Disorders - Obsessive Compulsive Disorder
Gorenstein, G., Gorenstein, C., de-Oliveira, M. C., Asbahr, F. R., Shavitt, R. G.
This study aimed to investigate the impact of child-focused pediatric OCD treatment on
parental anxiety, family accommodation and family environment. Forty-three parents (72.1% female, mean age+/-SD = 43.1+/-5.6 years) were evaluated at
baseline and after their children's (n =33, 54.5% female, mean age+/-SD =12.9+/-2.7 years) randomized treatment with Group Cognitive-Behavioral
Therapy or fluoxetine for 14 weeks. Validated instruments were administered by trained clinicians. Parents were assessed with the State-Trait Anxiety
Inventory (STAI), the Family Accommodation Scale (FAS) and the Family Environment Scale (FES). The Yale-Brown Obsessive-Compulsive Scale was
administered to children. Significant findings after the children's treatment include decreased family accommodation levels (participation,
modification and distress/consequences domains); increased cohesion and active-recreational components of the family environment. In addition,
changes in the FAS distress/consequences and the FES cohesion subscores were correlated with the children's clinical improvement. These results
suggest that child-focused OCD treatment may have a positive impact on family accommodation and family environment. Future studies should further
clarify the reciprocal influences of pediatric OCD treatment and family factors. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
(journal abstract).
Psychiatry Research, 229(1-2) : 161-
166
- Year: 2015
- 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), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Vakili,
Y., Gharaee, B., Habibi, M.
Background: Selective serotonin reuptake inhibitors (SSRIs) and exposure with response prevention for treatment of
obsessive-compulsive disorder (OCD) have demonstrated empirical support; however, a substantial number of patients remain with clinically significant
OCD symptoms after such treatments. Objectives: The aim of this study was to compare the effectiveness of acceptance and commitment therapy (ACT),
selective serotonin reuptake inhibitors (SSRIs) and combination of ACT and SSRIs in the treatment of adults with obsessive-compulsive disorder (OCD).
Patients and Methods: Thirty-two outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria
for OCD were randomly assigned to one of the three treatment conditions: ACT, SSRIs and combined treatment. The Yale-Brown Obsessive-Compulsive Scale
and Acceptance and Action Questionnaire were administered at pre-treatment and post-treatment. Twenty-seven patients completed the study. Data was
analyzed using one-way analysis of variance (ANOVA) and one-way analysis of covariance (ANCOVA), clinically significant change (CSC) and complete
remission status. Results: ANCOVA revealed that patients treated with ACT and combined treatment experienced a significantly greater improvement in
obsessive-compulsive (OC) symptoms and experiential avoidance (EA) at post-treatment compared to those treated with SSRIs alone. However, there were
no significant differences between ACT and combined treatment on OC symptoms and EA. CSC and complete remission status results showed that unlike
SSRI, ACT and combined treatment led to more improvement in OC symptoms. Conclusions: ACT and combined treatment are more effective than SSRIs alone
in treating OC symptoms and EA. However, it appears that adding SSRIs to ACT does not increase the effectiveness of ACT in the treatment of adults
with OCD in the short-term.
Iranian Journal of Psychiatry & Behavioral Sciences, 9(2) : 16-
20
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Acceptance & commitment therapy
(ACT)
Skarphedinsson, G., Weidle, B., Thomsen, P. H., Dahl, K., Torp, N. C., Nissen, J.
B., Melin, K. H., Hybel, K., Valderhaug, R., Wentzel-Larsen, T., Compton, S. N., Ivarsson, T.
Expert guidelines recommend cognitive-behavior
therapy (CBT) as a first-line treatment in pediatric obsessive-compulsive disorder (OCD) and the addition of selective serotonin reuptake inhibitors
when CBT is not effective. However, the recommendations for CBT non-responders are not supported by empirical data. Our objective was to investigate
the effectiveness of sertraline (SRT) versus continued CBT in children and adolescents that did not respond to an initial course of CBT. Randomized
controlled trial conducted in five sites in Denmark, Sweden and Norway, 54 children and adolescents, age 7-17 years, with DSM-IV primary OCD were
randomized to SRT or continued CBT for 16 weeks. These participants had been classified as non-responders to CBT following 14 weekly sessions.
