Disorders - Obsessive Compulsive Disorder
Merlo, L. J., Storch, E. A., Lehmkuhl,
H. D., Jacob, M. L., Murphy, T. K., Goodman, W. K., Geffken, G. R.
Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients
with obsessive-compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence
and support their self-efficacy in their efforts at behavior change. The authors present a preliminary randomized trial (N = 16) to evaluate the
effectiveness of adding motivational interviewing (MI) as an adjunct to CBT. Patients aged 6 to 17 years who were participating in intensive family-
based CBT for OCD were randomized to receive either CBT plus MI or CBT plus extra psychoeducation (PE) sessions. After four sessions, the mean
Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score for the CBT plus MI group was significantly lower than for the CBT plus
psychoeducation group, t(14) = 2.51, p < .03, Cohen's d = 1.34. In addition, the degree of reduction in CY-BOCS scores was significantly greater, t
(14) = 2.14, p = .05, Cohen's d = 1.02, for the CBT plus MI group (mean (Delta) = 16.75, SD = 9.66) than for the CBT plus psychoeducation group
(mean (Delta) = 8.13, SD = 6.01). This effect decreased over time, and scores at posttreatment were not significantly different. However,
participants in the MI group completed treatment on average three sessions earlier than those in the psychoeducation group, providing support for the
utility of MI in facilitating rapid improvement and minimizing the burden of treatment for families. (copyright) 2010 Taylor & Francis.
Cognitive Behaviour Therapy, 39(1) : 24-
27
- Year: 2010
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Motivational interviewing, includes Motivational Enhancing Therapy
Marazziti, D., Consoli, G., Baroni, S., Dell'Osso, M. Catena
In the last decades, the treatment of obsessive-compulsive disorder (OCD) has been revolutioned by the
introduction into the clinical practice of the selective serotonin (5-HT) reuptake inhibitors (SSRIs), following the observation of the unique
response of OCD patients to clomipramine. However, if with no doubt the 5-HT system is central to the pharmacological treatment of OCD, it is
unlikely that it represents the whole story. In fact, different studies suggest abnormalities of other neurotransmitters, neuropeptides or second
messengers, so that it can be hypothesized that the possible heterogeneity of pathophysiological mechanisms might underlie the different clinical
pictures and responses to treatment. Moreover, latest developments in the pharmacology of SSRIs have shown that they share the common property of 5-
HT reuptake blockade, but, with the exception of citalopram and escitalopram, they do interact with other receptors and systems. In this paper, the
latest findings on pharmacological treatments of OCD will be reviewed, together with a focus on putative targets for future drugs, such as the
glutamate system or second messengers, and the problems related to treating OCD in different ages.
Current Medicinal Chemistry, 17(29) : 3410-3421
- Year: 2010
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Najmi, S., Amir, N.
In the current study, we evaluated the effectiveness of attention training in individuals with
subclinical obsessive-compulsive symptoms. We hypothesized that after completing attention training, participants would be more likely to complete
steps in a hierarchy approaching their feared contaminant compared with participants in the control condition. Participants completed a probe
detection task by identifying letters replacing one member of a pair of words (neutral or contamination related). We trained attention by building a
contingency between the location of the contamination-related word in the active condition and not in the control condition. Participants in the
active group showed a significant reduction in attention bias for threat and completed significantly more steps when approaching their feared objects
compared with participants in the control group. Our results suggest that attention disengagement training may facilitate approaching feared objects
in individuals with obsessive-compulsive symptoms. (copyright) 2010 American Psychological Association.
Journal of Abnormal Psychology, 119(1) : 136-142
- Year: 2010
- 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
Khodarahimi, S.
The purpose of present study was to test the comparative effectiveness of Satiation Therapy and Exposure Response Prevention techniques in the
treatment of obsessive-compulsive disordered patients. Sixty self-referred male outpatient cases were investigated within a randomized controlled
trial. Patients were allocated to Satiation Therapy, Exposure Response Prevention or wait-list control groups. Obsessive-compulsive symptoms were
measured by the Yale-Brown Obsessive Compulsive Scale at baseline, post-treatment, and 3 and 6 month follow-ups. The therapeutic groups had more
significant improvement than the control group. In addition, there was not a significant difference between therapeutic groups on post-treatment and
follow-up assessments which showed that Satiation Therapy and Exposure Response Prevention were similarly effective in reducing obsessive-compulsive
symptoms. Analyses revealed that therapeutic groups had improved significantly while the control group had continued unchanged. Finally, the present
investigation supported both Satiation Therapy and Exposure Response Prevention in the treatment of obsessive-compulsive disorder. (copyright) 2009
Springer Science+Business Media, LLC.
Journal of Contemporary Psychotherapy, 39(3) : 203-
207
- Year: 2009
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Other Psychological Interventions
O'Leary, E. M. M., Barrett, P., Fjermestad, K. W.
This study evaluated the long-term durability of individual and group cognitive-
behavioral family-based therapy (CBFT) for childhood obsessive-compulsive disorder (OCD). Thirty-eight participants (age 13-24 years) from a
randomized controlled trial of individual or group CBFT for childhood OCD were assessed 7 years post-treatment. Diagnostic, symptom severity
interviews and self-report measures of OCD, anxiety, and depression were administered. Seven years after treatment, 79% of participants from
individual therapy and 95% from group therapy had no diagnosis of OCD. These results are near identical to results found at 12 and 18 months follow-
ups of the same sample. No significant differences were found between treatment conditions, self-reports of symptom severity, except that depressive
symptoms were significantly more pronounced for individual treatment condition, and those in the older age group (19-24 years of age). Results
suggest that CBFT for obsessive-compulsive disorder is effective 7 years post-treatment. (copyright) 2009 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders, 23(7) : 973-978
- Year: 2009
- Problem: Obsessive Compulsive Disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Kaiser, B., Bouvard,
M.
The empirical literature on treatment of obsessive-compulsive
disorder (OCD) in children and adolescents supports the efficacy of OCD-specific cognitive-behavioural therapy (CBT) or pharmacotherapy with
selective serotonin reuptake inhibitors (SSRI). However, little is known about their combined efficacy in this type of population. The objective of
this article was to review the whole of work referring to the implementation of therapeutic protocols associating CBT and medication. It revealed
that treatments with the combination of CBT plus a SSRI seem to be at least as effective as the CBT alone with children and adolescents suffering
from OCD, and that these two methods of treatment would be at the origin of a reduction in the severity of OCD, in spite of the presence of
comorbidities considered as factors of bad treatment prognosis. In addition, the combination between CBT and atypical antipsychotics could constitute
a promising approach for the treatment of OCD. Future research will have to confirm these preliminary results coming from too few studies, often not
controlled, or simple case studies. (copyright) 2009 Giovanni Fioriti Editore s.r.l.
Clinical Neuropsychiatry, 6(2) : 94-
100
- Year: 2009
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Alaghband-Rad, J., Hakimshooshtary, M.
Objective: Several controlled
trials have demonstrated the efficacy and safety of Fluoxetine in children and adolescents with Obsessive-Compulsive Disorder (OCD), but there is no
controlled study on the effectiveness of Citalopram in this group. This report describes the use of Citalopram in comparison with Fluoxetine in
childhood-onset OCD. Method: This study is a randomized, double blind, fixed-does (20mg) trial of Fluoxetine versus Citalopram in 29 children and
adolescents (17 boys and 12 girls) with OCD, aged 7-18 years (mean 13.8 and SD 3.05). The length of study was 6 weeks. Obsessive-Compulsive symptom
severity was measured by Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and Clinician's Global Impression Scale (CGI). DICA (Diagnostic Interview
of Children and Adolescents) was used to diagnose the psychiatric disorders. Results: Each group showed significant improvement over the baseline as
measured by the CY-BOCS (p < 0.01) but not by CGI (p = NS). The Comparison between two groups showed no significant differences in efficacy and
safety of the drugs. Most common adverse effects were headache for Citalopram and tremor for Fluoxetine. Conclusion: The results suggest that
Citalopram is as safe and effective as Fluoxetine for children and adolescents with OCD. Further studies are needed to replicate our findings.
(copyright) 2009 Steinkopff Verlag Darmstadt.
European Child & Adolescent
Psychiatry, 18(3) : 131-135
- Year: 2009
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Sheehan, David V., Kamijima, Kunitoshi
Sertraline is a selective serotonin reuptake inhibitor that has been used and studied extensively throughout the
world and found to be safe and well tolerated in numerous patient populations, including those with either psychiatric and/or medical comorbidities.
Randomized clinical trials have shown that it is an effective treatment for depressive and anxiety disorders and its efficacy is unaffected by
psychiatric comorbidity. In non-comorbid patients, sertraline is effective for the acute treatment of major depressive disorders and prevention of
relapse or recurrence. It is effective for acute treatment and longer-term management of social anxiety disorder, posttraumatic stress disorder,panic
disorder, and generalized anxiety disorder. In adults and in pediatric patients, it is an effective short-term and long-term treatment for obsessive
compulsive disorder.Sertraline has a good tolerability profile and has low fatal toxicity. In summary, sertraline is as effective as other
antidepressants over a wide range of indications but may offer tolerability benefits as well as efficacy in patients with psychiatric and/or medical
comorbidities and certain subtypes of depression.
