1
|
Pinciotti CM, Van Kirk N, Horvath G, Storch EA, Mancebo MC, Abramowitz JS, Fontenelle LF, Goodman WK, Riemann BC, Cervin M. Co-occurring PTSD in intensive OCD treatment: Impact on treatment trajectory vs. response. J Affect Disord 2024; 353:109-116. [PMID: 38452939 DOI: 10.1016/j.jad.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding the precise barriers to OCD treatment effectiveness for individuals with co-occurring PTSD may help elucidate unique treatment needs. METHODS The current study used linear regression and latent growth curve analysis comparing treatment response and trajectory from patients with OCD (n = 3083, 94.2 %) and OCD + PTSD (n = 191, 5.2 %) who received CBT with ERP in two major intensive OCD treatment programs. RESULTS Although patients with OCD + PTSD evidenced similar trajectories of overall severity change, patients at one site required nearly 11 additional treatment days to achieve comparable reduction in OCD severity. Further, at the dimensional level, those with OCD + PTSD had poorer treatment response for unacceptable thoughts and symmetry symptoms. The moderate effect for unacceptable thoughts, indicating the widest gap in treatment response, suggests these symptoms may be particularly relevant to PTSD. LIMITATIONS Findings are limited by a naturalistic treatment sample with variation in treatment provision. CONCLUSIONS Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD + PTSD within intensive OCD treatment programs, as broadly defined outcomes (e.g., reduction in overall severity) may not translate to reduction in the nuanced symptom dimensions likely to intersect with trauma. Unacceptable thoughts and symmetry symptoms, when co-occurring with PTSD, may require a trauma-focused treatment approach within intensive OCD treatment.
Collapse
Affiliation(s)
- Caitlin M Pinciotti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Nathaniel Van Kirk
- OCD Institute, Office of Clinical Assessment and Research (OCAR), McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Gregor Horvath
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Maria C Mancebo
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leonardo F Fontenelle
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Matti Cervin
- Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| |
Collapse
|
2
|
Szuhany KL, Steinberg MH, McLaughlin NCR, Mancebo MC, Brown RA, Greenberg BD, Simon NM, Abrantes AM. Predictors of Long-Term Exercise Engagement in Patients With Obsessive-Compulsive Disorder: The Role of Physical Activity Enjoyment. Behav Ther 2023; 54:610-622. [PMID: 37330252 PMCID: PMC10279973 DOI: 10.1016/j.beth.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
Most U.S. adults, even more so those with psychiatric conditions like obsessive-compulsive disorder (OCD), do not engage in the recommended amount of physical activity (PA), despite the wide array of physical and mental health benefits associated with exercise. Therefore, it is essential to identify mechanistic factors that drive long-term exercise engagement so they can be targeted. Using the science of behavior change (SOBC) framework, this study examined potential predictors of long-term exercise engagement as a first step towards identifying modifiable mechanisms, in individuals with OCD, such as PA enjoyment, positive or negative affect, and behavioral activation. Fifty-six low-active patients (mean age = 38.8 ± 13.0, 64% female) with a primary diagnosis of OCD were randomized to either aerobic exercise (AE; n = 28) or health education (HE; n = 28), and completed measures of exercise engagement, PA enjoyment, behavioral activation, and positive and negative affect at baseline, postintervention, and 3-, 6-, and 12-month follow-up. Significant predictors of long-term exercise engagement up to 6-months postintervention were baseline PA (Estimate = 0.29, 95%CI [0.09, 0.49], p = .005) and higher baseline PA enjoyment (Estimate = 1.09, 95%CI [0.30, 1.89], p = .008). Change in PA enjoyment from baseline to postintervention was greater in AE vs. HE, t(44) = -2.06, p = .046, d = -0.61, but endpoint PA enjoyment did not predict follow-up exercise engagement above and beyond baseline PA enjoyment. Other hypothesized potential mechanisms (baseline affect or behavioral activation) did not significantly predict exercise engagement. Results suggest that PA enjoyment may be an important modifiable target mechanism for intervention, even prior to a formal exercise intervention. Next steps aligned with the SOBC framework are discussed, including examining intervention strategies to target PA enjoyment, particularly among individuals with OCD or other psychiatric conditions, who may benefit most from long-term exercise engagement's effects on physical and mental health.
Collapse
Affiliation(s)
| | | | - Nicole C R McLaughlin
- Alpert Medical School-Brown University; COBRE Center for Neuromodulation, Butler Hospital
| | | | | | - Benjamin D Greenberg
- Alpert Medical School-Brown University; COBRE Center for Neuromodulation, Butler Hospital; RR&D Center for Neurorestoration and Neurotechnology VA Providence Healthcare System
| | | | | |
Collapse
|
3
|
Mancebo MC, Yip AG, Boisseau CL, Rasmussen SA, Zlotnick C. Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center. Behav Ther 2021; 52:1296-1309. [PMID: 34452681 PMCID: PMC8629130 DOI: 10.1016/j.beth.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.
Collapse
Affiliation(s)
- Maria C. Mancebo
- Butler Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA,Corresponding Author: Maria C. Mancebo, Ph.D., Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906. Phone:401-455-6216 Fax:401-680-4122
| | | | - Christina L Boisseau
- Butler Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| |
Collapse
|
4
|
Chatterjee A, Zumpf K, Sprague J, Ciolino J, Wisner KL, Clark C, Mancebo MC, Eisen JL, Rasmussen SA, Boisseau CL. Impact of the peripartum period on the longitudinal course of obsessive-compulsive disorder. Arch Womens Ment Health 2021; 24:941-947. [PMID: 33884486 PMCID: PMC8059869 DOI: 10.1007/s00737-021-01134-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/13/2021] [Indexed: 01/02/2023]
Abstract
Some women are vulnerable to developing new onset obsessive-compulsive disorder (OCD) or having an exacerbation of pre-existing OCD during reproductive cycle events. Reports on the impact of the peripartum period on pre-existing OCD are inconsistent, with both worsening and improving symptom severity described. Studies have primarily been retrospective or have collected few data points, which limits the investigators' ability to capture the range of OCD symptoms during this time period, systematically and prospectively. The objective of this investigation was to add to the existing literature on the impact of the peripartum period on the course of pre-existing OCD. We conducted a secondary analysis of a subset data from the Brown Longitudinal Obsessive Compulsive Study, a prospective, observational study of OCD course. Nineteen women who experienced a pregnancy during the course of the study (9.5% of overall sample of women) were followed on average for 486 ± 133 weeks. Weekly psychiatric status ratings (PSRs) of OCD severity were compared between peripartum and non-peripartum periods. We found that the peripartum period did not significantly impact the course of OCD severity in the majority of women (N = 13, 69%). Of the minority of women with measurable variability in OCD symptoms, no statistically significant difference in PSR scores was observed between peripartum and non-peripartum periods. In this novel yet small dataset, the severity of OCD does not appear to worsen for most women during the peripartum period.
Collapse
Affiliation(s)
- Aparna Chatterjee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Meridian Psychiatric Partners, Chicago, IL, USA.
| | - Katelyn Zumpf
- grid.16753.360000 0001 2299 3507Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Jennifer Sprague
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA ,grid.413330.60000 0004 0435 6194Advocate Illinois Masonic Medical Center, Chicago, IL USA
| | - Jody Ciolino
- grid.16753.360000 0001 2299 3507Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Katherine L. Wisner
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Crystal Clark
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Maria C. Mancebo
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Chicago, IL USA ,grid.273271.20000 0000 8593 9332Butler Hospital, Providence, RI USA
| | - Jane L. Eisen
- grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA ,grid.240206.20000 0000 8795 072XMcLean Hospital, Belmont, MA USA
| | - Steven A. Rasmussen
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Chicago, IL USA
| | - Christina L. Boisseau
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| |
Collapse
|
5
|
Brown LA, Wakschal E, Russman-Block S, Boisseau CL, Mancebo MC, Eisen JL, Rasmussen SA. Directionality of change in obsessive compulsive disorder (OCD) and suicidal ideation over six years in a naturalistic clinical sample ✰. J Affect Disord 2019; 245:841-847. [PMID: 30699868 PMCID: PMC6361538 DOI: 10.1016/j.jad.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/17/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is associated with elevated suicide risk, but the directionality of the association between OCD severity and suicidal ideation has not been established, which was the goal of this study. METHODS Participants (n = 325) were adults with either a current or past diagnosis of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) OCD who were assessed annually for suicidal ideation and OCD symptom severity for six years. Cross-lagged panel analyses statistically compared unidirectional and bidirectional models over time. Serious suicide-related adverse events were reported. RESULTS The best-fitting and most parsimonious model included paths predicting suicidal ideation from OCD symptom severity, but not vice versa. These results were confirmed by comparing a model with cross-lagged paths constrained equal to a freely estimated model. Higher OCD symptom severity in a given year was associated with a higher suicidal ideation severity in the subsequent year. Five suicide-related adverse events were reported throughout the duration of the study, including two suicide deaths and three suicide attempts. LIMITATIONS The study relied on a single-item, annual measure of suicidal ideation in adults, with substantial variability in severity of suicide risk, and missing data increased with later observations in the study. DISCUSSION OCD symptom severity predicted next year suicidal ideation severity. In contrast, suicidal ideation severity in a given year did not predict next-year OCD symptom severity in this OCD sample. Thus, rather than waiting for suicidal ideation to resolve, clinicians should consider providing empirically supported treatments for OCD.
Collapse
Affiliation(s)
- Lily A. Brown
- University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA,Corresponding author information: Lily A. Brown, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North Philadelphia, PA 19104; 215-746-3346; Fax: 215-746-3311;
| | - Emily Wakschal
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Stefanie Russman-Block
- Warren Alpert Medical School of Brown University, Providence RI, USA,Michigan State University, East Lansing, MI, USA
| | - Christina L. Boisseau
- Warren Alpert Medical School of Brown University, Providence RI, USA,Butler Hospital, Providence RI, USA
| | - Maria C. Mancebo
- Warren Alpert Medical School of Brown University, Providence RI, USA,Butler Hospital, Providence RI, USA
| | | | | |
Collapse
|
6
|
Boisseau CL, Sibrava NJ, Garnaat SL, Mancebo MC, Eisen JL, Rasmussen SA. The Brown Incompleteness Scale (BINCS): Measure development and initial evaluation. J Obsessive Compuls Relat Disord 2018; 16:66-71. [PMID: 29750139 PMCID: PMC5937536 DOI: 10.1016/j.jocrd.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years, incompleteness has received increased clinical attention as a core motivation underlying obsessive-compulsive spectrum disorders. Yet, assessment of incompleteness has relied almost exclusively on self-report and has assumed a unitary conceptualization of this phenomenon. Therefore, we sought to develop and validate a new multi-faceted clinician-administered measure of incompleteness. The Brown Incompleteness Scale (BINCS) consists of 21 items; each rated on a 5-point scale, with higher scores indicating a greater degree of incompleteness. The current study describes the measure's development and preliminary validation. METHODS The scale was administered to 100 consecutive participants who were part of a longitudinal follow-up study of OCD. The reliability, validity, and factor analytic structure of the scale were evaluated. RESULTS Exploratory factor analysis supported a two-factor solution, which can best be described as representing both behavioral and sensory manifestations of incompleteness. CONCLUSIONS The BINCS demonstrated strong internal consistency as well as convergent and divergent validity. This clinician-administered scale will provide a more comprehensive clinical assessment of patients with incompleteness.
Collapse
Affiliation(s)
- Christina L. Boisseau
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
| | - Nicholas J. Sibrava
- Department of Psychology, Baruch College – The City University of New York, NY, United States
| | - Sarah L. Garnaat
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
| | - Maria C. Mancebo
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
| | - Jane L. Eisen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Psychiatry, Icahn School of Medicine, New York, NY, United States
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| |
Collapse
|
7
|
Ojserkis R, Boisseau CL, Reddy MK, Mancebo MC, Eisen JL, Rasmussen SA. The impact of lifetime PTSD on the seven-year course and clinical characteristics of OCD. Psychiatry Res 2017; 258:78-82. [PMID: 28988123 PMCID: PMC5681424 DOI: 10.1016/j.psychres.2017.09.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/12/2017] [Accepted: 09/17/2017] [Indexed: 02/06/2023]
Abstract
Research has suggested that the co-occurrence of PTSD in individuals with OCD is associated with more severe symptoms and less responsivity to empirically supported treatment as compared to individuals with OCD and no history of PTSD. However, much of this work has been limited by non-empirical case report design, cross-sectional and retrospective analyses, or small sample sizes. The current study extended this research by comparing the clinical characteristics of individuals with OCD with and without a lifetime PTSD diagnosis in a large, naturalistic, longitudinal sample over the course of seven years. At baseline, individuals with comorbid lifetime PTSD reported significantly more severe symptoms of OCD (including symptom levels and insight), lower quality of life, and higher rates of comorbid lifetime mood and substance use disorders than participants without lifetime PTSD. Further, individuals with comorbid OCD and lifetime PTSD reported significantly more severe OCD symptoms over the course of seven years than those without lifetime PTSD. These results are largely consistent with the existing literature and support the need to consider PTSD symptoms in the assessment and treatment of OCD.
Collapse
Affiliation(s)
- Rachel Ojserkis
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA.
| | - Christina L Boisseau
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA
| | - Madhavi K Reddy
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; McGovern Medical School, The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, USA
| | - Maria C Mancebo
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA
| | - Jane L Eisen
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; Mount Sinai St. Luke's/Mount Sinai West, Department of Psychiatry, 1090 Amsterdam Avenue, New York, NY 10025, USA
| | - Steven A Rasmussen
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA
| |
Collapse
|
8
|
Medeiros GC, Torres AR, Boisseau CL, Leppink EW, Eisen JL, Fontenelle LF, do Rosário MC, Mancebo MC, Rasmussen SA, Ferrão YA, Grant JE. A cross-cultural clinical comparison between subjects with obsessive-compulsive disorder from the United States and Brazil. Psychiatry Res 2017; 254:104-111. [PMID: 28457988 PMCID: PMC5517316 DOI: 10.1016/j.psychres.2017.04.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/12/2017] [Indexed: 11/18/2022]
Abstract
Although OCD is a global problem, the literature comparing, in a direct and standardized way, the manifestations across countries is scarce. Therefore, questions remain as to whether some important clinical findings are replicable worldwide, especially in the developing world. The objective of this study was to perform a clinical comparison of OCD patients recruited in the United States (U.S.) and Brazil. Our sample consisted of 1187 adult, treatment-seeking OCD outpatients from the U.S. (n=236) and Brazil (n=951). With regards to the demographics, U.S. participants with OCD were older, more likely to identify as Caucasian, had achieved a higher educational level, and were less likely to be partnered when compared to Brazilians. Concerning the clinical variables, after controlling for demographics the two samples presented largely similar profiles. Brazilian participants with OCD, however, endorsed significantly greater rates of generalized anxiety disorder and post-traumatic stress disorder, whereas U.S. subjects were significantly more likely to endorse a lifetime history of addiction (alcohol-use and substance-use disorders). This is the largest direct cross-cultural comparison to date in the OCD field. Our results provide much needed insight regarding the development of culture-sensitive treatments.
Collapse
Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States of America.
| | - Albina R Torres
- Botucatu Medical School-São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Christina L Boisseau
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Eric W Leppink
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States of America
| | - Jane L Eisen
- Department of Psychiatry, Mount Sinai St. Lukes/Mount Sinai West, New York, NY, United States of America
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro (RJ), Brazil
| | - Maria C do Rosário
- Department of Psychiatry and Psychology, Federal University of São Paulo, São Paulo (SP), Brazil
| | - Maria C Mancebo
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Steven A Rasmussen
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Ygor A Ferrão
- Porto Alegre Health Sciences Federal University, Rio Grande do Sul, Porte Alegre/RS, Brazil
| | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States of America
| |
Collapse
|
9
|
Boisseau CL, Schwartzman CM, Lawton J, Mancebo MC. App-guided exposure and response prevention for obsessive compulsive disorder: an open pilot trial. Cogn Behav Ther 2017; 46:447-458. [PMID: 28565937 DOI: 10.1080/16506073.2017.1321683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Although effective treatments for obsessive-compulsive disorder (OCD) exist, there are significant barriers to receiving evidence-based care. Mobile health applications (Apps) offer a promising way of overcoming these barriers by increasing access to treatment. The current study investigated the feasibility, acceptability, and preliminary efficacy of LiveOCDFree, an App designed to help OCD patients conduct exposure and response prevention (ERP). Twenty-one participants with mild to moderate symptoms of OCD were enrolled in a 12-week open trial of App-guided self-help ERP. Self-report assessments of OCD, depression, anxiety, and quality of life were completed at baseline, mid-treatment, and post-treatment. App-guided ERP was a feasible and acceptable self-help intervention for individuals with OCD, with high rates of retention and satisfaction. Participants reported significant improvement in OCD and anxiety symptoms pre- to post-treatment. Findings suggest that LiveOCDFree is a feasible and acceptable self-help intervention for OCD. Preliminary efficacy results are encouraging and point to the potential utility of mobile Apps in expanding the reach of existing empirically supported treatments.
Collapse
Affiliation(s)
- Christina L Boisseau
- a Department of Psychiatry and Human Behavior , Warren Alpert Medical School of Brown University , Providence , RI , USA.,b Butler Hospital , 345 Blackstone Boulevard, Providence , RI 02906 , USA
| | | | - Jessica Lawton
- b Butler Hospital , 345 Blackstone Boulevard, Providence , RI 02906 , USA
| | - Maria C Mancebo
- a Department of Psychiatry and Human Behavior , Warren Alpert Medical School of Brown University , Providence , RI , USA.,b Butler Hospital , 345 Blackstone Boulevard, Providence , RI 02906 , USA
| |
Collapse
|
10
|
Schwartzman CM, Boisseau CL, Sibrava NJ, Mancebo MC, Eisen JL, Rasmussen SA. Symptom subtype and quality of life in obsessive-compulsive disorder. Psychiatry Res 2017; 249:307-310. [PMID: 28152463 PMCID: PMC5526338 DOI: 10.1016/j.psychres.2017.01.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 10/31/2016] [Accepted: 01/06/2017] [Indexed: 11/17/2022]
Abstract
Quality of life (QoL) is significantly impaired in OCD across several facets of life, such as social, occupational, and family functioning, subjective sense of well-being, and enjoyment of leisure activities. The present study examined the relationship between 5 symptom subtypes of OCD (contamination, symmetry, hoarding, overresponsibility for harm, and taboo) and QoL. Participants were 325 adults with OCD enrolled in the Brown Longitudinal Obsessive Compulsive Study. Hierarchical linear regression analyses indicated hoarding, contamination, symmetry, and overresponsibility for harm were associated with impairment in household functioning, enjoyment of leisure activities, social relationships, and physical health. The implications of these findings are discussed.
Collapse
Affiliation(s)
| | - Christina L Boisseau
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
| | - Nicholas J Sibrava
- Department of Psychology, Baruch College - The City University of New York, New York, NY, USA
| | - Maria C Mancebo
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Jane L Eisen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Psychiatry, Mount Sinai St. Luke's/Mount Sinai West, New York, NY, USA
| | - Steven A Rasmussen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
11
|
Francazio SK, Flessner CA, Boisseau CL, Sibrava NJ, Mancebo MC, Eisen JL, Rasmussen SA. Parental Accommodation Predicts Symptom Severity at Long-term Follow-Up in Children with Obsessive-Compulsive Disorder. J Child Fam Stud 2016; 25:2562-2570. [PMID: 28989268 PMCID: PMC5627772 DOI: 10.1007/s10826-016-0408-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pediatric obsessive-compulsive disorder (OCD) is a chronic condition affecting millions of children. Though well intentioned, accommodation (i.e., a parent's attempt to assuage their child's distress and anxiety) is thought to increase OCD symptom severity and may cause greater OCD-related impairment. The present study sought to examine the relative contribution of parental accommodation in predicting OCD symptom severity. Children between the ages of 6 and 18 (and their parents) participated in a prospective, longitudinal study investigating the course of pediatric OCD utilizing a longitudinal design. Data was collected at intake (n = 30) and two-years (n = 22) post-intake controlling for age, anxiety and depression. Parental accommodation (measured at intake) significantly predicted OCD symptom severity and was the strongest predictor at both intake and two-year follow-up. These preliminary findings highlight the importance of further research seeking to delineate factors relevant to the development and maintenance of accommodation as well as parent-level variables that might mediate the relationship between accommodation and OCD symptom severity.
Collapse
Affiliation(s)
| | | | - Christina L. Boisseau
- Butler Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Nicholas J. Sibrava
- Butler Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Maria C. Mancebo
- Butler Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Jane L. Eisen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| |
Collapse
|
12
|
Sibrava NJ, Boisseau CL, Eisen JL, Mancebo MC, Rasmussen SA. An empirical investigation of incompleteness in a large clinical sample of obsessive compulsive disorder. J Anxiety Disord 2016; 42:45-51. [PMID: 27268401 PMCID: PMC5003676 DOI: 10.1016/j.janxdis.2016.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 03/17/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
Obsessive Compulsive Disorder (OCD) is a disorder with heterogeneous clinical presentations. To advance our understanding of this heterogeneity we investigated the prevalence and clinical features associated with incompleteness (INC), a putative underlying core feature of OCD. We predicted INC would be prominent in individuals with OCD and associated with greater severity and impairment. We examined the impact of INC in 307 adults with primary OCD. Participants with clinically significant INC (22.8% of the sample) had significantly greater OCD severity, greater rates of comorbidity, poorer ratings of functioning, lower quality of life, and higher rates of unemployment and disability. Participants with clinically significant INC were also more likely to be diagnosed with OCPD and to endorse symmetry/exactness obsessions and ordering/arranging compulsions than those who reported low INC. Our findings provide evidence that INC is associated with greater severity, comorbidity, and impairment, highlighting the need for improved assessment and treatment of INC in OCD.
Collapse
Affiliation(s)
- Nicholas J. Sibrava
- Baruch College – The City University of New York, New York, NY,Alpert Medical School of Brown University, Providence, RI
| | - Christina L. Boisseau
- Alpert Medical School of Brown University, Providence, RI,Butler Hospital, Providence, RI
| | - Jane L. Eisen
- Alpert Medical School of Brown University, Providence, RI
| | - Maria C. Mancebo
- Alpert Medical School of Brown University, Providence, RI,Butler Hospital, Providence, RI
| | | |
Collapse
|
13
|
Garnaat SL, Boisseau CL, Yip A, Sibrava NJ, Greenberg BD, Mancebo MC, McLaughlin NC, Eisen JL, Rasmussen SA. Predicting course of illness in patients with severe obsessive-compulsive disorder. J Clin Psychiatry 2015; 76:e1605-10. [PMID: 26717540 PMCID: PMC4989860 DOI: 10.4088/jcp.14m09468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Few data are available to inform clinical expectations about course and prognosis of severe obsessive-compulsive disorder (OCD). Such information is necessary to guide clinicians and to inform criteria for invasive interventions for severe and intractable OCD. This study sought to examine course and prospective predictors of a chronic course in patients with severe OCD over 5 years. METHOD A selected subset of adults in the Brown Longitudinal Obsessive-Compulsive Study (BLOCS) was included. Adult BLOCS participants were enrolled between 2001 and 2006. All participants in the current study (N = 113) had DSM-IV OCD diagnosis, severe OCD symptoms at baseline, and at least 1 year of follow-up data. RESULTS Cox proportional hazard models were used to examine the general pattern of course in the severe OCD sample based on Longitudinal Interval Follow-Up Evaluation (LIFE) psychiatric status ratings, as well as test predictors of chronically severe course. Results indicated that approximately half of patients with severe OCD at baseline had illness drop to a moderate or lower range of severity during 5 years of follow-up (50.4%) and that marked improvement was rare after 3 years of severe illness. The only unique predictor of a more chronically severe course was patient report of ever having been housebound for a week or more due to OCD symptoms (P < .05). CONCLUSIONS Findings of this study were 3-fold: (1) half of participants with severe OCD have symptom improvement over 5 years of follow-up, (2) the majority of participants that drop out of the severe range of symptom severity do so within the first 3 years of follow-up, and (3) patient-reported history of being housebound for 1 week or more due to OCD is a significant predictor of OCD's remaining severe over the 5-year follow-up.
Collapse
Affiliation(s)
- Sarah L. Garnaat
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Christina L. Boisseau
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Agustin Yip
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicholas J. Sibrava
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin D. Greenberg
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Maria C. Mancebo
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole C.R. McLaughlin
- Butler Hospital, Providence, RI, USA,Alpert Medical School of Brown University, Providence, RI, USA
| | - Jane L. Eisen
- Alpert Medical School of Brown University, Providence, RI, USA
| | | |
Collapse
|
14
|
Grant JE, Mancebo MC, Mooney ME, Eisen JL, Rasmussen SA. Longitudinal course of body-focused repetitive behaviors in obsessive-compulsive disorder. Ann Clin Psychiatry 2015; 27:185-91. [PMID: 26247217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The course of body-focused repetitive behaviors (BFRBs) (eg, trichotillomania, skin picking, and nail biting) has received scant research attention. We sought to understand the longitudinal course of BFRBs over an 8-year period and whether the co-occurrence of a BFRB with obsessive-compulsive disorder (OCD) affects the course of OCD. METHODS Three hundred ninety-five participants with OCD completed annual interviews using the Longitudinal Interval Follow-up Evaluation to estimate BFRB and OCD symptom severity during each week of follow-up. RESULTS Of the 395 participants, 83 (21%) had a co-occurring BFRB. In almost one-half of the participants, BFRB onset occurred before OCD. Participants with OCD and BFRB spent the majority of the rating period experiencing full BFRB symptoms. Having a BFRB was associated with spending less time in remission from OCD. CONCLUSIONS Although BFRBs have long been known to be common in individuals with OCD, these data demonstrate that most individuals who have a co-occurring BFRB with OCD do not experience BFRB remission and that having a BFRB predicts a worse course for OCD.
Collapse
Affiliation(s)
- Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA. E-mail:
| | | | | | | | | |
Collapse
|
15
|
Mancebo MC, Boisseau CL, Garnaat SL, Eisen JL, Greenberg BD, Sibrava NJ, Stout RL, Rasmussen SA. Long-term course of pediatric obsessive-compulsive disorder: 3 years of prospective follow-up. Compr Psychiatry 2014; 55:1498-504. [PMID: 24952937 PMCID: PMC4624317 DOI: 10.1016/j.comppsych.2014.04.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/11/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study assesses the long-term course of treatment-seeking youth with a primary diagnosis of DSM-IV OCD. METHOD Sixty youth and their parents completed intake interviews and annual follow-up interviews for 3 years using the youth version of the Longitudinal Interval Follow-up Evaluation (Y-LIFE) and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Remission was defined as no longer meeting DSM-IV criteria for OCD for 8 weeks or more, and recurrence was defined as meeting full criteria for OCD for 4 consecutive weeks after having achieved symptom remission. Remission rates for youth were compared to rates of adults participating in the same study. RESULTS The probability of achieving partial remission of OCD was 0.53 and the probability of achieving full remission was 0.27. Among the 24 youth participants who achieved remission, 79% stayed in remission throughout the study (mean of 88 weeks of follow-up) and 21% experienced a recurrence of symptoms. Better functioning at intake and a shorter latency to initial OCD treatment were associated with faster onset of remission (P<.001). CONCLUSIONS Remission is more likely among youth versus adults with OCD. Treatment early in the course of illness and before substantial impact on functioning predicted a better course.
Collapse
Affiliation(s)
- Maria C Mancebo
- Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
| | - Christina L Boisseau
- Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Sarah L Garnaat
- Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Jane L Eisen
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin D Greenberg
- Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Nicholas J Sibrava
- Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Robert L Stout
- Alpert Medical School of Brown University, Providence, RI, USA; Pacific Institute for Research and Evaluation, Calverton, MD, USA
| | - Steven A Rasmussen
- Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| |
Collapse
|
16
|
Pardue CM, Sibrava NJ, Boisseau CL, Mancebo MC, Eisen JL, Rasmussen SA. Differential Parental Influence in the Familial Aggregation of Obsessive Compulsive Disorder. J Obsessive Compuls Relat Disord 2014; 3:215-219. [PMID: 25068099 PMCID: PMC4110208 DOI: 10.1016/j.jocrd.2014.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The familial nature of OCD has been well established. Clinical characteristics such as early age of onset, comorbidity with tic disorders, and higher rates of symmetry symptoms have been associated with the familial aggregation of OCD, though little research has examined the differential impact of paternal and maternal OCD. The current study explored parental influence on the expression of these characteristics and reports on 310 probands diagnosed with OCD as well as 1,580 of their biological first-degree relatives. The probands were evaluated by trained clinical raters using semi-structured assessments, and relative diagnoses were obtained based on probands' reports. Similar to previous findings, 10.13% of the 1,580 relatives (n = 160) were reported to have significant OCD symptoms. Only probands who reported having a father with OCD, rather than any first-degree relative, were more likely to have an early age of onset, symmetry and exactness obsessions, and higher rates of comorbidity. No significant differences were found with respect to the probands who reported their mothers as having OCD. These findings suggest that paternal OCD, rather than simply any first-degree relative having OCD, may influence whether probands exhibit the clinical characteristics commonly associated with the familial subtype of OCD.
Collapse
Affiliation(s)
| | - Nicholas J. Sibrava
- Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christina L. Boisseau
- Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Maria C. Mancebo
- Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jane L. Eisen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
17
|
Odlaug BL, Weinhandl E, Mancebo MC, Mortensen EL, Eisen JL, Rasmussen SA, Schreiber LRN, Grant JE. Excluding the typical patient: thirty years of pharmacotherapy efficacy trials for obsessive-compulsive disorder. Ann Clin Psychiatry 2014; 26:39-46. [PMID: 24501729 PMCID: PMC4236296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Over the past 30 years, clinical trials have resulted in several successful pharmacotherapies for obsessive-compulsive disorder (OCD), yet patients in clinical settings often report inadequate response. This study compares clinical characteristics of treatment-seeking OCD patients to the inclusion/exclusion criteria used in pharmacotherapy trials. METHODS The sample consisted of 325 community members with a DSM-IV diagnosis of OCD who underwent systematic interviews with clinicians knowledgeable in the diagnosis and treatment of OCD. We compiled pharmacotherapy studies for OCD published between 1980 and 2010 using Medline, PubMed, and library resources, and estimated the proportion of patients in each decade satisfying the most common inclusion/exclusion criteria. RESULTS We included 39 clinical trials and found 72% of the 325 patients would have been excluded from trials conducted between 1980 and 2010. Exclusion was projected as dramatically lower for trials conducted between 1980 and 1989 (19.7%) compared with 74.8% for trials conducted between 1990 and 1999 and 76.9% for trials between 2000 and 2010. CONCLUSIONS The majority of treatment-seeking individuals with OCD would not qualify for OCD treatment studies due to comorbid psychiatric disorders, and failure to meet OCD severity threshold criteria. This illustrates the need to include a more community-representative sample of OCD patients in clinical trials examining pharmacotherapy efficacy.
Collapse
Affiliation(s)
- Brian L Odlaug
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Garnaat SL, Greenberg BD, Sibrava NJ, Goodman WK, Mancebo MC, Eisen JL, Rasmussen SA. Who qualifies for deep brain stimulation for OCD? Data from a naturalistic clinical sample. J Neuropsychiatry Clin Neurosci 2014; 26:81-6. [PMID: 24515679 PMCID: PMC4093791 DOI: 10.1176/appi.neuropsych.12090226] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A few patients with obsessive-compulsive disorder (OCD) remain severely impaired despite exhausting best-practice treatments. For them, neurosurgery (stereotactic ablation or deep brain stimulation) might be considered. The authors investigated the proportion of treatment-seeking OCD patients, in a naturalistic clinical sample, who met contemporary neurosurgery selection criteria. Using comprehensive baseline data on diagnosis, severity, and treatment history for adult patients from the NIMH-supported Brown Longitudinal OCD Study, only 2 of 325 patients met screening criteria for neurosurgery. This finding prompts consideration of new models for clinical trials with limited samples as well as methods of refining entry criteria for such invasive treatments.
Collapse
Affiliation(s)
- Sarah L. Garnaat
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - Benjamin D. Greenberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA
- Butler Hospital, Providence, RI 02906, USA
| | - Nicholas J. Sibrava
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA
- Butler Hospital, Providence, RI 02906, USA
| | - Wayne K. Goodman
- Department of Psychiatry, Mt. Sinai Hospital, New York, NY 10029, USA
| | - Maria C. Mancebo
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA
- Butler Hospital, Providence, RI 02906, USA
| | - Jane L. Eisen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA
- Butler Hospital, Providence, RI 02906, USA
| |
Collapse
|
19
|
Eisen JL, Sibrava NJ, Boisseau CL, Mancebo MC, Stout RL, Pinto A, Rasmussen SA. Five-year course of obsessive-compulsive disorder: predictors of remission and relapse. J Clin Psychiatry 2013; 74:233-9. [PMID: 23561228 PMCID: PMC3899346 DOI: 10.4088/jcp.12m07657] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 10/04/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a heterogeneous and disabling condition; however, no studies have examined symptom categories or subtypes as predictors of long-term clinical course in adults with primary OCD. METHOD A total of 213 adults with DSM-IV OCD were recruited from several mental health treatment sites between July 2001 and February 2006 as part of the Brown Longitudinal Obsessive Compulsive Study, a prospective, naturalistic study of treatment-seeking adults with primary OCD. OCD symptoms were assessed annually over the 5-year follow-up period using the Longitudinal Interval Follow-Up Evaluation. RESULTS Thirty-nine percent of participants experienced either a partial (22.1%) or a full (16.9%) remission. Two OCD symptom dimensions impacted remission. Participants with primary obsessions regarding overresponsibility for harm were nearly twice as likely to experience a remission (P < .05), whereas only 2 of 21 participants (9.5%) with primary hoarding achieved remission. Other predictors of increased remission were lower OCD severity (P < .0001) and shorter duration of illness (P < .0001). Fifty-nine percent of participants who remitted subsequently relapsed. Participants with obsessive-compulsive personality disorder were more than twice as likely to relapse (P < .005). Participants were also particularly vulnerable to relapse if they experienced partial remission versus full remission (70% vs 45%; P < .05). CONCLUSIONS The contributions of OCD symptom categories and comorbid obsessive-compulsive personality disorder are critically important to advancing our understanding of the prognosis and ultimately the successful treatment of OCD. Longer duration of illness was also found to be a significant predictor of course, highlighting the critical importance of early detection and treatment of OCD. Furthermore, having full remission as a treatment target is an important consideration for the prevention of relapse in this disorder.
Collapse
|
20
|
Sibrava NJ, Boisseau CL, Mancebo MC, Eisen JL, Rasmussen SA. Prevalence and clinical characteristics of mental rituals in a longitudinal clinical sample of obsessive-compulsive disorder. Depress Anxiety 2011; 28:892-8. [PMID: 21818825 PMCID: PMC3188668 DOI: 10.1002/da.20869] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 06/06/2011] [Accepted: 06/15/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a chronic and debilitating anxiety disorder associated with significant impairment in quality of life and functioning. Research examining the differences in clinical correlates and treatment response associated with different obsessions in OCD has yielded important findings underscoring the heterogeneous nature of this disorder. To date, most of this research has focused on differences associated with primary obsessions, and little attention has been paid to the clinical utility of studying how compulsive symptoms affect clinical course. Virtually no systematic research has explored the clinical characteristics of one understudied symptom presentation, mental rituals, and what impact this primary symptom has on severity and course of illness. Mental rituals, or compulsions without overt signs, represent unique clinical challenges but often go understudied for numerous methodological and clinical reasons. METHODS In this study, we explored the impact of primary mental rituals on clinical severity and chronicity in a large, longitudinal sample of OCD patients (N = 225) over 4 years. RESULTS Mental rituals were a primary presenting symptom for a sizable percentage of the sample (12.9%). Primary mental rituals were associated with greater clinical severity and lower functioning at intake, as well as a more chronic course of illness, as participants with primary mental rituals spent nearly 1 year longer in full DSM-IV criteria episodes over the 4-year follow-up interval than OCD patients without mental rituals. CONCLUSIONS These results suggest that mental rituals are uniquely impairing and highlight the need for further empirical exploration and consideration in treatment.
Collapse
Affiliation(s)
- Nicholas J. Sibrava
- Corresponding Author: Alpert Medical School of Brown University, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, Phone: 401.455.6484 Fax: 401.455.6442,
| | | | | | | | | |
Collapse
|
21
|
Mancebo MC, Eisen JL, Sibrava NJ, Dyck IR, Rasmussen SA. Patient utilization of cognitive-behavioral therapy for OCD. Behav Ther 2011; 42:399-412. [PMID: 21658523 PMCID: PMC3857709 DOI: 10.1016/j.beth.2010.10.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 10/27/2010] [Accepted: 10/27/2010] [Indexed: 11/19/2022]
Abstract
The current study examined utilization of cognitive-behavioral therapy (CBT) by individuals receiving treatment for obsessive-compulsive disorder (OCD). Participants were 202 adults with primary DSM-IV OCD who enrolled in a longitudinal, observational study of the course of OCD and completed 2 years of annual follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. One hundred twenty participants reported that a mental health professional recommended CBT for their OCD symptoms at some point during the 2-year follow-up period. One quarter (n = 31) of these participants did not initiate CBT despite receiving a treatment recommendation. Thirty-one percent of the 89 participants who entered CBT endorsed dropping out of CBT prematurely and less than one third received an adequate "dose" of CBT sessions. Self-reported CBT drop-out rates were significantly greater than attrition rates reported in clinical trials using intensive schedules of exposure and ritual prevention (EX/RP). Perceived environmental barriers and fears regarding treatment participation were the most frequently endorsed reasons for not participating or dropping out of CBT. Despite its efficacy for OCD, many individuals with clinically significant symptoms fail to initiate CBT when recommended by a mental health professional, receive treatments that are less intensive than those used in clinical trials, or drop out of treatment prematurely. Financial costs of CBT, difficulty attending sessions, and fears regarding treatment are significant barriers to initiating and completing therapy.
Collapse
Affiliation(s)
- Maria C Mancebo
- Butler Hospital, Brown University Medical School, Providence, RI 02906, USA.
| | | | | | | | | |
Collapse
|
22
|
Eisen JL, Pinto A, Mancebo MC, Dyck IR, Orlando ME, Rasmussen SA. A 2-year prospective follow-up study of the course of obsessive-compulsive disorder. J Clin Psychiatry 2010; 71:1033-9. [PMID: 20797381 PMCID: PMC4083757 DOI: 10.4088/jcp.08m04806blu] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Accepted: 07/10/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surprisingly little is known about the long-term course of obsessive-compulsive disorder (OCD). This prospective study presents 2-year course findings, as well as predictors of course, from the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the observational course of OCD in a large clinical sample. METHOD The sample included 214 treatment-seeking adults with DSM-IV OCD at intake who identified OCD as the most problematic disorder over their lifetime. Subjects were enrolled from 2001-2004. At annual interviews, data on weekly OCD symptom status were obtained using the Longitudinal Interval Follow-Up Evaluation. Probabilities of full remission and partial remission over the first 2 years of collected data and potential predictors of remission were examined. RESULTS The probability of full remission from OCD was 0.06, and the probability of partial remission was 0.24. Of the 48 subjects whose OCD symptoms partially or fully remitted, only 1 relapsed within the first 2 years. Earlier age at onset of OCD, greater severity of symptoms at intake, older age at intake, and being male were associated with a decreased likelihood of remission. Insight, diagnostic comorbidity, and treatment were not found to be associated with the likelihood of achieving full or partial remission. CONCLUSIONS Though one-quarter of the sample had periods of subclinical OCD symptoms during the prospective period, full remission was rare, consistent with the view of OCD as a chronic and persistent illness. Age at onset, OCD symptom severity, current age, and sex emerged as potent predictors of course.
Collapse
Affiliation(s)
- Jane L Eisen
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
| | | | | | | | | | | |
Collapse
|
23
|
Abrantes AM, Strong DR, Cohn A, Cameron AY, Greenberg BD, Mancebo MC, Brown RA. Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder. J Anxiety Disord 2009; 23:923-7. [PMID: 19616916 DOI: 10.1016/j.janxdis.2009.06.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 06/02/2009] [Accepted: 06/05/2009] [Indexed: 11/30/2022]
Abstract
Aerobic exercise can acutely influence anxious and depressive mood in both clinical and nonclinical populations. However, there are no existing studies that have examined the acute effect of exercise on mood, anxiety, obsessions, and compulsions in patients with OCD. The primary aim of this study was to examine acute changes in these symptoms after engaging in single exercise sessions during a 12-week exercise intervention for 15 (53% female; mean age=41.9 years) patients with OCD. Participants reported reductions in negative mood, anxiety, and OCD symptoms at the end of each exercise session relative to the beginning. Changes in the magnitude of the effect of exercise in reducing negative mood and anxiety remained fairly stable while levels of self-reported obsessions and compulsions decreased over the duration of the intervention. Results of this study point toward the promising effect of exercise for acute symptom reduction in patients with OCD.
Collapse
Affiliation(s)
- Ana M Abrantes
- Butler Hospital/Alpert Medical School of Brown University, Providence, RI 02906, USA.
| | | | | | | | | | | | | |
Collapse
|
24
|
Mancebo MC, Garcia AM, Pinto A, Freeman JB, Przeworski A, Stout R, Kane JS, Eisen JL, Rasmussen SA. Juvenile-onset OCD: clinical features in children, adolescents and adults. Acta Psychiatr Scand 2008; 118:149-59. [PMID: 18699949 PMCID: PMC2705172 DOI: 10.1111/j.1600-0447.2008.01224.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine clinical correlates of juvenile-onset OCD across the lifespan. METHOD Data collected at the intake interview from 257 consecutive participants with juvenile-onset OCD (20 children, 44 adolescents and 193 adults) in a naturalistic study of the clinical course of OCD were examined. Participants and parents of juvenile participants completed a structured diagnostic interview, rater-administered severity measures and self-report questionnaires. RESULTS Children and adolescents (i.e. juveniles) shared similar features with the exception of age at onset and OCD symptom expression. Clinically meaningful differences between juvenile and adult participants were also found. Compared with adults, juveniles were more likely to be male, recall an earlier age at OCD onset and have different lifetime comorbidity patterns. CONCLUSION Juvenile-onset OCD symptom expression is remarkably similar across the lifespan. However, findings also suggest clinically meaningful differences between juveniles and adults. Future work using a prospective design will improve our understanding of course patterns of juvenile-onset OCD.
Collapse
Affiliation(s)
- Maria C. Mancebo
- Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, RI
| | - Abbe M. Garcia
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, RI,Bradley/Hasbro Research Center, Providence, RI
| | - Anthony Pinto
- Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, RI
| | - Jennifer B. Freeman
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, RI,Bradley/Hasbro Research Center, Providence, RI
| | - Amy Przeworski
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, RI,Bradley/Hasbro Research Center, Providence, RI
| | - Robert Stout
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, RI
| | - Joshua S. Kane
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, RI
| | - Jane L. Eisen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, RI
| | - Steven A. Rasmussen
- Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, RI
| |
Collapse
|
25
|
Abstract
OBJECTIVE The current study examined the validity of using comorbid obsessive-compulsive personality disorder (OCPD) to identify a subtype of individuals with obsessive-compulsive disorder (OCD). METHOD Data for the current study were drawn from an ongoing, longitudinal study of the course of OCD and include intake assessments for 238 subjects with primary and current DSM-IV OCD who were treatment seeking. RESULTS More than one fourth of the subjects (N=65, 27%) met criteria for comorbid OCPD. As compared to OCD-OCPD subjects, the OCD+OCPD subjects had a significantly younger age at onset of first OC symptoms (p=0.013), and a higher rate of symmetry and hoarding obsessions, and cleaning, ordering, repeating, and hoarding compulsions (all p's<0.01). Individuals with OCD+OCPD had higher rates of comorbid anxiety disorders (p=0.007) and avoidant personality disorder (p=0.006). The OCD+OCPD subjects also had significantly lower ratings of global functioning (p=0.001) and more impaired social functioning (p=0.004), despite a lack of significant differences on overall severity of OCD symptoms. CONCLUSIONS Our findings indicate that individuals with both OCD and OCPD have distinct clinical characteristics in terms of age at onset of initial OC symptoms, the types of obsessions and compulsions they experience, and psychiatric comorbidity. Our findings, coupled with data from family studies showing a higher than expected frequency of OCPD in first degree relatives of OCD probands, suggest that OCD associated with OCPD may represent a specific subtype of OCD. Additional research is warranted to further establish the validity of this subtype.
Collapse
|
26
|
Mancebo MC, Greenberg B, E.Grant J, Pinto A, Eisen JL, Dyck I, Rasmussen SA. Correlates of occupational disability in a clinical sample of obsessive-compulsive disorder. Compr Psychiatry 2008; 49:43-50. [PMID: 18063040 PMCID: PMC2211449 DOI: 10.1016/j.comppsych.2007.05.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 02/20/2007] [Accepted: 05/02/2007] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to examine correlates of occupational disability in a large, clinical sample of individuals with a primary diagnosis of obsessive-compulsive disorder (OCD). METHODS A total of 238 individuals with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were interviewed at entry into an observational study of the course of OCD. Primary was defined as the diagnosis that patients identified as the most problematic over their lifetime. RESULTS At the time of interview, 38% of the sample reported being unable to work for psychiatric reasons. Obsessive-compulsive disorder with occupational disability was associated with greater functional impairment in completing household duties, social functioning, and quality of life. Few differences in treatments received were found among individuals with and without occupational disability. Although the number of years on psychotropic medications was similar among the 2 groups, those with disability had been on a greater number of serotonin-reuptake inhibitors over their lifetime. Half of individuals with occupational disability had entered cognitive-behavioral therapy at some point, but only one third had received at least 13 sessions. Regression analyses revealed that OCD severity was the most powerful predictor of occupational disability, followed by depression severity and presence of a lifetime substance use disorder. CONCLUSIONS A substantial proportion of individuals in our sample were unable to work. Cognitive-behavioral therapy was underutilized, and reasons for this remain unclear. Comorbid depression and substance use disorders present additional risk factors for disability. Further advances in biologic and psychosocial treatments are needed to improve functioning and the overall prognosis of the disorder.
Collapse
Affiliation(s)
- Maria C. Mancebo
- Butler Hospital, Providence, RI 02906, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02906
| | - Benjamin Greenberg
- Butler Hospital, Providence, RI 02906, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02906
| | - Jon E.Grant
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454
| | - Anthony Pinto
- Butler Hospital, Providence, RI 02906, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02906
| | - Jane L. Eisen
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02906
| | - Ingrid Dyck
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02906
| | - Steven A. Rasmussen
- Butler Hospital, Providence, RI 02906, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02906
| |
Collapse
|
27
|
Mancebo MC, Eisen JL, Pinto A, Rasmussen SA. Development of the Treatment Adherence Survey-patient version (TAS-P) for OCD. J Anxiety Disord 2008; 22:32-43. [PMID: 17324553 PMCID: PMC3858011 DOI: 10.1016/j.janxdis.2007.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 01/04/2007] [Accepted: 01/31/2007] [Indexed: 12/30/2022]
Abstract
This paper reports on the development and initial psychometric evaluation of the Treatment Adherence Survey-patient version (TAS-P), a brief instrument designed to assess patient adherence to Cognitive-Behavioral Therapy (CBT) and pharmacotherapy recommendations for OCD. Eighty individuals with Obsessive Compulsive Disorder (OCD) were administered the TAS-P as part of the intake interview of a prospective, observational study of the course of OCD. Results demonstrated excellent test-retest reliability. Responses on the TAS-P were also significantly correlated with scores on a self-report measure of general treatment adherence and with data collected from a chart-review, demonstrating concurrent validity. Treatment adherence was not explained by demographic variables. However, participants who reported nonadherence to CBT recommendations had more severe OCD symptoms at the time of intake than those who did not endorse CBT nonadherence (mean Y-BOCS = 23.27 +/- 7.5 versus 18.20 +/- 8.0, respectively). Results suggest that the TAS-P is a promising instrument for assessing reasons for nonadherence to recommendations for CBT and pharmacotherapy interventions.
Collapse
Affiliation(s)
- Maria C. Mancebo
- Brown Medical School, Department of Psychiatry & Human Behavior, Providence, RI
- Butler Hospital Providence, RI
| | - Jane L. Eisen
- Brown Medical School, Department of Psychiatry & Human Behavior, Providence, RI
| | - Anthony Pinto
- Brown Medical School, Department of Psychiatry & Human Behavior, Providence, RI
- Butler Hospital Providence, RI
| | - Steven A. Rasmussen
- Brown Medical School, Department of Psychiatry & Human Behavior, Providence, RI
- Butler Hospital Providence, RI
| |
Collapse
|
28
|
Grant JE, Mancebo MC, Pinto A, Williams KA, Eisen JL, Rasmussen SA. Late-onset obsessive compulsive disorder: clinical characteristics and psychiatric comorbidity. Psychiatry Res 2007; 152:21-7. [PMID: 17363071 DOI: 10.1016/j.psychres.2006.09.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 08/12/2006] [Accepted: 09/20/2006] [Indexed: 10/23/2022]
Abstract
There has been little research examining clinical correlates of late-onset OCD in a large sample of individuals with a primary diagnosis of OCD. Using a sample of 293 consecutive subjects with lifetime DSM-IV OCD, we compared subjects with late-onset (after age 30 years) OCD to those with earlier onset on a variety of clinical measures. Symptom severity was examined using the Yale-Brown Obsessive Compulsive Scale. Thirty-three (11.3%) of the 293 subjects with OCD reported onset of OCD on or after age 30 years (mean age of OCD onset of 38.8+/-9.7 years). Subjects with late-onset had significantly shorter durations of illness prior to receiving treatment, less severe obsessinality, and a trend demonstrating a greater likelihood of responding to cognitive behavioral therapy (CBT). Late-onset OCD subjects were also significantly less likely to report contamination, religious, or somatic obsessions. Comorbidity, insight, depressive symptoms, quality of life, and social functioning did not differ between groups. These preliminary results suggest that although onset on or after age 30 years is fairly uncommon among people with OCD, individuals developing OCD later in life have similar clinical characteristics as those with earlier onset and may respond better to CBT.
Collapse
Affiliation(s)
- Jon E Grant
- Department of Psychiatry, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Pinto A, Eisen JL, Mancebo MC, Greenberg BD, Stout RL, Rasmussen SA. Taboo thoughts and doubt/checking: a refinement of the factor structure for obsessive-compulsive disorder symptoms. Psychiatry Res 2007; 151:255-8. [PMID: 17368563 PMCID: PMC2039929 DOI: 10.1016/j.psychres.2006.09.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Revised: 06/15/2006] [Accepted: 09/11/2006] [Indexed: 11/24/2022]
Abstract
The purpose of this report was to improve upon earlier factor analyses of obsessive-compulsive disorder (OCD) symptom categories by minimizing the heterogeneity in the aggressive obsessions category. An exploratory factor analysis was conducted on data from 293 adults with primary OCD. The resulting five factors (Symmetry/Ordering, Hoarding, Doubt/Checking, Contamination/Cleaning, and Taboo Thoughts) are phenomenologically more homogeneous than prior category-based factors and are consistent with those derived in previous item-level analyses.
Collapse
Affiliation(s)
- Anthony Pinto
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02906, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Brown RA, Abrantes AM, Strong DR, Mancebo MC, Menard J, Rasmussen SA, Greenberg BD. A pilot study of moderate-intensity aerobic exercise for obsessive compulsive disorder. J Nerv Ment Dis 2007; 195:514-20. [PMID: 17568300 DOI: 10.1097/01.nmd.0000253730.31610.6c] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This preliminary study examined the impact of aerobic exercise as an adjunctive intervention to regular care in reducing obsessive compulsive disorder (OCD) symptoms in a clinical sample. Fifteen patients (53% male; mean age = 44.4 years) receiving behavioral therapy and/or pharmacotherapy for OCD and who still demonstrated clinically significant OCD symptoms (i.e., Yale-Brown obsessive compulsive scale, Y-BOCS scores above 16) were enrolled in a 12-week moderate-intensity exercise intervention. Measures of OCD symptom severity were obtained at baseline, end of treatment, and at 3- and 6-week, and 6-month follow-up. Study findings at the end of this 12-week aerobic exercise intervention point to a beneficial effect (Cohen's d = 1.69) on reduction in OCD symptom severity. Further, reductions in OCD symptom severity appear to persist 6 months later. Lastly, improvement in overall sense of well-being was observed after the 12-week intervention. Results of this study suggest that a randomized clinical trial evaluating the efficacy of this 12-week aerobic exercise intervention is warranted.
Collapse
Affiliation(s)
- Richard A Brown
- Butler Hospital/Brown Medical School, Providence, RI 02906, USA
| | | | | | | | | | | | | |
Collapse
|
31
|
Mancebo MC, Eisen JL, Pinto A, Greenberg BD, Dyck IR, Rasmussen SA. The brown longitudinal obsessive compulsive study: treatments received and patient impressions of improvement. J Clin Psychiatry 2006; 67:1713-20. [PMID: 17196050 DOI: 10.4088/jcp.v67n1107] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The primary aim of this study was to assess the extent to which individuals with obsessive-compulsive disorder (OCD) received recommended doses of treatment and perceived a response to these treatments. METHOD Participants were 293 adults with primary OCD (DSM-IV) who were enrolled in the Brown Longitudinal Obsessive Compulsive Study, a naturalistic, prospective study of course in OCD. Data were collected at intake interviews between June 2001 and October 2004. Patient impressions of response to treatments received were assessed using the Clinical Global Impressions-Improvement Scale-patient version. RESULTS Of the 182 participants taking recommended doses of serotonin reuptake inhibitors (SRIs) at intake, 112 (62%) rated themselves as being very much or much improved. The remaining participants rated themselves as minimally improved, unchanged, or worse while taking recommended doses of SRIs. These participants (N = 70) reported receiving their current SRI for a mean (SD) of 2.7 (3.2) years. Twelve (29%) of the 42 participants receiving neuroleptic augmentation of SRIs reported a response. Thirty-eight percent of the sample received the recommended number of 13 sessions of cognitive-behavioral therapy (CBT) lifetime. Only 24% reported completing a continuous course of 13 weekly sessions. Eighteen (67%) of the 27 participants who received a course of CBT in the past year rated themselves as very much or much improved. CONCLUSIONS In this large, naturalistic study of OCD, over one third of participants receiving recommended doses of SRIs did not perceive substantial long-term benefit from pharmaco-therapy. Relatively few participants received recommended doses of CBT. Clinical implications and future directions are discussed.
Collapse
|
32
|
Grant JE, Pinto A, Gunnip M, Mancebo MC, Eisen JL, Rasmussen SA. Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder. Compr Psychiatry 2006; 47:325-9. [PMID: 16905392 DOI: 10.1016/j.comppsych.2006.01.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 01/10/2006] [Accepted: 01/27/2006] [Indexed: 11/23/2022] Open
Abstract
Because little is known about sexual obsessions in individuals with obsessive-compulsive disorder (OCD), we examined rates and clinical correlates of sexual obsessions in 293 consecutive subjects with primary lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, OCD (54.6% females; mean age, 40.5 +/- 12.9 years). Symptom severity was examined using the Yale-Brown Obsessive Compulsive Scale. Comorbidity, treatment response, insight, depression symptoms, quality of life, and social functioning were also assessed. All variables were compared in subjects who have OCD with and without sexual obsessions. Of the 293 subjects with primary OCD, 73 (24.9%) reported a history of sexual obsessions, and 39 (13.3%) of the subjects with OCD reported current sexual obsessions. Women were as likely as men to report sexual obsessions. As compared to those without these symptoms, subjects with current sexual obsessions were significantly more likely to report current aggressive (P < .001) and religious (P = .001) obsessions. Subjects with sexual obsessions also reported an earlier age of onset of OCD than subjects without these symptoms. Severity of OCD, comorbidity, treatment response, insight, depressive symptoms, quality of life, and social functioning did not differ between those with and without sexual obsessions. These preliminary results suggest that sexual obsessions are fairly common among individuals with OCD and may be associated with important clinical characteristics.
Collapse
Affiliation(s)
- Jon E Grant
- Department of Psychiatry, University of Minnesota, Minneapolis, 55454, USA.
| | | | | | | | | | | |
Collapse
|
33
|
Pinto A, Mancebo MC, Eisen JL, Pagano ME, Rasmussen SA. The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. J Clin Psychiatry 2006; 67:703-11. [PMID: 16841619 PMCID: PMC3272757 DOI: 10.4088/jcp.v67n0503] [Citation(s) in RCA: 244] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This article describes the method and intake findings of the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the naturalistic course of obsessive-compulsive disorder (OCD) in a large clinical sample using longitudinal research methodology. METHOD Intake data, collected between June 2001 and October 2004, are presented for 293 adult participants in a prospective, naturalistic study of OCD. Participants had a primary diagnosis of DSM-IV OCD and had sought treatment for the disorder. RESULTS Our findings indicate that OCD typically has a gradual onset and a continuous course regardless of age at onset. There is a substantial lag between the onset of the disorder and initiation of treatment. OCD, which almost always coexists with other psychiatric symptoms, leads to serious social and occupational impairment. Compared with participants with late-onset OCD, early-onset participants had higher rates of lifetime panic disorder, eating disorders, and obsessive-compulsive personality disorder. The groups also differed on the types of obsessive-compulsive symptoms that were first noticed, as well as on rates of current obsessions and compulsions. CONCLUSION The demographics, clinical characteristics, comorbidity rates, and symptom presentation of the sample are consistent with those reported for cross-sectional studies of OCD, including the DSM-IV Field Trial. The current sample has a number of advantages over previously collected prospective samples of OCD in that it is large, diagnostically well characterized, recruited from multiple settings, and treatment seeking. This unique data set will contribute to the identification of meaningful phenotypes in OCD based on stability of symptom dimensions, prospective course patterns, and treatment response.
Collapse
|
34
|
Mancebo MC, Eisen JL, Grant JE, Rasmussen SA. Obsessive compulsive personality disorder and obsessive compulsive disorder: clinical characteristics, diagnostic difficulties, and treatment. Ann Clin Psychiatry 2005; 17:197-204. [PMID: 16402751 DOI: 10.1080/10401230500295305] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The overlap between obsessive compulsive personality disorder (OCPD) and obsessive compulsive disorder (OCD) has received increasing recognition and continues to be a source of much debate. With the advent of new research methodologies, researchers have attempted to distinguish whether OCPD and OCD are two distinct phenomena that can co-occur or whether they are similar, overlapping constructs. METHODS MEDLINE was used to systematically review the OCPD and OCD literature published between 1991 and 2004. RESULTS Using the more stringent DSM-IV criteria, results from OCD clinical samples suggest that the majority of individuals with OCD (75%) do not have OCPD. Similarly, results from personality disorder samples suggest that the majority of individuals with OCPD (80%) do not have OCD. CONCLUSIONS While there is evidence that OCD and OCPD are linked, the literature does not support either one as a necessary or sufficient component of the other.
Collapse
Affiliation(s)
- Maria C Mancebo
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02906, USA.
| | | | | | | |
Collapse
|
35
|
Abstract
This article presents an overview of pathological self-injurious behavior (SIB). Historical and cultural aspects, epidemiology, classification and clinical aspects and pathogenesis are described. The importance of comprehensive assessment of symptomatology and functions of SIB for treatment planning are discussed.
Collapse
|