Primary outcomes were the CY-BOCS total score and clinical response (CY-BOCS <16). The study was a part of the Nordic Long-Term OCD Treatment Study
(NordLOTS). Intent-to-treat sample included 50 participants, mean age 14.0 (SD = 2.7) and 48 % (n = 24) males. Twenty-one of 28 participants (75 %)
completed continued CBT and 15 of 22 participants (69.2 %) completed SRT. Planned pairwise comparison of the CY-BOCS total score did not reveal a
significant difference between the treatments (p = .351), the response rate was 50.0 % in the CBT group and 45.4 % in the SRT group. The multivariate
chi 2 test suggested that there were no statistically significant differences between groups (p = .727). Within-group effect sizes were large and
significant across both treatments. These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial.
However, there was no significant between-group differences in SRT or continued CBT at post-treatment. (PsycINFO Database Record (c) 2015 APA, all
rights reserved) (journal abstract).
European
Child & Adolescent Psychiatry, 24(5) : 591-602
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Salemink, E., Wolters, L., de-Haan, E.
Background and objectives:
Cognitive Behavioral Therapy for children and adolescents with Obsessive Compulsive Disorder (OCD) is effective. However, since almost half of
patients remain symptomatic after treatment, there remains room for improvement. Cognitive Bias Modification training of Interpretations (CBM-I) is a
promising new intervention, as it targets misinterpretation of intrusions, which is seen as an important characteristic in OCD. To date, there have
been no published studies of CBM-I in adolescents with OCD. The aim of the current pilot study was to examine the added value of online CBM-I
training as an adjunctive treatment to the Treatment As Usual (TAU; that included CBT and pharmacotherapy) in adolescents with OCD. Methods: Patients
receiving TAU were randomly assigned to either an additional CBM-I training (n = 9), or to an additional placebo variant of this procedure (n = 7).
Results: Immediate, on-line interpretations changed in response to the CBM-I training, while no such effects were observed on slower retrospective
off-line interpretations. Patients in the CBM-I training condition reported fewer obsessive compulsive symptoms after training, and clinicians rated
them as having fewer obsessive symptoms (corresponding to medium-large effect sizes). No such changes were observed in the placebo group.
Limitations: The small sample size precludes strong conclusions and replication is necessary to test the robustness of the findings. Conclusions:
This small randomized controlled trial is suggestive, although not conclusive, regarding the promising additive value of OC-related CBM-I training as
an adjunctive intervention to TAU in an adolescent clinical population. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal
abstract).
Journal of Behavior Therapy & Experimental Psychiatry, 49(Part A) : 112-
119
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS)
Schumer, M. C., Panza, K. E., Mulqueen, J. M., Jakubovski, E., Bloch, M.
H.
Objective: To examine long-term outcome in children with trichotillomania. Method: We conducted follow-up clinical assessments an
average of 2.8 +/- 0.8 years after baseline evaluation in 30 of 39 children who previously participated in a randomized, double-blind, placebo-
controlled trial of N-acetylcysteine (NAC) for pediatric trichotillomania. Our primary outcome was change in hairpulling severity on the
Massachusetts General HospitalHairpulling Hospital Hairpulling Scale (MGH-HPS) between the end of the acute phase and follow-up evaluation. We also
obtained secondary measures examining styles of hairpulling, comorbid anxiety and depressive symptoms, as well as continued treatment utilization. We
examined both correlates and predictors of outcome (change in MGH-HPS score) using linear regression. Results: None of the participants continued to
take NAC at the time of follow-up assessment. No significant changes in hairpulling severity were reported over the follow-up period. Subjects
reported significantly increased anxiety and depressive symptoms but improvement in automatic pulling symptoms. Increased hairpulling symptoms during
the follow-up period were associated with increased depression and anxiety symptoms and increased focused pulling. Older age and greater focused
pulling at baseline assessment were associated with poor long-term prognosis. Conclusions: Our findings suggest that few children with
trichotillomania experience a significant improvement in trichotillomania symptoms if behavioral treatments are inaccessible or have failed to
produce adequate symptom relief. Our findings also confirm results of previous cross-sectional studies that suggest an increased risk of depression
and anxiety symptoms with age in pediatric trichotillomania. Increased focused pulling and older age among children with trichotillomania symptoms
may be associated with poorer long-term prognosis. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Depression & Anxiety, 32(10) : 737-743
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Romanelli, R. J., Wu, F. M., Gamba, R., Mojtabai, R., Segal, J. B.
