Disorders - Obsessive Compulsive Disorder
Mataix-Cols, D., Turner, C., Monzani, B., Isomura, K., Murphy, C., Krebs, G., Heyman, I.
A partial N-methyl-D-aspartate agonist, D-cycloserine, enhances fear extinction when given before or shortly after exposure to feared
stimuli in animals. In this pilot double-blind placebo-controlled trial (trial number: ISRCTN70977225), 27 youth with obsessive-compulsive disorder
were randomised to either 50mg D-cycloserine or placebo administered immediately after each of ten cognitive-behavioural therapy (CBT) sessions,
primarily consisting of exposure and ritual prevention. Both groups improved significantly and maintained their gains at 1-year follow-up, with no
significant advantage of D-cycloserine over placebo at any time point. The effects of CBT may not be augmented or accelerated when D-cycloserine is
administered after sessions.
British Journal of Psychiatry, 204(1) : 77-
78
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), D-cycloserine (DCS)
Freeman, J., Sapyta, J., Garcia, A., Compton, S., Khanna, M., Flessner, C., FitzGerald, D., Mauro, C., Dingfelder, R., Benito, K., Harrison, J., Curry, J., Foa, E., March, J., Moore, P., Franklin, M.
IMPORTANCE Cognitive behavior therapy (CBT) has been established as efficacious for obsessive-compulsive disorder (OCD)
among older children and adolescents, yet its effect on young children has not been evaluated sufficiently. OBJECTIVE To examine the relative
efficacy of family-based CBT (FB-CBT) involving exposure plus response prevention vs an FB relaxation treatment (FB-RT) control condition for
children 5 to 8 years of age. DESIGN, SETTING, AND PARTICIPANTS A 14-week randomized clinical trial (Pediatric Obsessive-Compulsive Disorder
Treatment Study for Young Children [POTS Jr]) conducted at 3 academic medical centers between 2006 and 2011, involving 127 pediatric outpatients 5 to
8 years of age who received a primary diagnosis of OCD and a Children's Yale-Brown Obsessive Compulsive Scale total score of 16 or higher.
INTERVENTIONS Participants were randomly assigned to 14 weeks of (1) FB-CBT, including exposure plus response prevention, or (2) FB-RT. MAIN OUTCOMES
AND MEASURES Responder status defined as an independent evaluator-rated Clinical Global Impression-Improvement scale score of 1 (very much improved)
or 2 (much improved) and change in independent evaluator-rated continuous Children's Yale-Brown Obsessive Compulsive Scale total score. RESULTS
Family-based CBT was superior to FB-RT on both primary outcome measures. The percentages of children who were rated as 1 (very much improved) or 2
(much improved) on the Clinical Global Impression-Improvement scale at 14 weeks were 72%for FB-CBT and 41% for FB-RT. The effect size difference
between FB-CBT and FB-RT on the Clinical Global Impression-Improvement scale was 0.31 (95%CI, 0.17-0.45). The number needed to treat (NNT) with FB-
CBT vs FB-RT was estimated as 3.2 (95%CI, 2.2-5.8). The effect size difference between FB-CBT and FB-RT on the Children's Yale-Brown Obsessive
Compulsive Scale at week 14 was 0.84 (95%CI, 0.62-1.06). CONCLUSIONS AND RELEVANCE A comprehensive FB-CBT program was superior to a relaxation
program with a similar format in reducing OCD symptoms and functional impairment in young children (5-8 years of age) with OCD. Copyright 2014
American Medical Association. All rights reserved.
JAMA Psychiatry, 71(6) : 689-698
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention, Relaxation
Park, J. M., Small, B. J., Geller, D. A., Murphy, T. K., Lewin, A. B., Storch, E. A.
Clinical studies in adults and children with obsessive - compulsive
disorder (OCD) have shown that D-cycloserine (DCS) can improve treatment response by enhancing fear extinction learning during exposure-based
psychotherapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework
tasks, a core component of behavioral treatment. The present study examined the relationship between DCS augmented cognitive- behavioral therapy
(CBT) and homework compliance in a double-blind, placebo controlled trial with 30 youth with OCD. All children received 10 CBT sessions, the last
seven of which included exposure and response prevention paired with DCS or placebo dosed 1 h before the session started. Results suggested that DCS
augmented CBT did not predict improved homework compliance over the course of treatment, relative to the placebo augmented CBT group. However, when
groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that while DCS may not increase
homework compliance over time, more generally, homework compliance is an integral part of pediatric OCD treatment outcome. (PsycINFO Database Record
(c) 2014 APA, all rights reserved). (journal abstract)
Journal of Child & Family
Studies, 23(5) : 863-871
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention, D-cycloserine (DCS)
Baldwin, D.S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den-Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., Malizia, A., McCrone, P., Nabarro, D., O'Neill, C, Scott, J., van-der-Wee, N., Wittchen, H-U.,
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based
pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute
treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A
consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting
evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants,
and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source
of information for patients, their carers, and medicines management and formulary committees.;
Journal of
Psychopharmacology, 28(5) : 403-439
- Year: 2014
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Beadel, J. R., Smyth, F. L., Teachman, B. A.
Multiple studies have found that cognitive bias modification (CBM) can be an effective intervention to reduce maladaptive, anxiety-linked
cognitive biases and symptoms, but little is known about how it achieves its effects. CBM is posited to work by altering contingency learning about
potential threat cues, rather than via habituation of fear and arousal (as hypothesized for exposure-based interventions). In the current study,
multi-level modeling was used to examine the trajectories of potential change processes over the course of CBM for interpretation bias in a sample
high in obsessive-compulsive (OC) symptoms (n = 75). Psychophysiological arousal (heart rate and galvanic skin response), subjective fear, and the
development of a learned contingency between ambiguity tied to threat and safe outcomes were measured before, during, and after CBM. Results showed
that, compared to a control group, CBM was effective at reducing OC beliefs (though not responses to subsequent OC stressors). Additionally, as
expected, only contingency learning significantly changed as a function of training condition, while subjective fear and arousal did not. Moreover,
post-training indicators of contingency learning predicted the extent OC beliefs changed from pre- to post-training for the \"positive\" CBM group
only (and not for the control group). This indicates that CBM is likely not operating similarly to habituation, but is instead marked by change in
cognitive processing. However, change in contingency learning did not fully mediate the effect of this intervention on change in OC beliefs,
suggesting more work is needed to fully understand the mechanisms underlying CBM. (copyright) 2013 Springer Science+Business Media.
Cognitive Therapy &
Research, 38(2) : 103-119
- Year: 2014
- 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
Sanchez-Meca, J., Rosa-Alcazar, A. I., Iniesta-Sepulveda, M., Rosa-Alcazar, A.
The aim of this paper is to present a meta-analysis about the differential efficacy of
cognitive-behavioral therapy (CBT), pharmacological and combined treatment for pediatric obsessive-compulsive disorder (OCD). The literature research
and the application of the inclusion criteria enabled us to locate 18 studies, yielding a total of 24 independent comparisons between a treated (10
pharmacological, 11 CBT, and 3 combined interventions) and a control group. All types of interventions were efficacious in reducing obsessive-
compulsive symptoms, with effect sizes adjusted by the type of control group of d=1.203 for CBT, d=0.745 for pharmacological treatments, and d=1.704
for mixed treatments. Depression, anxiety and other secondary responses were also improved, especially with CBT interventions. The analysis of
moderator variables showed that the CBT protocol and the total of intervention hours exhibited a significant influence on the effect size. Within
pharmacological treatment, clomipramine (d=1.305) was more efficacious than selective serotonin reuptake inhibitors (d=0.644), but its adverse
effects were more severe. Finally, the clinical implications of the results are discussed.; Copyright © 2013 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders, 28(1) : 31-
44
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Shavitt, R. G., DeMarco,
M., Batistuzzo, M. C., Oki, F. H., Bernardes, E., Monti, C., Morais, I., Borcato, S. R., Fatori, D.
Background: Neuropsychological studies
indicate that impairment on planning strategies could mediate visual episodic memory deficits observed in obsessivecompulsive disorder (OCD)
patients. The aims of this study were: (1) to verify if episodic memory is affected by visual information planning strategies and (2) to explore the
influence of treatment on the improvement of planning and nonverbal memory skills in pediatric patients. Methods: Sixty-five OCD patients, aged 6-17
years, participating in a randomized trial, were evaluated at baseline and post-treatment with either group Cognitive- Behavioral Therapy (CBT, n=33)
or Fluoxetine (FLX, n=32). CBT was delivered in 2-hour sessions for 14 weeks. FLX was administered in a daily dose range of 20-60mg for 14 weeks.
Severity of symptoms was measured with the Yale-Brown Obsessive-Compulsive Scale at baseline and post-treatment. Planning skills and nonverbal memory
were assessed through the Rey Complex Figure (at baseline) and the Taylor Complex Figure (at post-treatment). Results: At baseline, a linear
regression analysis indicated that planning strategies affected performance in recall information (immediate recall: r2=0.20, (beta)=2.28, p<0.001;
delayed recall: r2=0.16, (beta)=2.15, p=0.001). At post-treatment, the Wilcoxon test showed a significant improvement on the planning ability
(p<0.001), on the immediate (p<0.001) and delayed recall (p<0.001) of the complex figure. Moreover, both treatments were equally effective in
improving the cognitive performance in the aforementioned tests (Mann-Whitney test, p<0.001). Conclusions: First line treatments for OCD, regardless
the modality (cognitivebehavioral therapy or pharmacological), seem to positively influence the planning ability and nonverbal memory in OCD
pediatric patients.
Biological
Psychiatry, 75(9) : 195S
- Year: 2014
- 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), Cognitive & behavioural therapies (CBT)
Fabricant, L. E., Abramowitz, J. S., Dehlin, J. P., Twohig, M. P.
Exposure and response prevention (ERP) is the most
effective psychological treatment for unwanted, intrusive thoughts associated with obsessive-compulsive disorder (OCD). However, the procedures
involved in ERP (i.e., exposure) are challenging, provoke high levels of anxiety, and may contribute to treatment refusal and dropout (Franklin &
Foa, 1998). To address this problem, researchers have begun to evaluate alternative treatments for OCD, such as Acceptance and Commitment Therapy
(ACT). Despite the value of both techniques, little is known about the differential impact of these strategies. This study examined the relative
effects of a single session of ACT or exposure for obsessional thoughts. There were 56 undergraduate participants with obsessional thoughts randomly
assigned to receive a brief intervention with the core components of exposure, ACT, or an expressive writing control condition. Obsessional symptoms
and related process variables were assessed at baseline and at 1-week follow-up. There were no statistical differences in believability or
acceptability of the 3 conditions. Significant reductions in obsessional severity, behavioral tests of distress and willingness to experience
intrusive thoughts, and negative appraisals of intrusive thoughts occurred in all conditions, but no differences were found between these conditions.
Furthermore, changes in dysfunctional beliefs, but not in willingness to experience intrusive thoughts, predicted changes in obsessional symptoms in
both the ACT and exposure conditions. (copyright) 2013 Springer Publishing Company.
Journal of
Cognitive Psychotherapy, 27(3) : 195-
209
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Acceptance & commitment therapy
(ACT), Creative expression: music, dance, drama, art
Farrell, Lara J., Waters, Allison M., Boschen, Mark J., Hattingh, Laetitia, McConnell, Harry, Milliner, Ella L., Collings, Nigel, Shelton, Doug, Ollendick, Thomas H., Testa, Chris, Storch, Eric A.
Background: This study examined the feasibility and preliminary effectiveness of D-cycloserine (DCS)
- augmented cognitive behavioral therapy (CBT) for children and adolescents with difficult-to-treat Obsessive Compulsive Disorder, in a double-blind
randomized controlled pilot trial (RCT). Methods: Seventeen children and adolescents (aged 8 - 18 years) with a primary diagnosis of OCD, which was
deemed difficult-to-treat, were randomly assigned to either nine sessions of CBT including five sessions of DCS-augmented exposure and response
prevention (ERP) [ERP + DCS] or nine sessions of CBT including five sessions of placebo-augmented ERP [ERP + PBO]. Weight-dependent DCS or placebo
doses (25 or 50 mg) were taken 1 hour before ERP sessions. Results: At posttreatment, both groups showed significant improvements with 94% of the
entire sample classified as responders. However, a greater improvement in the ERP + DCS relative to the ERP + PBO condition was observed at 1-month
follow-up on clinician-rated obsessional severity and diagnostic severity, and parent ratings of OCD severity. There were no changes across time or
condition from 1- to 3-month follow-up. Conclusions: In this preliminary study, DCS-augmented ERP produced significant improvements in OCD severity
from posttreatment to 1-month follow-up, relative to a placebo control condition, in severe and difficult-to-treat pediatric OCD. The significant
effect on obsessional severity suggests that DCS augmentation might be associated with enhanced modification of obsessional thoughts during ERP, and
warrants further investigation. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Depression & Anxiety, 30(8) : 723-731
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention, D-cycloserine (DCS)
Fineberg, Naomi A., Reghunandanan, Samar, Brown, Angus, Pampaloni, Ilenia
Background: Obsessive-compulsive disorder (OCD) is a neuropsychiatric
disorder associated with a significant degree of functional disability and poor quality of life. Pharmacotherapy may have a substantial impact on the
course and outcome of OCD.; Method: We review the evidence supporting available strategies for the pharmacological treatment of OCD.; Results:
Selective serotonin reuptake inhibitors (SSRIs) remain the pharmacological treatment of choice and are associated with improved health-related
quality of life. Discontinuation is associated with relapse and loss of quality of life, implying treatment should continue long-term. A substantial
minority of patients who fail to respond to SSRI may benefit from dose elevation or adjunctive antipsychotics, though long-term trials validating the
effectiveness and tolerability of these strategies are relatively lacking.; Conclusion: The pharmacological evidence-base for the treatment of OCD is
becoming increasingly robust. Treatment with SSRIs and clomipramine remains uncontroversial and improvements are sustained over time. Newer compounds
targeting serotonin receptor subtypes and other neurotransmitter systems are undergoing evaluation.;
Australian & New Zealand Journal of Psychiatry, 47(2) : 121-
141
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Peris, Tara S., Piacentini, John
Family factors such as conflict, blame, and poor cohesion have been found
to attenuate response to cognitive behavior therapy (CBT) for pediatric obsessive compulsive disorder (OCD). This study examined the feasibility and
acceptability of a brief, personalized intervention for cases of pediatric OCD complicated by these family features. Twenty youth with a primary
Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of OCD (M age = 12.50 years; 55% male; 60% Caucasian) and their families
participated. To be included in the study, families were required to evidence poor functioning on measures of blame, conflict, and/or cohesion.
Eligible families were randomly assigned either to standard treatment (ST) with 12 weeks of individual child CBT that included weekly parent check-
ins and psychoeducation or to Positive Family Interaction Therapy (PFIT), which consisted of 12 weeks of individual child CBT plus an additional 6
sessions of family treatment aimed at shifting family dynamics. Clinical outcomes were determined by blind independent evaluators using the
Clinician's Global Impressions-Improvement (CGI-I) scale. All families completed the study. High levels of satisfaction were reported among
participants in both arms of the study, despite the added burden of attending the PFIT sessions. Both mothers and fathers attended 95% of the PFIT
family sessions. Families in the ST condition demonstrated a 40% response rate on the CGI-I; families in the PFIT condition demonstrated a 70%
response rate. Treatment gains were maintained in both conditions at 3-month follow-up. Preliminary data suggest that PFIT is acceptable and
feasible. Further testing and treatment development are needed to optimize outcomes for complicated cases of pediatric OCD.;
Journal of Clinical Child & Adolescent Psychology, 42(1) : 1-
8
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy
Koprivova, J., Congedo, M., Raszka, M., Prasko, J., Brunovsky, M., Horacek, J.
Aims: The goal of this study was to assess the effect of independent component neurofeedback (NFB) on EEG and clinical
symptoms in patients with obsessive-compulsive disorder (OCD). Subsequently, we explored predictors of treatment response and EEG correlates of
clinical symptoms. Methods: In a randomized, double-blind, parallel design, 20 inpatients with OCD underwent 25 sessions of NFB or sham feedback
(SFB). NFB aimed at reducing EEG activity in an independent component previously reported abnormal in this diagnosis. Resting-state EEG recorded
before and after the treatment was analyzed to assess its posttreatment changes, relationships with clinical symptoms and treatment response.
Results: Overall, clinical improvement in OCD patients was not accompanied by EEG change as assessed by standardized low-resolution electromagnetic
tomography and normative independent component analysis. Pre- to posttreatment comparison of the trained component and frequency did not yield
significant results; however, in the NFB group, the nominal values at the downtrained frequency were lower after treatment. The NFB group showed
significantly higher percentage reduction of compulsions compared to the SFB group (p = 0.015). Pretreatment higher amount of delta (1-6 Hz) and low
alpha oscillations as well as a lower amount of high beta activity predicted a worse treatment outcome. Source localization of these delta and high
beta oscillations corresponded with previous EEG resting-state findings in OCD patients compared to healthy controls. Conclusion: Independent
component NFB in OCD proved useful in percentage improvement of compulsions. Based on our correlation analyses, we hypothesize that we targeted a
network related to treatment resistance. (copyright) 2013 S. Karger AG, Basel.
Neuropsychobiology, 67(4) : 210-223
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Biofeedback, neurofeedback, audio/video feedback