussion forum whereby we can receive feedback from others.
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Harris PM, Drummond LM. Compliance of community teams with specialist service recommendations for obsessive-compulsive and body dysmorphic disorders. BJPsych Bull 2016; 40:245-248. [PMID: 27752342 PMCID: PMC5046782 DOI: 10.1192/pb.bp.115.052530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method To examine how often referring community mental health teams (CMHTs) utilised treatment recommendations made by the national highly specialised service for patients with severe obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). We analysed all patient notes for admissions to the unit (August 2012-August 2014) and recorded how many treatment recommendations were implemented by CMHTs prior to admission and at 6 months post-discharge. Results Overall, 66% of our recommendations were met by CMHTs prior to admission and 74% after discharge. Most recommendations concerned medication and the continued need for care coordination by the CMHT. Clinical implications A significant proportion of patients in our audit did not receive optimum treatment in the community as recommended by our service. As highly specialised services are a limited resource and these patients have not responded to previous treatment, this has implications for the use of such resources.
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Affiliation(s)
- Paul M Harris
- South West London and St George's Mental Health NHS Trust
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Veale D, Miles S, Read J, Troglia A, Wylie K, Muir G. Sexual Functioning and Behavior of Men with Body Dysmorphic Disorder Concerning Penis Size Compared with Men Anxious about Penis Size and with Controls: A Cohort Study. Sex Med 2015; 3:147-55. [PMID: 26468378 PMCID: PMC4599552 DOI: 10.1002/sm2.63] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Little is known about the sexual functioning and behavior of men anxious about the size of their penis and the means that they might use to try to alter the size of their penis. Aim To compare sexual functioning and behavior in men with body dysmorphic disorder (BDD) concerning penis size and in men with small penis anxiety (SPA without BDD) and in a control group of men who do not have any concerns. Methods An opportunistic sample of 90 men from the community were recruited and divided into three groups: BDD (n = 26); SPA (n = 31) and controls (n = 33). Main Outcome Measures The Index of Erectile Function (IEF), sexual identity and history; and interventions to alter the size of their penis. Results Men with BDD compared with controls had reduced erectile dysfunction, orgasmic function, intercourse satisfaction and overall satisfaction on the IEF. Men with SPA compared with controls had reduced intercourse satisfaction. There were no differences in sexual desire, the frequency of intercourse or masturbation across any of the three groups. Men with BDD and SPA were more likely than the controls to attempt to alter the shape or size of their penis (for example jelqing, vacuum pumps or stretching devices) with poor reported success. Conclusion Men with BDD are more likely to have erectile dysfunction and less satisfaction with intercourse than controls but maintain their libido. Further research is required to develop and evaluate a psychological intervention for such men with adequate outcome measures.
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Affiliation(s)
- David Veale
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Sarah Miles
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Julie Read
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Andrea Troglia
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Kevan Wylie
- Porterbrook Clinic, Sheffield Health and Social Care NHS Foundation Trust Sheffield, UK
| | - Gordon Muir
- King's College Hospital, NHS Foundation Trust London, UK
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Drummond LM, Kolb P. Obsessive–Compulsive Contamination Fears and Anorexia Nervosa: The Application of the New Psycho-Educational Treatment of Danger Ideation Reduction Therapy (DIRT). BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.25.1.44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe case history of a woman with severe and enduring anorexia nervosa and obsessive–compulsive disorder (OCD) with contamination fears is presented. These contamination fears centred on her fear of contamination by fat and fatty substances as she worried about gaining weight. Previous treatment with graded exposure had shown no clinically significant benefits. She was admitted to a specialist unit for the treatment of OCD as an inpatient. Due to the previous failure of the recognised psychological treatments for OCD it was decided to use the new psychoeducational approach of danger ideation reduction therapy (DIRT). This treatment resulted in an improvement in her OCD symptoms despite the fact that the emphasis of the treatment was on the risk of bacteria and dirt. It is believed that this is the first documented case of DIRT being used for a patient with anorexia nervosa and OCD.
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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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Boschen MJ, Drummond LM, Pillay A, Morton K. Predicting outcome of treatment for severe, treatment resistant OCD in inpatient and community settings. J Behav Ther Exp Psychiatry 2010; 41:90-5. [PMID: 19926074 DOI: 10.1016/j.jbtep.2009.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 10/19/2009] [Accepted: 10/26/2009] [Indexed: 11/18/2022]
Abstract
Treatment of OCD is effective, even for the most chronic and severe cases. It has been difficult to identify predictors of treatment outcome, with little work aimed at predicting treatment outcome in severe OCD. We examined the ability of a range of demographic and psychopathology variables to predict treatment outcome in a cohort of 52 inpatients and a second group of 62 community outpatients with severe, treatment-refractory OCD. Despite both cohorts showing significant improvement in OCD symptoms, reliable predictors were difficult to identify, and were different in the two cohorts. In the inpatient group, marital status was a significant predictor, with those who were married or cohabiting showing better outcome that those not currently in a relationship. This relationship was not observed in the community treatment group. Initial symptom severity was also found to be a significant predictor, but only in the community treatment group, where higher initial severity was associated with greater reduction in symptoms during treatment. Further research examining a wider range of predictors may assist in identifying those factors which predict outcome in severe OCD.
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Affiliation(s)
- Mark J Boschen
- South West London and St George's Mental Health NHS Trust, London, United Kingdom.
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Treatment of severe, treatment-refractory obsessive-compulsive disorder: a study of inpatient and community treatment. CNS Spectr 2008; 13:1056-65. [PMID: 19179942 DOI: 10.1017/s1092852900017119] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This research reports on a prospective outcome study of two cohorts of patients with severe, chronic, resistant obsessive-compulsive disorder (OCD). METHODS One cohort consisted of a total of 52 patients treated in an inpatient setting, while the second group comprised 65 patients treated in a community-outpatient setting. Treatment consistent primarily of intensive graded exposure and self-imposed response prevention augmented with cognitive restructuring. RESULTS The groups demonstrated significant improvement over the course of treatment. In the inpatient and community groups, there was significant improvement over the first 12 weeks of treatment, and further improvement between 12 and 24 weeks. CONCLUSION These results suggest that even for patients who have demonstrated treatment-resistance, there may be benefit in intensive behavioral treatment of OCD. In addition it was found that even for those patients with the most profound refractory OCD and complicating factors inpatient stays of up to 24 weeks were effective in reducing symptoms.
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Abstract
INTRODUCTION To study the prevalence of delayed sleep phase (DSP) in a cohort of inpatients with severe obsessive-compulsive disorder (OCD) and to identify clinical and demographic correlates. METHODS A systematic retrospective case-report study of consecutive OCD admissions to a specialist inpatient unit from January 1995 to December 2003. Nursing and medical records of sleep, demographic, clinical, and other relevant details were recorded. RESULTS Of 194 eligible consecutive case reports, 187 were located, and nursing and medical reports of sleep were identified in all 187 (100%). Thirty-three patients (17.6%) fulfilled operationally defined criteria for DSP after exclusion of possible confounding factors. All the patients with DSP were unemployed. Phase-shifted patients were significantly younger than non-shifted patients (P=.019) and reported an earlier age of onset of their OCD (P=.005). There was a non-significant trend toward more severe OCD in the phase-shifted group, but they were not more depressed than their non-shifted counterparts. CONCLUSION A substantial number of patients with severe, enduring OCD also suffer with DSP, which seems to be specifically linked to OCD as opposed to comorbid depression. Clarification of the etiology within DSP and its interaction with core OCD symptoms on clinical function and disability may identify new treatment targets. To this end, further studies of sleep in OCD using actigraphy and biological measures are indicated.
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