Background: Effective treatments for
obsessive-compulsive disorder (OCD) include behavioral therapy (exposure and response/ritual prevention and cognitive behavioral therapy) and
serotonin-reuptake inhibitors (SRIs); however, the relative efficacy of these treatments is not well established. We sought to review evidence from
head-to-head randomized-controlled trials (RCTs) of behavioral therapy and SRIs in the treatment of OCD.; Methods: A systematic search of multiple
databases was conducted from first available date to June 30, 2012, for RCTs in the treatment of OCD among outpatients, comparing behavioral therapy
and SRIs, alone or combined. Two independent reviewers evaluated studies for eligibility and risk of bias. The main outcome measure was posttreatment
mean Yale-Brown Obsessive-Compulsive Scale (YBOCS) score.; Results: We identified 2,186 unique articles. Fifteen articles were included, describing
13 RCTs. Pooled standardized mean difference (SMD; 95% confidence intervals) in YBOCS score significantly favored behavioral therapy over SRIs (0.37;
0.10, 0.64; P = .007), but not in a subset of trials that used selective SRIs (0.22; -0.02, 0.47; P = .070). Within individual trials, effect sizes
significantly favored the combination of behavioral therapy plus an SRI over an SRI, but not behavioral therapy, alone.; Conclusions: This review
provides evidence that, among outpatients with OCD, behavioral therapy is more effective than SRIs, overall, but not selective SRIs. Furthermore, the
combination of behavioral therapy plus an SRI is more effective than an SRI alone. These data may be used to inform the development of evidence-based
treatment guidelines; however, more studies are also needed to further evaluate the relative efficacy of these interventions.; © 2014 Wiley
Periodicals, Inc.
Depression &
Anxiety, 31(8) : 641-652
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention
Turner, CM, Mataix-Cols, D: Lovell, K, Krebs, G, Lang, K, Byford, S, Heyman, I.
Objective Many adolescents with obsessive-compulsive disorder (OCD) do not have access to evidence-based treatment. A
randomized controlled non-inferiority trial was conducted in a specialist OCD clinic to evaluate the effectiveness of telephone cognitive-behavioral
therapy (TCBT) for adolescents with OCD compared to standard clinic-based, face-to-face CBT.\rMethod Seventy-two adolescents, aged 11 through 18
years with primary OCD, and their parents were randomized to receive specialist TCBT or CBT. The intervention provided differed only in the method of
treatment delivery. All participants received up to 14 sessions of CBT, incorporating exposure with response prevention (E/RP), provided by
experienced therapists. The primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Blind assessor ratings were
obtained at midtreatment, posttreatment, 3-month, 6-month, and 12-month follow-up.\rResults Intent-to-treat analyses indicated that TCBT was not
inferior to face-to-face CBT at posttreatment, 3-month, and 6-month follow-up. At 12-month follow-up, there were no significant between-group
differences on the CY-BOCS, but the confidence intervals exceeded the non-inferiority threshold. All secondary measures confirmed non-inferiority at
all assessment points. Improvements made during treatment were maintained through to 12-month follow-up. Participants in each condition reported high
levels of satisfaction with the intervention received.\rConclusion TCBT is an effective treatment and is not inferior to standard clinic-based CBT,
at least in the midterm. This approach provides a means of making a specialized treatment more accessible to many adolescents with OCD. Clinical
trial registration information-Evaluation of telephone-administered cognitive-behaviour therapy (CBT) for young people with obsessive-compulsive
disorder (OCD); http://www.controlled-trials.com; ISRCTN27070832.