International Clinical Psychopharmacology, 24(2) : 43-60
- Year: 2009
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Bolton, D., Perrin, S.
The present study was undertaken to estimate the effect of exposure plus response-prevention
(E/RP), delivered alone intensively over 5-weeks and without concomitant pharmacotherapy, for children and adolescents with OCD. Twenty children and
adolescents with OCD, not receiving medication for this condition, were randomized to E/RP or a wait-list condition. Statistically and clinically
significant symptomatic improvement was found in the E/RP group compared with controls, with improvement maintained at follow-up an average of 14
weeks later. Effect size in the main intention-to-treat analysis was 1.23 and in the secondary per protocol analysis was 1.64. This study lends
further support to the view that E/RP is an effective treatment for childhood OCD. (copyright) 2007 Elsevier Ltd. All rights reserved.
Journal
of Behavior Therapy & Experimental Psychiatry, 39(1) : 11-22
- Year: 2008
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention
Hanstede, Marijke, Gidron, Yori, Nyklicek, Ivan
This controlled pilot study tested the effects of a mindfulness intervention on obsessive compulsive disorder (OCD)
symptoms and tested the psychological processes possibly mediating such effects. Participants with OCD symptoms (12 women, 5 men) received either
mindfulness training (N=8) or formed a waiting-list control group (N = 9). Meditation included 8 group meetings teaching meditative breathing, body-
scan, and mindful daily living, applied to OCD. The intervention had a significant and large effect on mindfulness, OCD symptoms, letting go, and
thought-action fusion. Controlling for changes in \"letting go,\" group effects on change in OCD symptoms disappeared, pointing at a mediating role
for letting go. This may be the first controlled study demonstrating that a mindfulness intervention reduces OCD symptoms, possibly explained by
increasing letting go capacity. If replicated in larger and clinical samples, mindfulness training may be an alternative therapy for OCD.
Journal
of Nervous & Mental Disease, 196(10) : 776-9
- Year: 2008
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Mindfulness based
therapy
Freeman, Jennifer B., Garcia, Abbe M., Coyne, Lisa, Ale, Chelsea, Przeworski, Amy, Himle, Michael, Compton, Scott, Leonard, Henrietta L.
OBJECTIVE: To examine the relative efficacy of family-based cognitive-behavioral therapy (CBT) versus family-based relaxation treatment
(RT) for young children ages 5 to 8 years with obsessive-compulsive disorder (OCD). METHOD: Forty-two young children with primary OCD were randomized
to receive 12 sessions of family-based CBT or family-based RT. Assessments were conducted before and after treatment by independent raters blind to
treatment assignment. Primary outcomes included scores on the Children's Yale-Brown Obsessive Compulsive Scale and Clinical Global Impressions-
Improvement. RESULTS: For the intent-to-treat sample, CBT was associated with a moderate treatment effect (d = 0.53), although there was not a
significant difference between the groups at conventional levels. For the completer sample, CBT had a large effect (d = 0.85), and there was a
significant group difference favoring CBT. In the intent-to-treat sample, 50% of children in the CBT group achieved remission as compared to 20% in
the RT group. In the completer sample, 69% of children in the CBT group achieved a clinical remission compared to 20% in the RT group. CONCLUSIONS:
Results indicate that children with early-onset OCD benefit from a treatment approach tailored to their developmental needs and family context. CBT
was effective in reducing OCD symptoms and in helping a large number of children achieve a clinical remission.
Journal of the American Academy of Child &
Adolescent Psychiatry, 47(5) : 593-602
- Year: 2008
- 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), Relaxation
Watson, Hunna J., Rees, Clare
S.
OBJECTIVE: To conduct a meta-analysis on randomized, controlled treatment trials of pediatric obsessive-
compulsive disorder (OCD). METHOD: Studies were included if they employed randomized, controlled methodology and treated young people (19 years or
under) with OCD. A comprehensive literature search identified 13 RCTs containing 10 pharmacotherapy to control comparisons (N = 1016) and five
cognitive-behavioral therapy (CBT) to control comparisons (N = 161). RESULTS: Random effects modeling yielded statistically significant pooled effect
size (ES) estimates for pharmacotherapy (ES = .48, 95% CI = .36 to .61, p < .00001) and CBT (ES = 1.45, 95% CI = .68 to 2.22, p = .002). The results
were robust to publication bias. CONCLUSIONS: This is the first meta-analysis of treatment RCTs for pediatric OCD. CBT and pharmacotherapy were the
only treatments effective beyond control in alleviating OCD symptoms. CBT showed a greater ES than pharmacotherapy. Previous meta-analyses that
included uncontrolled trials exaggerated the efficacy of both treatments.
Journal of Child Psychology & Psychiatry &
Allied Disciplines, 49(5) : 489-98
- Year: 2008
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)