Disorders - Obsessive Compulsive Disorder
Reynolds, S. A., Clark, S., Smith, H., Langdon, P. E., Payne, R., Bowers, G., Norton, E., McIlwham, H.
Objective: Obsessive-compulsive disorder (OCD) in young people can be effectively treated with Cognitive Behavior Therapy
(CBT). Practice guidelines in the United Kingdom recommend that CBT be delivered with parental or family involvement; however, there is no evidence
from randomized trials that this enhances effectiveness. The aim of this trial was to assess if CBT with high parental involvement was more effective
than CBT with low parental involvement (individual CBT) in reducing symptoms of OCD. Method: Fifty young people ages 12-17 years with OCD were
randomly allocated to individual CBT or parent-enhanced CBT. In parent-enhanced CBT parents attended all treatment sessions; in individual CBT,
parents attended only Sessions 1, 7, and the final session. Participants received up to 14 sessions of CBT. Data were analyzed using intent-to-treat
and per-protocol methods. The primary outcome measure was the Children's Yale-Brown Obsessive Compulsion Scale (Scahill et al., 1997). Results: Both
forms of CBT significantly reduced symptoms of OCD and anxiety. Change in OCD symptoms was maintained at 6 months. Per-protocol analysis suggested
that parent-enhanced CBT may be associated with significantly larger reductions in anxiety symptoms. Conclusions: High and low parental involvement
in CBT for OCD in young people were both effective, and there was no evidence that 1 method of delivery was superior on the primary outcome measure.
However, this study was small. Future trials should be adequately powered and examine interactions with the age of the young person and comorbid
anxiety disorders. (copyright) 2013 American Psychological Association.
Journal of Consulting & Clinical
Psychology, 81(6) : 1021-1026
- 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)
Rezvan, S., Bahrami, F., Abedi, M., Macleod, C., Doost, H. T. N., Ghasemi, V.
Background: Research on attachment has shed new light on understanding one of
the underlying mechanisms of psychopathology in children. The aim of this study was to investigate the therapeutic efficacy of attachment based
intervention in a pediatric sample with obsessive compulsive disorder (OCD). Methods: Twelve participants, 10-12 years of age, were treated across an
eight week period. They had not been treated with either pharmacotherapy or psychotherapy previously and remained medication free during the
attachment based therapy. This study comprised two groups of children: The experimental group, who received attachment based intervention, and the
control group, who did not receive treatment. All participants were assessed in terms of severity of OCD symptoms by administrating the Children's
Yale-Brown Obsessive-Compulsive Scale before and after the experimental group had received the therapeutic sessions. The children were assessed again
one month later. The level of children's depression, and attachment insecurity, as well as their mothers' depression, OCD symptoms, and attachment
insecurity, were statistically controlled in this study. Results: Multivariate analysis of covariance (MANCOVA) indicated that the OCD symptoms in
children decreased significantly over the course of the therapy, and this gain was maintained at follow up. The results of this study demonstrated
that the attachment based intervention was efficacious in alleviating the OCD symptoms. Conclusion: It is suggested that parental instruction in
attachment based relationships may help prevent young children from developing OCD symptoms in middle childhood and adulthood.
International Journal of Preventive Medicine, 4(1) : 78-87
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Olatunji, Bunmi O., Davis, Michelle L, Powers, Mark B., Smits, Jasper A. J.
The present
investigation employed meta-analysis to examine the efficacy of cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) as well as
potential moderators that may be associated with outcome. A literature search revealed sixteen randomized-controlled trials (RCTs) with a total
sample size of 756 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures
at post-treatment (Hedges's g = 1.39) and at follow-up (Hedges's g = 0.43). Subsequent analyses revealed few moderators of CBT efficacy. Neither
higher pre-treatment OCD (p = 0.46) or depression symptom severity (p = 0.68) was significantly associated with a decrease in CBT effect size.
Similarly, effect size did not vary as a function of 'type' of CBT, treatment format, treatment integrity assessment, blind assessment, age of
onset, duration of symptoms, percentage of females, number of sessions, or percent comorbidity. However, active treatments showed smaller effect
sizes when compared to placebo controls than when compared to waitlist controls. Effect sizes were also smaller for adult RCTs than child RCTs.
Likewise, older age was associated with smaller effect sizes. However, an association between age and effect size was not observed when examining
child and adult samples separately. This review indicates that while CBT is efficacious in the treatment of OCD, more research is needed to identify
processes that may predict more favorable treatment responses.; Copyright © 2012 Elsevier Ltd. All rights reserved.
Journal of Psychiatric Research, 47(1) : 33-41
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Storch, Eric A., Bussing, Regina, Small, Brent J., Geffken, Gary
R., McNamara, Joseph P., Rahman, Omar, Lewin, Adam B., Garvan, Cynthia S., Goodman, Wayne K., Murphy, Tanya K.
Background: To examine the efficacy of sequential sertraline and cognitive-behavioral therapy (CBT) treatment relative to
CBT with pill placebo over 18 weeks in children and adolescents with obsessive-compulsive disorder (OCD). Methods: Forty-seven children and
adolescents with OCD (Range = 7-17 years) were randomized to 18- weeks of treatment in one of three arms: 1) sertraline at standard dosing + CBT
(RegSert + CBT); 2) sertraline titrated slowly but achieving at least 8weeks on the maximally tolerated daily dose + CBT (SloSert + CBT); or 3) pill
placebo + CBT (PBO + CBT). Assessments were conducted at screening, baseline,weeks 1-9,13, and 17, and post-treatment. Raters and clinicians were
blinded to sertraline (but not CBT) randomization status. Primary outcomes included the Children's Yale-Brown Obsessive-Compulsive Scale, and
response and remission status. Secondary outcomes included the Child Obsessive Compulsive Impact Scale-Parent/Child, Children's Depression Rating
Scale-Revised,Multidimensional Anxiety Scale for Children, and Clinical-Global Impressions-Severity. Results: All groups exhibited large within-group
effects across outcomes. There was no group by time interaction across all outcomes suggesting that group changes over time were comparable.
Conclusions: Among youth with OCD, there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with
CBT. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Behaviour
Research & Therapy, 51(12) : 823-829
- Year: 2013
- 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)
Rosa-Alcazar, A. I., Iniesta-Sepulveda, M., Rosa-Alcazar, A.
We
present the results of a systematic review on the effectiveness of pharmacological treatments for children and adolescents with obsessive-compulsive
disorder. Sixty-four studies fulfilled the selection criteria, being the most of them focused in SSRI and Clomipramine. The trials on augmentation
strategies and third line monotherapies are scarce, being the majority open-trials and case series. Similarly, studies on combined treatment
(psychological and pharmacological) are few; furthermore this is a relevant future research line. It is also remarkable the lack of quasi-
experimental and experimental comparison studies and the long-term follow-up measures.
Actas Espanolas De Psiquiatria, 41(3) : 196-203
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Antidepressants
(any)
Herbst, Nirmal, Voderholzer, Ulrich, Stelzer, Nicola, Knaevelsrud, Christine, Hertenstein, Elisabeth, Schlegl, Sandra, Nissen, Christoph Kulz, Anne Katrin
Background: Only a small percentage of patients
with obsessive-compulsive disorder (OCD) receive adequate treatment. Reasons include a high level of shame and stigmatisation and the paucity of
specialised treatment services. Telemental health (TMH) treatment could improve the therapeutic situation as has been shown for various mental
disorders. This review critically evaluates the current body of evidence on TMH applications for OCD patients. The review focuses on studies that
include exposure therapy with response prevention as the best validated treatment component.; Methods: Relevant publications were identified through
computerised searches of the databases PsycINFO and PubMed and manual searches. No date or study type restrictions were applied.; Results: Twenty-
four studies on different types of TMH applications were identified: bibliotherapy (7), telephone-delivered (11), computer-aided (3), online self-
help group (1) and video-conference (2). Nearly all interventions lead to a significant improvement of OC symptoms. Effect sizes ranged from 0.46 to
2.5.; Conclusions: Preliminary evidence suggests that TMH applications represent a low-threshold, efficacious, time-effective and economic treatment
for patients with OCD. Future studies are needed to further investigate the potential of TMH treatment to improve health care for patients with OCD.;
Copyright © 2012 Elsevier Ltd. All rights reserved.
Clinical
Psychology Review, 32(6) : 454-466
- Year: 2012
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS)
Geller, DA, March, MD
Research in etiology, neurobiology, genetics, clinical correlates, and evidence-based treatments in children and adolescents with
obsessive-compulsive disorder indicate a need for the revision of the Practice Parameters for the Assessment and Treatment of Children and
Adolescents with Obsessive-Compulsive Disorder first published a decade ago. The present article highlights the clinical assessment and reviews and
summarizes the evidence base for treatment. Based on this evidence, specific recommendations are provided for assessment, cognitive behavioral
therapy, pharmacotherapy, combined treatment, and other interventions. (copyright) 2012 American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent
Psychiatry, 51(1) : 98-113
- Year: 2012
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
DiFrancesco, M. F., Halpern, C. H., Hurtig, H. H., Baltuch, G. H., Heuer, G. G.
Purpose Based on the success of deep brain stimulation (DBS) in the treatment of adult disorders, it is reasonable to assume that the
application of DBS in the pediatric population is an emerging area worthy of study. The purpose of this paper is to outline the current movement
disorder indications for DBS in the pediatric population, and to describe areas of investigation, including possible medically refractory psychiatric
indications. Methods We performed a structured review of the English language literature from 1990 to 2011 related to studies of DBS in pediatrics
using Medline and PubMed search results. Results Twenty-four reports of DBS in the pediatric population were found. Based on published data on the
use of DBS for pediatric indications, there is a spectrum of clinical evidence for the use of DBS to treat different disorders. Dystonia, a disease
associated with a low rate of remission and significant disability, is routinely treated with DBS and is currently the most promising pediatric
application of DBS. We caution the application of DBS to conditions associated with a high remission rate later in adulthood, like obsessive-
compulsive disorder and Tourette's syndrome. Moreover, epilepsy and obesity are currently being investigated as indications for DBS in the adult
population; however, both are associated with significant morbidity in pediatrics. Conclusion While currently dystonia is the most promising
application of DBS in the pediatric population, multiple conditions currently being investigated in adults also afflict children and adolescents, and
thus warrant further research. (copyright)Springer-Verlag 2012.
Child's Nervous System, 28(10) : 1701-
1714
- Year: 2012
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Deep brain stimulation (DBS)
Fineberg, Naomi A., Brown, Angus, Reghunandanan, Samar, Pampaloni, Ilenia
Pharmacological strategies for the treatment of obsessive-compulsive disorder (OCD) continue to develop apace but deficiencies remain. We
present an updated literature review of the evidence supporting available strategies. We aim to answer key questions including: (1) What are the
first-line treatments? (2) Does pharmacotherapy improve health-related quality of life? (3) How do we evaluate clinical response and relapse? (4) How
long should treatment continue? (5) Can we predict treatment outcomes? (6) What is the management of treatment-refractory OCD? Selective serotonin
reuptake inhibitors (SSRIs) remain the pharmacological treatment of choice for most patients and are associated with improved health-related quality
of life. However, discontinuation is associated with relapse and loss of quality of life, implying treatment should continue long term. A substantial
minority of patients fail to respond to SSRI. Such patients may respond to strategies such as dose elevation or adjunctive antipsychotic, although
long-term trials validating the effectiveness and tolerability of these strategies are relatively lacking. Newer compounds targeting other
neurotransmitter systems, such as glutamate, are undergoing evaluation.;
International Journal of Neuropsychopharmacology, 15(8) : 1173-
1191
- Year: 2012
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Bloch, M., Panza, K., Grant, J. E., Leckman, J., Pittenger, C.
Background: N-acetylcysteine (NAC) is an over-the-
counter supplement that acts as an antioxidant and a glutamate modulatingagent. A randomized, placebo-controlled trial demonstrated theefficacy of
NAC in the treatment of adults with trichotillomania(TTM). The goal of the current study was to examine the efficacy ofNAC for the treatment of
pediatric TTM in a double-blind,placebo-controlled study.Methods: Thirty-nine children aged 8-17 years with pediatrictrichotillomania were randomly
assigned to receive NAC or matchingplacebo for 12 weeks. Our primary outcome was change in severity ofhairpulling as measured by the Massachusetts
General HospitalHairpulling Scale (MGH-HPS). Secondary measures assessed hairpullingseverity, automatic vs. focused pulling, clinician-rated
improvementand comorbid anxiety and depression. Outcomes wereexamined using linear mixed models to test the treatment x timeinteraction in an
intention-to-treat population.Results: No significant difference between N-acetylcysteine andplacebo was found on any of the primary or secondary
outcomemeasures. On several measures of hairpulling, subjects significantlyimproved with time regardless of treatment assignment.Twenty-five percent
of subjects in the NAC group were judged astreatment responders compared to 21% in the placebo group.Conclusions: We observed no benefit of NAC for
the treatment ofchildren with trichotillomania. Our findings stand in contrast to aprevious, similarly designed trial in adults with TTM, which
demonstrateda very large, statistically significant benefit of NAC. Based on thediffering results of NAC in pediatric and adult TTM populations,
theassumption that pharmacological interventions demonstrated to beeffective in adults with TTM will be as effective in children, may beinaccurate.
This trial highlights the importance of referring childrenwith TTM to appropriate behavioral therapy before initiatingpharmacological interventions,
as behavioral therapy has demonstratedefficacy in both children and adults with trichotillomania.
Neuropsychopharmacology, 38 : S270
- Year: 2012
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Vitamins and supplements
Soomro, G. M.
INTRODUCTION: Obsessions or compulsions that cause personal distress or social dysfunction affect about 1% of adult men and 1.5% of
adult women. About half of adults with obsessive compulsive disorder (OCD) have an episodic course, whereas the other half have continuous problems.
Prevalence in children and adolescents is 2.7%. The disorder persists in about 40% of children and adolescents at mean follow-up of 5.7 years.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of initial
treatments for obsessive compulsive disorder in adults? What are the effects of initial treatments for obsessive compulsive disorder in children and
adolescents? What are the effects of maintenance treatment for obsessive compulsive disorder in adults? What are the effects of maintenance treatment
for obsessive compulsive disorder in children and adolescents? What are the effects of treatments for obsessive compulsive disorder in adults who
have not responded to initial treatment with serotonin reuptake inhibitors (SRIs)? We searched: Medline, Embase, The Cochrane Library, and other
important databases up to April 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of
this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and
Healthcare products Regulatory Agency (MHRA). RESULTS: We found 43 systematic reviews, RCTs, or observational studies that met our inclusion
criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information
relating to the effectiveness and safety of the following interventions: addition of antipsychotics to serotonin reuptake inhibitors, behavioural
therapy alone or with serotonin reuptake inhibitors, cognitive therapy or cognitive behavioural therapy (CBT) (alone or with serotonin reuptake
inhibitors), electroconvulsive therapy, optimum duration of maintenance treatment, psychosurgery, serotonin reuptake inhibitors (citalopram,
clomipramine, fluoxetine, fluvoxamine, paroxetine, or sertraline), and transcranial magnetic stimulation.
BMJ clinical
evidence, (pagination) :
- Year: 2012
- 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)
Franklin, M. E., Edson, A. L., Ledley, D. A., Cahill, S. P.
Objective: To examine the efficacy and durability of a behavioral therapy (BT) protocol for pediatric TTM compared with a
minimal attention control (MAC) condition. It was hypothesized that the BT condition would be superior to MAC at the end of acute treatment, and
would also demonstrate durability of gains through the maintenance treatment phase. Method: A randomized controlled trial in which 24 youths were
assigned to either a pilot-tested BT protocol, consisting of eight weekly sessions, or to MAC, consisting of three sessions and five telephone calls
over 8 weeks. Independent evaluators assessed outcome at pretreatment (week 0) and post-treatment (week 8) for BT and MAC, and again at week 16 for
BT patients only. The primary outcome measure was the National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS). Results: For
the BT condition, the week 8 mean NIMH-TSS score was significantly lower than that of the MAC condition. The BT condition's mean week 8 score was
also significantly lower than their own mean week 0 score, whereas no such reductions were observed for the MAC condition. Upon completion of acute
treatment at week 8, the BT group's gains were maintained through an 8-week maintenance treatment phase. Conclusions: BT produced a superior outcome
compared with a condition that controlled for participation in a pediatric TTM research study, nonspecific therapist contact effects, repeated
assessments, and the passage of time. Maintenance of gains after acute BT provides preliminary support for the durability of treatment gains.
Journal of the American Academy of Child &Adolescent Psychiatry, 50(8) : 763-
771
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)