Journal of the American Academy of Child & Adolescent Psychiatry, 53(12) : 1298-
1307.e2
- Year: 2014
- 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), Other service delivery and improvement
interventions
Thompson-Hollands, J., Edson, A., Tompson, M. C., Comer, J.
S.
Psychological treatments for obsessive - compulsive disorder (OCD) are increasingly aimed at improving outcomes by directly incorporating
family members to address family disruption, dysfunction, or symptom accommodation. Much remains to be learned about the pooled effects of \"family
inclusive treatment\" (FIT) for OCD and factors that may explain variation in response. Random-effects meta-analytic procedures were conducted to
empirically evaluate the overall effect of FITs on OCD, and treatment moderators. Study search criteria yielded 29 studies examining FIT response in
1,366 OCD patients. Outcome variables included OCD symptoms and global functioning. Examined moderators included age group, gender, minority status,
treatment length and format, and inclusion of specific family focused treatment elements. FITs for OCD demonstrated a large overall effect on OCD
symptoms (pooled d = 1.68, SE = 0.14) and global functioning (pooled d = 0.98, SE = 0.14). Moderator analyses found that individual family treatments
(vs. group) and FITs targeting family accommodation of symptoms (vs. those that did not target accommodation) were associated with greater
improvements in patient functioning. Results indicate a robust overall response to FITs for OCD and clarify key moderators that inform optimal
circumstances for effective treatment. Findings underscore the need for continued momentum in the development, evaluation, and dissemination of FITs
for OCD. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Journal of Family Psychology, 28(3) : 287-
298
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Other Psychological Interventions
McGuire, J. F., Ung, D., Selles, R. R., Rahman, O., Lewin, A. B., Murphy, T. K., Storch, E. A.
Few randomized controlled trials (RCTs) exist examining the efficacy of behavior
therapy (BT) or serotonin reuptake inhibitors (SRIs) for the treatment of trichotillomania (TTM), with no examination of treatment moderators. The
present meta-analysis synthesized the treatment effect sizes (ES) of BT and SRI relative to comparison conditions, and examined moderators of
treatment. A comprehensive literature search identified 11 RCTs that met inclusion criteria. Clinical characteristics (e.g., age, comorbidity,
therapeutic contact hours), outcome measures, treatment subtypes (e.g., SRI subtype, BT subtype), and ES data were extracted. The standardized mean
difference of change in hair pulling severity was the outcome measure. A random effects meta-analysis found a large pooled ES for BT (ES=1.41,
p<0.001). BT trials with greater therapeutic contact hours exhibited larger ES (p=0.009). Additionally, BT trials that used mood enhanced therapeutic
techniques exhibited greater ES relative to trials including only traditional BT components (p=0.004). For SRI trials, a random effects meta-analysis
identified a moderate pooled ES (ES=0.41, p=0.02). Although clomipramine exhibited larger ES relative to selective serotonin reuptake inhibitors, the
difference was not statistically significant. Publication bias was not identified for either treatment. BT yields large treatment effects for TTM,
with further examination needed to disentangle confounded treatment moderators. SRI trials exhibited a moderate pooled ES, with no treatment
moderators identified. Sensitivity analyses highlighted the need for further RCTs of SRIs, especially among youth with TTM.
Journal of Psychiatric Research, 58 : 76-
83
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Freeman, J., Garcia, A., Frank, H., Benito, K., Conelea, C., Walther, M., Edmunds, J.
Pediatric obsessive-compulsive disorder (OCD) is a chronic and impairing condition
that often persists into adulthood. Barrett, Farrell, Pina, Peris, and Piacentini (2008), in this journal, provided a detailed review of evidence-
based psychosocial treatments for youth with OCD. The current review provides an evidence base update of the pediatric OCD psychosocial treatment
literature with particular attention to advances in the field as well as to the methodological challenges inherent in evaluating such findings.
Psychosocial treatment studies conducted since the last review are described and evaluated according to methodological rigor and evidence-based
classification using the JCCAP evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, this issue). Findings from this review
clearly converge in support of cognitive-behavioral therapy as an effective and appropriate first line treatment for youth with OCD (either alone or
in combination with medication). Although no treatment for pediatric OCD has yet to be designated as \"well-established,\" both individual and
individual family-based treatments have been shown to be \"probably efficacious.\" Moderators and predictors of treatment outcome are discussed as
are the areas where we have advanced the field and the areas where we have room to grow. The methodological and clinical challenges inherent in a
review of the evidence base are reviewed. Finally, future research directions are outlined. (copyright) 2014 Copyright Taylor and Francis Group,
LLC.
Journal of Clinical Child & Adolescent Psychology, 43(1) : 7-
26
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Grant,
Paul. J., Joseph, Lisa. A., Farmer, Cristan. A., Luckenbaugh, David. A., Lougee, Lorraine. C., Zarate,
Carlos. A., Jr., Swedo, Susan. E.
Many children with childhood-onset obsessive-compulsive disorder (OCD) fail to respond adequately to standard therapies.
Evidence from preclinical and clinical studies suggests that the glutamatergic neurotransmitter system might be an alternative treatment target. This
study examined the efficacy of riluzole, a glutamatergic modulator, as an adjunctive therapy for children with treatment-resistant OCD. In a 12-week,
double-blind, placebo-controlled study, 60 treatment-resistant children and adolescents (mean age= 14.5 ± 2.4 years), with moderate to severe OCD
(mean Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) = 28.2 ± 3.7), 17 of whom also had concomitant autism spectrum disorder, were
randomized to receive riluzole (final dose of lOOmg/day) or placebo in addition to the existing treatment regimen. Fifty-nine subjects completed the
randomized trial. Primary outcome measures were changes on the CY-BOCS, the Clinical Global Impressions Scale, and the Children's Global Assessment
Scale. Riluzole was fairly well tolerated, although it was associated with one case of pancreatitis and five instances of slight increases in
transaminases. All subjects showed significant reductions in CY-BOCS scores during treatment; however, there was no significant difference between
placebo and riluzole on any of the primary or secondary outcome measures. The study failed to demonstrate superiority of riluzole over placebo as an
adjunctive treatment for children with childhood-onset OCD. However, future studies may show benefits for less treatment-refractory children with
fewer concomitant medications. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Neuropsychopharmacology, 39(6) : 1453-
1459
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Grisham, J. R., Becker, L., Williams,
A. D., Whitton, A. E., Makkar, S. R.
Cognitive-behavioural models of compulsive checking posit a dominant role for beliefs regarding onenulls responsibility to
prevent harm. In the current study we employed a computerised cognitive bias modification of interpretation (CBM-I) paradigm to target and modify
responsibility biases in a sample of undergraduate students with high levels of checking symptoms (N = 100). Participants were randomly assigned to
either a positive (decrease responsibility bias) or negative (increase responsibility bias) CBM-I training condition. Relative to participants in the
negative training condition, participants in the positive training condition demonstrated reduced responsibility bias in a subsequent interpretive
bias test. Positive training also resulted in more adaptive physiological responding during a responsibility stressor task. There were no
differential effects of CBM-I training, however, on observed or self-reported checking or self-reported responsibility beliefs. In light of these
mixed findings, we outline future avenues for improving the efficacy of CBM-I training targeting responsibility biases.
Cognitive Therapy & Research, 38(5) : 505-517
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS)