Disorders - Obsessive Compulsive Disorder
Wuthrich, V.
M., Zagic, D., Dickson, S. J., McLellan, L. F., Chen, J. T., Jones, M. P., Rapee, R. M.
This systematic review and meta-analysis aimed to
examine the effectiveness of psychological interventions for internalising disorders in youth when delivered in routine settings. Secondary aims were
to examine the effectiveness of cognitive behavioural therapy and determine moderators of treatment response. The study was pre-registered (PROSPERO
2020 CRD42020202776). Databases were systematically searched (PsycINFO, Medline, Embase, PubMed, ERIC) in December 2022 and screened according to the
PRISMA 2020 statement. Inclusion: School aged participants (4-18 years) with a primary internalising disorder; psychotherapy delivered in a routine
setting (e.g. outpatient clinic, school) by setting staff; compared psychotherapy to any control in a randomised controlled trial; reported pre-to-
post or pre-to-follow-up comparisons on the primary disorder according to child, parent or independent evaluator report; and was published in
English. Risk of bias was assessed using the ROB 2.0 Cochrane tool. Results were synthesised using random effects to pool estimates. Risk ratios were
used to analyse dichotomous data and standardised mean differences (SMD) for continuous data. Forty-five studies were included (N = 4901
participants; M = 13 years; range 8-16; SD = 2.5). Nine used waitlist control, 17 treatment as usual, 4 placebo; 15 compared psychotherapy to active
control. Psychotherapy was associated with small significant effects pre- to post-treatment compared to non-active controls for anxiety (SMD = - 0.24
to 0.50) and depression (SMD = - 0.19 to 0.34) with effects differing by informant. Psychotherapy led to small significant pre-to-post-benefits in
youth internalising disorders in routine settings. Results are limited by reporter type and follow-up.
Clinical Child &
Family Psychology Review, 14 : 14
- Year: 2023
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Wang, Y., Jia, N., Zhou,
Y., Fu, L., Fan, L., Li, B.
Aim: To compare the differences in the effects of
based on remote coached high intensity interval training and combined exercise training on the physical and mental health of university students.
\rMethod: Sixty university students were recruited from Shandong Normal University and randomly divided into HIIT group (n = 30) and AR group (n =
30), with the HIIT group using high-intensity interval training intervention and the AR group using combined exercise (aerobic combined with
resistance) training intervention for 8 weeks. Mental health indicators, fitness indicators and body composition indicators were measured at the
beginning and end of the intervention.\rResults: After 8 weeks, among the mental health indicators, the results of the Symptom Self-Rating Scale
(SCL-90) test showed a significant improvement in the HIIT group in terms of total score, somatization, obsessive-compulsive, interpersonal
sensitivity, depression, hostility, and psychoticism (p < 0.05); the AR group showed significant improvements in psychoticism (P < 0.05). There were
no significant differences between the two groups. The results of the Pittsburgh Sleep Quality Index scale (PSQI) showed a significant difference in
sleep efficiency in the HIIT group with an inverse improvement in scores; the AR group showed no significant improvement in each test item. The
results of the between-group covariance showed significant differences in sleep efficiency and hypnotic drugs in the HIIT group (p < 0.05). Among the
fitness indicators, the HIIT group showed significant improvements in maximum oxygen uptake, grip strength and flexibility (P < 0.05); the AR group
showed significant improvements in back muscle strength and flexibility (P < 0.05). The results of the between-group covariance showed significant
improvements in maximum oxygen uptake in the HIIT group (P < 0.01). Regarding body composition indicators, there was a significant improvement in
Body weight, BMI, Body fat percentage and Waist-to-hip ratio in both the HIIT and AR groups (P < 0.01). There were no significant differences between
the two groups.\rConclusion: HIIT and combined exercise training based on remote coaching had some improvement on fitness level and body composition
of university students, HIIT was more advantageous in improving aerobic endurance, and HIIT based on remote coaching may have better effect than
combined exercise in mental health.\rTrial registration: Chinese Clinical Trial Register, ChiECRCT20220149. Registered on 16 May 2022.
, 14 : 1182332
- Year: 2023
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Physical activity, exercise, Technology, interventions delivered using technology (e.g. online, SMS)
Wang, J., Hua, G., Wang, S., Guo, G., Quan, D., Yao, S., Zheng, H.
Objective: In obsessive-compulsive disorder (OCD), glutamatergic neurotransmission dysfunction played key roles in
pathophysiology. The current research assessed changes of neurometabolites in the bilateral striatum of OCD patients receiving low-frequency
repetitive transcranial magnetic stimulation (rTMS) using 1H proton magnetic resonance spectroscopy (1H-MRS). Method(s): 52 OCD patients were divided
into rTMS treatment group (29) and the control group (medication only) (22). The levels of neurometabolites in the bilateral striatum of patients
with OCD were measured using MRS before and after treatment. All participants were taking medication prior to the treatment and the process. Result
(s): Following rTMS treatment, Yale-Brown Obsessive-Compulsive Scale (YBOCS) score was significantly decreased in the rTMS group compared with the
control group. Glutamate (Glu) and glutamate and glutamine complexes (Glx) in the bilateral striatum of the rTMS treatment response group increased
significantly with the improvement of OCD. Glu in the bilateral striatum and Glx in the right striatum were positively correlated with compulsion
after the treatment. Conclusion(s): The physiopathological mechanism of OCD may be related to the glutamatergic dysfunction, and the low-frequency
repetitive transcranial magnetic stimulation applied to the supplementary motor area can improve OCD symptoms by modulating glutamatergic levels in
the bilateral striatum of patients with OCD. Copyright © 2023 Elsevier B.V.
, 325 : 762-
769
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Transcranial magnetic stimulation
(TMS)
Siwiec, S., Bodhy, S., Lotfi, S., Lee, H. J.
Unavailable
Journal of Obsessive-Compulsive and Related Disorders, 37 (no
pagination) :
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Schuberth, D. A., McMahon, R. J., Best, J. R., McKenney,
K., Selles, R., Stewart, S. E.
Coercive and disruptive behaviors
commonly interfere with cognitive-behavioral therapy (CBT) trials among youths with obsessive-compulsive disorder (OCD). Although evidence supports
parent management training (PMT) for reducing disruptive behavior, no group-based PMT interventions exist for OCD-related disruptive behaviors. We
studied feasibility and effectiveness of group-based adjunctive PMT among non-randomized, OCD-affected families receiving family-based group CBT.
Linear mixed models estimated treatment effects across OCD-related and parenting outcomes at post-treatment and 1-month follow-up. Treatment response
for 37 families receiving CBT + PMT (Mage = 13.90) was compared to 80 families receiving only CBT (Mage = 13.93). CBT + PMT was
highly accepted by families. Families who received CBT + PMT had improved disruptive behaviors, parental distress tolerance, and other OCD-related
outcomes. OCD-related outcomes did not significantly differ between groups. Results support CBT + PMT as effective treatment for pediatric OCD that
may not provide incremental benefits beyond CBT alone. Future research should determine feasible and effective ways to incorporate key PMT components
into CBT-based interventions.
Child Psychiatry & Human
Development, 20 : 20
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy, Other Psychological Interventions
Russman Block, S., Norman, L. J., Zhang, X., Mannella, K. A., Yang, H., Angstadt, M., Abelson, J. L., Himle, J. A., Taylor, S. F., Fitzgerald, K. D.
OBJECTIVE: Cortical-subcortical hyperconnectivity related to
affective-behavioral integration and cortical network hypoconnectivity related to cognitive control have been demonstrated in obsessive-compulsive
disorder (OCD); the study objective was to examine whether these connectivity patterns predict treatment response. METHOD(S): Adolescents (ages 12-
17) and adults (ages 24-45) were randomly assigned to 12 sessions of exposure and response prevention (ERP) or stress management therapy (SMT), an
active control. Before treatment, resting-state connectivity of ventromedial prefrontal cortical (vmPFC), cingulo-opercular, frontoparietal, and
subcortical regions was assessed with functional MRI. OCD severity was assessed with the Yale-Brown Obsessive Compulsive Scale before, during, and
after treatment. Usable fMRI and longitudinal symptom data were obtained from 116 patients (68 female; 54 adolescents; 60 medicated). RESULT(S): ERP
produced greater decreases in symptom scores than SMT. ERP was selectively associated with less vmPFC-subcortical (caudate and thalamus) connectivity
in both age groups and primarily in unmedicated participants. Greater symptom improvement with both ERP and SMT was associated with greater
cognitive-control (cingulo-opercular and frontoparietal) and subcortical (putamen) connectivity across age groups. Developmental specificity was
observed across ERP and SMT treatments, such that greater improvements with ERP than SMT were associated with greater frontoparietal-subcortical
(nucleus accumbens) connectivity in adolescents but greater connectivity between frontoparietal regions in adults. Comparison of response-predictive
connections revealed no significant differences compared with a matched healthy control group. CONCLUSION(S): The results suggest that less vmPFC-
subcortical connectivity related to affect-influenced behavior may be important for ERP engagement, whereas greater cognitive-control and motor
circuit connectivity may generally facilitate response to psychotherapy. Finally, neural predictors of treatment response may differ by age.
The American journal of psychiatry, 180(1) : 89-
99
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention
Parli, G.
M., Gales, M. A., Gales, B. J.
OBJECTIVE: To evaluate clinical data using oral n-acetylcysteine (NAC) in obsessive-
compulsive and related disorders (OCDRD) treatment.\rDATA SOURCES: PubMed, Ovid MEDLINE (1946-July 2022), and the Cochrane Library database were
searched using the terms NAC, children, adolescent, obsessive-compulsive disorder (OCD), trichotillomania (TTM), excoriation, hoarding disorder, and
body dysmorphic disorder. Bibliographies were reviewed for relevant trials and case studies.\rSTUDY SELECTION AND DATA EXTRACTION: English language,
clinical trials, or case studies analyzing NAC use in patients aged 3 to 21 years old with OCDRD as determined by the Diagnostic and Statistical
Manual of Mental Disorders, 5th Edition.\rDATA SYNTHESIS: Three randomized double-blind placebo-controlled trials of NAC in children and adolescents
studied 121 patients with OCDRD. Trials assessed symptom severity from baseline to 10 to 12 weeks of NAC therapy. Two OCD trials identified
statistically significant improvements, with only 1 trial demonstrating a clear clinically relevant difference from placebo. One trial in TTM found
no difference between the NAC and placebo. Adverse effects were mild and included nausea, blurred vision, fatigue, tremor, and sweats. N-
acetylcysteine titrated to 2400 or 2700 mg/day in divided doses was the most studied regimen.\rRELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Many
OCDRD patients fail to completely respond to first-line treatment with cognitive behavioral therapy (CBT) and/or selective serotonin reuptake
inhibitors (SSRIs) leaving practitioners with few additional treatment options. Preliminary efficacy and safety data are presented in this review.
\rCONCLUSIONS: Limited evidence suggests children and adolescents with OCD refractory to SSRIs or CBT may benefit from NAC augmentation.
Annals of Pharmacotherapy, 57(7) : 847-
854
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Mendez, E. M., Dahlsgaard,
K. K., Hjelmgren, J. M., Mills, J. A., Suresh, V., Strawn, J. R.
Background: Treatment of obsessive-compulsive disorder (OCD) in
children and adolescents frequently involves cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), or their
combination. However, how adding CBT to SSRIs affects the trajectory and magnitude of improvement has not been evaluated meta-analytically. Method
(s): We performed a meta-analysis using weekly data from prospective randomized parallel group trials of CBT and SSRIs in pediatric patients with
OCD. Response was modeled for the change in the Child Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) using a Bayesian hierarchical model over 12
weeks. Result(s): Fourteen studies included pharmacotherapy arms, 4 studies included combined pharmacotherapy and psychotherapy, and 10 studies
included a placebo or control arm. The studies included 1146 patients (mean age 12.7+/-1.3 years, mean 42.1% female). In the logarithmic model of
response, statistically significant differences in treatment effects for CBT+SSRI and SSRI monotherapy were observed compared with placebo (SSRI
beta=-3.59, credible interval [95% CrI]: -4.13 to -3.02, p<0.001; SSRI+CBT beta=-4.07, 95% CrI: -5.05 to -3.04, p<0.001). Adding CBT to an SSRI
produced numerically (but not statistically significantly) greater improvement over 12 weeks. Greater improvement was observed in studies with more
boys (p<0.001), younger patients (p<0.001), and in studies with greater baseline symptom severity (p<0.001). Conclusion(s): In children and
adolescents with OCD, compared with placebo, both SSRIs and SSRI+CBT produced early and sustained improvement over 12 weeks, although the improvement
was also related to sample characteristics. Longer term studies are needed to determine when the additive benefit of CBT emerges relative to SSRI
monotherapy.
Journal of Child and Adolescent
Psychopharmacology., 22 :
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Luo, G., Wang, S., Yao, S., Quan, D., Guo, G., Gao, J., Zheng, H.
Background and aim: Although Repetitive Transcranial Magnetic Stimulation (rTMS)
is a promising new noninvasive brain stimulation therapy, its underlying mechanisms of action remain unknown. OCD patients exhibit impaired response
control and attention shifting, which is linked to some brain areas such as anterior cingulate cortex and basal ganglia. OCD patients also display
altered neurometabolic concentrations in cortical cortical-striatal-thalamic-cortical (CSTC). In this study, we aimed to elucidate efficacy of rTMS
treatment in alleviating related symptoms and pregenual anterior cingulate cortex (pACC) neurometabolites. Method(s): OCD patients were randomly
divided into either drug (n = 23) or drug + rTMS (n = 29) groups, and those in the latter group subjected to 4-week rTMS treatment. All participants
were visited twice, at baseline and follow-up after four weeks. During both visits, all patients were subjected to 1H-MRS, then Yale-Brown Obsessive
Compulsive Scale (Y-BOCS) and the Global Assessment Function (GAF) used to assess severity of obsessive-compulsive symptoms. We also evaluated
synchronous anxiety and depression by Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Hamilton
Depression Scale (HAM-D). Result(s): After 4 weeks of treatment, patients in the Drug + rTMS group displayed significantly lower Y-BOCS (p = 0.038),
BDI (p = 0.009), HAM-D (p = 0.013), HAM-A (p = 0.012) scores than their counterparts in the Drug group. Conversely, patients in the Drug + rTMS group
had significantly higher tNAA concentrations (p = 0.030) than those in the Drug group. Notably, the Drug + rTMS group exhibited higher, but
insignificant Glu (p = 0.055) and Glx (p = 0.068) concentrations compared to the Drug group. Partial correlation analysis revealed a significant
negative correlation between post HAM-A scores and 4-week change of pACC glutamate levels in the Drug + rTMS group (r = -0.434, p = 0.02).
Conclusion(s): rTMS treatment is an efficacious treatment therapy for OCD, mainly by inducing changes in neurometabolites. Copyright © 2023 Elsevier
B.V.
, 333 : 79-85
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Transcranial magnetic stimulation
(TMS)
Lauri, K. O., Andersson, E., Mataix-Cols, D., Norlin, L., Eriksson, V., Melin, K., Lenhard, F., Serlachius, E., Aspvall, K.
Long-term follow-up data from trials of digital mental
health interventions are rare. This study reports 2-year follow-up data from a non-inferiority trial (N = 152) comparing stepped-care (internet-
delivered cognitive behavioral therapy [CBT] followed by traditional in-person CBT if needed) vs in-person CBT for pediatric obsessive-compulsive
disorder. Both treatment groups had comparable long-term effects, with the majority of participants being responders (stepped-care 66 %; in-person
CBT 71 %) 2 years after the end of treatment. Copyright © 2023 The Authors
Internet Interventions, 32 (no
pagination) :
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS), Technology, comparing delivery mode (e.g. online vs. face-to-face), Other service delivery and improvement
interventions
Joshi, M., Kar, S. K., Dalal, P. K.
Background Obsessive-compulsive disorder (OCD) is a chronic
psychiatric disorder that results in significant disability and substantial compromise in the quality of life. Until now, the role of repetitive
transcranial magnetic stimulation (rTMS) has been primarily explored in individuals with treatment-resistant OCD. In this study, we investigated the
safety and efficacy of rTMS as an early augmentation strategy in drug-free patients with OCD. Methods This is a randomized double-blind, placebo-
controlled study that involved the administration of a total of 20 sessions of rTMS (active/sham) to drug-naive OCD patients using a standard
protocol (1-Hz; 20 trains [80 pulses/train]; 1600 pulses per session at 100% resting motor threshold) at supplementary motor area. All patients
(active and sham) were started on escitalopram 10 mg/d, which was subsequently increased to 20 mg/d after 10 days. Results Out of the 24 patients, 13
received active and 11 received sham rTMS. At the end of rTMS therapy, there was a substantial reduction (P =.001) in total Yale-Brown Obsessive-
Compulsive Scale, obsessions (P =.030) and compulsions (P =.001) between the groups. Only few patients (N = 8) reported mild side effect with rTMS,
local pain, and headache being the commonest. The study revealed large effect size (Cohen's d = 1.6) of rTMS as an early augmentation strategy in
drug-free patients of OCD. Conclusions rTMS is a safe and effective early augmentation strategy in the management of OCD. Larger randomized
controlled trials are required to establish the therapeutic role of rTMS as early augmentation in OCD. Copyright © The Author(s), 2022. Published by
Cambridge University Press.
CNS Spectrums, 28(2) : 190-
196
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Transcranial magnetic stimulation
(TMS)
Agrawal,
A., Agarwal, V., Arya, A., Kar, S. K.
Background:
OCD is a common mental illness with a quarter of patients presenting before 10 years of age. Current treatment strategies takes weeks to show
response and augmentation with antipsychotics adds to the side effects. tDCS is safe in children and has shown promising results in OCD. Early
augmentation with tDCS can improve outcomes in adolescent OCD patients. Objective(s): Study the safety and efficacy of tDCS as an early augmentation
strategy in adolescents with OCD. Method(s): Drug naive adolescents patients aged 10-18 years were screened. Written informed consent was taken.
Baseline CY-BOCS scale was applied. Fluoxetine 20mg increased to 40mg was given to all patients and then randomized into active and sham groups.
Protocol chosen: cathode - Supplementary Motor Area, anode - right deltoid, 2mA, 20mins, ramp - 20s, 10 sessions were given. Side effects were
assessed. CY-BOCS was applied at 2, 6 and 12 weeks again and results were analyzed. Result(s): Total 16 patients completed the study (9-active, 7-
sham). Both groups showed significant reduction in CY-BOCS score from baseline to 12 weeks but change at baseline vs 2 weeks was significant in
active but not in sham group. Mean change at 2 weeks was significantly more in active group (12.89+/-7.89 v/s 5.28+/-2.56, p=0.026) but not at 6
weeks or 12 weeks. Remission rates were higher in active group at 2 weeks. Adverse effect between the groups was comparable. Conclusion(s): tDCS is a
safe and effective as an early augmentation strategy in adolescents with OCD. However, its effects seem to wean off after termination of
treatment.
, 65(Supplement 1) : S144
- Year: 2023
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions