Disorders - Obsessive Compulsive Disorder
Black, M. J., Grisham, J. R.
Pathological doubting and checking is a common symptom presentation in
obsessive-compulsive disorder (OCD). Previous research has established that compulsive checkers do not display an actual memory deficit, but lack
confidence in their memories and experience intolerance of uncertainty regarding the completion of tasks. We investigated whether interpretive
cognitive bias modification (CBM-I) reduced memory distrust and intolerance of uncertainty in a nonclinical sample. We also examined the possible
enhancement of CBM-I for OCD through imagery training. The results provide evidence that participants who received positive imagery CBM-I training
may have interpreted novel ambiguous checking scenarios more adaptively and endorsed negative checking beliefs less relative to participants in the
control imagery CBM-I condition. Findings on behavioural checking tasks did not indicate any specific response to CBM-I training. Future research may
translate these suggestive findings into a useful adjunct to traditional strategies targeting maladaptive OCD beliefs. Copyright © 2016 Elsevier
Ltd.
Behaviour Research and Therapy, 83 : 45-
52
- Year: 2016
- 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
Shavitt, R. G.
Objectives: This study aimed
to implement a sequential treatment trial for pediatric OCD. Methods: The attendance rates, postbaseline assessments, treatment adherence, and
completion were measured along a sequential randomized trial comprising four adaptive treatment strategies (ATSs). First, subjects were allocated to
group CBT (GCBT) or fluoxetine (FLX) for 14 weeks. Responders to the initial treatment continued to receive treatment for additional 14 weeks.
Nonresponders, defined by less than 50 percent reduction in baseline Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, were re-randomized to
either switch to or add the other treatment. Assessments were performed at baseline and at the middle and end of treatments. Results: Eighty-three
children [40 males, mean age (SD) = 11.8 (3.1) years] were randomized. Sixty-eight (81.9 percent) subjects completed the first treatment, and 63
(75.9 percent) completed the study. The overall rate of appointments/sessions attendance was 78.6 percent. Seventy-four (89.1 percent) subjects
completed at least one postbaseline assessment. Compliance with pharmacological treatment was high. The presence of a comorbid depressive disorder
was associated with dropout. The four groups improved after treatment [percent reduction of YBOCS scores (SD) from baseline to the end of the second
treatment is indicated as follows: 1) switch FLX to GCBT = 70.6 percent (35.4); 2) add GCBT to FLX = 72.8 percent (27.6); 3) switch GCBT to FLX =
64.5 percent (30.1); and 4) add FLX to GCBT = 66.7 percent (22.7); t-tests for comparisons: 1 x 3, p = 0.543; 1 x 4, p = 0.674; 2 x 3, p = 0.308; 2 x
4, p = 0.397]. Additional comparisons between the four ATSs performed by means of multiple imputations and generalized estimating equations did not
show significant differences between the four ATSs with regard to outcome. Conclusions: Different ATSs that use switching or adding first-choice
treatments for pediatric OCD seem to lead to the same treatment outcome. This observation is relevant to mental health policy and service planning.
The intensification of educational approaches throughout the trial seems necessary to enhance the feasibility of sequential trials for pediatric OCD.
Patients with comorbid depression may require specific retention strategies.
Journal of the American Academy of Child and Adolescent Psychiatry, 55 (10 Supplement
1) : S263
- Year: 2016
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Skapinakis, P., Caldwell, D., Hollingworth, W., Bryden, P., Fineberg,
N., Salkovskis, P., Welton,
N., Baxter, H., Kessler, D., Churchill, R., Lewis, G.
Background: Obsessive-compulsive disorder (OCD) is a relatively common and disabling condition. Objectives: To
determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of
OCD in children, adolescents and adults. Data sources: We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Trials Registers,
which includes trials from routine searches of all the major databases. Searches were conducted from inception to 31 December 2014. Review methods:
We undertook a systematic review and network meta-analysis (NMA) of the clinical effectiveness and acceptability of available treatments. Outcomes
for effectiveness included mean differences in the total scores of the Yale-Brown Obsessive-Compulsive Scale or its children's version and total
dropouts for acceptability. For the cost-effectiveness analysis, we developed a probabilistic model informed by the results of the NMA. All analyses
were performed using OpenBUGS version 3.2.3 (members of OpenBUGS Project Management Group; see www.openbugs.net). Results: We included 86 randomised
controlled trials (RCTs) in our systematic review. In the NMA we included 71 RCTs (54 in adults and 17 in children and adolescents) for effectiveness
and 71 for acceptability (53 in adults and 18 in children and adolescents), comprising 7643 and 7942 randomised patients available for analysis,
respectively. In general, the studies were of medium quality. The results of the NMA showed that in adults all selective serotonin reuptake
inhibitors (SSRIs) and clomipramine had greater effects than drug placebo. There were no differences between SSRIs, and a trend for clomipramine to
be more effective did not reach statistical significance. All active psychological therapies had greater effects than drug placebo. Behavioural
therapy (BT) and cognitive therapy (CT) had greater effects than psychological placebo, but cognitive-behavioural therapy (CBT) did not. BT and CT,
but not CBT, had greater effects than medications, but there are considerable uncertainty and methodological limitations that should be taken into
account. In children and adolescents, CBT and BT had greater effects than drug placebo, but differences compared with psychological placebo did not
reach statistical significance. SSRIs as a class showed a trend for superiority over drug placebo, but the difference did not reach statistical
significance. However, the superiority of some individual drugs (fluoxetine, sertraline) was marginally statistically significant. Regarding
acceptability, all interventions except clomipramine had good tolerability. In adults, CT and BT had the highest probability of being most cost-
effective at conventional National Institute for Health and Care Excellence thresholds. In children and adolescents, CBT or CBT combined with a SSRI
were more likely to be cost-effective. The results are uncertain and sensitive to assumptions about treatment effect and the exclusion of trials at
high risk of bias. Limitations: The majority of psychological trials included patients who were taking medications. There were few studies in
children and adolescents. Conclusions: In adults, psychological interventions, clomipramine, SSRIs or combinations of these are all effective,
whereas in children and adolescents, psychological interventions, either as monotherapy or combined with specific SSRIs, were more likely to be
effective. Future RCTs should improve their design, in particular for psychotherapy or combined interventions. Copyright © Queen's Printer and
Controller of HMSO 2016.
Health Technology Assessment, 20(43) :
- Year: 2016
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Skarphedinsson, G., Hanssen-Bauer, K., Kornor, H., Heiervang, E. R., Landro, N. I., Axelsdottir, B., Biedilae, S., Ivarsson, T.
Background: Previous meta-analyses of paediatric obsessive-compulsive disorder (OCD)
have shown much higher effect size for standard individual cognitive behaviour therapy (SI-CBT) compared with control conditions than for serotonin
reuptake inhibitors (SRIs) compared with placebo. Other factors, such as systematic differences in the provided care or exposure to factors other
than the interventions of interest (performance bias) may be stronger confounders in psychotherapy research than in pharmacological research. Aims:
These facts led us to review SI-CBT studies of paediatric OCD with the aim to compare the effect estimates across different comparisons, including
active treatments. Method: We included only randomized controlled trials (RCTs) or cluster RCTs with treatment periods of 12-16 weeks. Outcome was
post-test score on the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS). Results: Thirteen papers reporting from 13 RCTs with 17 comparison
conditions were included. SI-CBT was superior to wait-list and placebo therapy but not active treatments. Effect estimates for SI-CBT in wait-list
comparison studies were significantly larger than in placebo-therapy comparison studies. In addition, the SI-CBT effect estimate was not
significantly different when compared with SRIs alone or combined SRIs and CBT. Conclusions: Performance bias may have inflated previous effect
estimates for SI-CBT when comparison contingencies included wait-list. However, the calculated SI-CBT effect estimate was lower but significant when
compared with placebo therapy. The effects of SI-CBT and active treatments were not significantly different. In conclusion, our data support the
current clinical guidelines, although better comparisons between SI-CBT and SRIs are needed. (PsycINFO Database Record (c) 2015 APA, all rights
reserved) (journal abstract).
Nordic Journal of
Psychiatry, 69(2) : 81-92
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Rosa-Alcazar, A. I., Sanchez-Meca, J., Rosa-Alcazar, A., Iniesta-Sepulveda, M., Olivares-Rodriguez, J., Parada-Navas, J.
L.
Although several meta-analyses have investigated the efficacy of psychological
treatments for pediatric obsessive-compulsive disorder (OCD), there is not yet a consensus on the most efficacious treatment components. A meta-
analysis was carried out to examine the efficacy of the different treatment techniques used in the psychological interventions of pediatric OCD. An
exhaustive literature search from 1983 to February 2014 enabled us to locate 46 published articles that applied some kind of cognitive-behavioral
therapy (CBT). For each group the effect size was the standardized pretest-posttest mean change, and it was calculated for obsessive-compulsive
symptoms and for other outcome measures. The results clearly showed large effect sizes for CBT in reducing obsessive-compulsive symptoms and, to a
lesser extent, other outcome measures (d + = 1.860; 95% CI: 1.639; 2.081). The most promising treatments are those based on multicomponent programs
comprising ERP, cognitive strategies, and relapse prevention. The analysis of other potential moderator variables and the implications for clinical
practice are discussed.;
Spanish Journal of Psychology, 18 : E20-
E20
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention
Bloch, M. H., Storch, E. A.
Objective: To review the assessment and treatment of treatment-refractory
pediatric obsessive-compulsive disorder (OCD). Method: A PubMed search was conducted to identify controlled trials in pediatric OCD. In addition,
practice guidelines for the treatment of adults and children were further reviewed for references in treatment-refractory OCD across the lifespan.
Results: Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) were found to be effective
treatments for pediatric OCD. Evidence suggests that CBT is also effective even in pediatric patients with refractory OCD symptoms. Antipsychotic
augmentation, raising SSRI dosage, and several glutamate-modulating agents have some evidence of efficacy in adults with treatment-refractory OCD but
have not been studied in pediatric populations. Conclusion: Several pharmacological treatment options exist for children with refractory OCD
symptoms. However, little evidence-based data exist to guide treatment for our most challenging pediatric OCD patients. Further research is needed to
evaluate the efficacy/side effect profile of commonly used interventions in treatment-refractory pediatric OCD. (PsycINFO Database Record (c) 2015
APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 54(4) : 251-
262
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Franklin, M. E., Kratz, H. E., Freeman, J. B., Ivarsson, T., Heyman, I., Sookman, D., McKay, D., Storch, E. A., March, J.
The efficacy of cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive
disorder (OCD) has been the subject of much study over the past fifteen years. Building on a foundation of case studies and open clinical trials, the
literature now contains many methodologically sound studies that have compared full CBT protocols to waitlist controls, pill placebo, psychosocial
comparison conditions, active medication, combined treatments, and brief CBT. This review is part of a series commissioned by The Canadian Institute
for Obsessive Compulsive Disorders (CIOCD) in an effort to publish in one place what is known about the efficacy of treatments for OCD. A total of
fourteen studies were identified; collectively their findings support the efficacy of CBT for youth with OCD. CBT protocols that emphasized either
strictly behavioral or cognitive conceptualizations have each been found efficacious relative to waitlist controls. Efforts to enhance CBT?s efficacy
and reach have been undertaken. These trials provide guidance regarding next steps to be taken to maximize efficacy and treatment availability.
Findings from studies in community clinics suggest that significant treatment benefits can be realized and are not reported only from within academic
contexts. These findings bode well for broader dissemination efforts. Recommendations for future research directions are provided.; Copyright © 2015
Elsevier Ireland Ltd. All rights reserved.
Psychiatry Research, 227(1) : 78-
92
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Murphy, T.
K., Parker-Athill, E. C., Lewin, A. B., Storch, E. A., Mutch, P. J.
Objective: Previous
studies suggest that the unexplained sudden and severe onset of obsessive-compulsive disorder (OCD) and/or tics may be infection or immune
precipitated. Beta lactam antibiotics may be neuroprotective beyond their antimicrobial efficacy. We examine the preliminary safety and efficacy of
cefdinir in reducing obsessive-compulsive and/or tic severity in children with new-onset symptoms.; Method: Twenty subjects were randomized to
receive placebo or cefdinir for 30 days for the treatment of recent-onset OCD and/or tics. The placebo group received a comparable inactive treatment
matched for taste, color, and consistency. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and Yale Global Tic Severity Scale (YGTSS)
were the primary outcome measures utilized.; Results: Subjects receiving cefdinir saw notable improvements in tic symptoms, with 44.4% showing at
least a 25% reduction in YGTSS (mean decrease=9.5) scores compared with 9.1% of the placebo group (mean decrease=0.13). Despite improvements,
significant group differences were not observed for YGTSS (F [1, 13]=4.03, p=0.066) although there were moderate differences between group treatment
effects (d=0.72). For OCD symptoms, subjects receiving cefdinir saw improvements in OCD symptoms, with 33.3% showing at least a 25% reduction in CY-
BOCS scores (mean decrease=7.8) compared with 27.3% of the placebo group (mean decrease=4.7), but there were also no significant differences for CY-
BOCS (F [1, 13]=0.385, p=0.546; d=0.24).; Conclusions: Subjects assigned to cefdinir exhibited notable, albeit nonstatistically significant,
improvements in tic symptoms, compared with the placebo group. There were also some improvements in OCD symptoms, although these were not
significant. Overall, cefdinir was well tolerated. Given these preliminary results, a fully powered study is warranted to explore the efficacy of
cefdinir as a therapeutic tool for new-onset pediatric neuropsychiatric symptoms, particularly those that appear to be precipitated by
infection.;
Journal of Child
& Adolescent Psychopharmacology, 25(1) : 57-64
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
McGuire, J. F., Piacentini, J., Lewin, A. B., Brennan, E.
A., Murphy, T. K., Storch, E.A.
Background: Individual randomized controlled trials (RCTs) have
demonstrated the efficacy of cognitive behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) for the treatment of youth with obsessive-
compulsive disorder (OCD). Although meta-analyses have confirmed these results, there has been minimal examination of treatment moderators or an
examination of treatment response and symptom/diagnostic remission for these two treatment types. The present report examined the treatment efficacy,
treatment response, and symptom/diagnostic remission for youth with OCD receiving either CBT or SRIs relative to comparison conditions, and examined
treatment moderators.; Method: A comprehensive literature search identified 20 RCTs that met inclusion criteria, and produced a sample size of 507
CBT participants and 789 SRI participants.; Results: Random effects meta-analyses of CBT trials found large treatment effects for treatment efficacy
(g = 1.21), treatment response (relative risk [RR] = 3.93), and symptom/diagnostic remission (RR = 5.40). Greater co-occurring anxiety disorders,
therapeutic contact, and lower treatment attrition were associated with greater CBT effects. The number needed to treat (NNT) was three for treatment
response and symptom/diagnostic remission. Random effects meta-analyses of SRI trials found a moderate treatment effect for treatment efficacy (g =
0.50), treatment response (RR = 1.80), and symptom/diagnostic remission (RR = 2.06). Greater methodological quality was associated with a lower
treatment response for SRI trials. The NNT was five for treatment response and symptom/diagnostic remission.; Conclusions: Findings demonstrate the
treatment effects for CBT and SRIs across three important outcome metrics, and provide evidence for moderators of CBT across trials.; © 2015 Wiley
Periodicals, Inc.
Depression & Anxiety, 32(8) : 580-
593
- 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), Tricyclic antidepressants, Antidepressants
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Memik, N. C., Gundogdu,
O. Y., Tural, U.
Information on the use
of N-acetylcysteine (NAC) in neuropsychiatric disorders has increased in recent publications. Although there are positive reports on the use of NAC
in obsessive-compulsive and related disorders (OCRD), such data have not yet been validated. This article aims to review the research, case series
and case reports that have been published about the use of NAC in OCRD. Research papers and case reports on the use of NAC in OCRD published within
the last five years have been reviewed using the search engines of \"Pubmed\" and \"Medline Central\" databases. The search was performed by matching
the terms \"obsessive-compulsive disorder (OCD)\", \"trichotillomania (TTM)\", \"nail biting\", \"skin picking\", \"hoarding disorder\", and \"body
dysmorphic disorder\" with \"N-acetylcysteine\". The search identified 4 papers on TTM, 3 papers on nail biting behavior, 1 paper on OCD and 1 paper
on skin-picking behavior. Three of these papers were double-blind, placebo-controlled studies and four were case reports/series. The results of 2
papers out of the 7 that we reviewed showed that there was no difference between NAC and placebo, while 5 papers reported that the response to the
NAC therapy was positive. We did not find any papers on the use of NAC in either hoarding disorder or body dysmorphic disorder. NAC is thought to be
a promising psychopharmacologic agent in OCD, which is defined under OCRD due to its common etiology, similar clinical features and similar response
to treatment, as well as in TTM, skin picking and nail biting. The effectiveness of glutamatergic modulators on repetitive behaviors or OCD has
increased interest in NAC. Although there are a few studies in the area, many research projects are being planned, with some already in progress
(www.clinicaltrials. gov), a fact that emphasizes the importance of NAC in OCRD treatment. NAC has been used in a broad spectrum of conditions such
as paracetamol intoxication, doxorubicin cardiotoxicity, ischemia-reperfusion-induced injury of the myocardium, acute respiratory distress syndrome,
bronchitis, chemotherapy intoxication and heavy metal intoxication. In recent years, there has been an increase in the number of studies exploring
the use of NAC in neuropsychiatric disorders such as schizophrenia, autism, bipolar disorder and OCRD. In this review, we have seen that the results
of studies assessing the efficacy of NAC in psychiatric disorders are promising; however, there is a need for further studies to evaluate its
mechanism of action, appropriate dose range and duration of treatment.
Klinik Psikofarmakoloji Bulteni, 25(2) : 193-
206
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Ivarsson, T., Skarphedinsson, G., Kornor, H., Axelsdottir, B., Biedilae,
S., Heyman, I., Asbahr, F., Thomsen,
P. H., Fineberg, N., March, J.
Serotonin reuptake
inhibiting drugs (SRI) have been used in the treatment of paediatric obsessive-compulsive disorder over the past 30 years. We performed a systematic
review and meta-analysis of the literature to discuss the place of and evidence for the use of SRI in paediatric OCD, based on 14 publications of
methodologically sound, randomized and controlled studies. Both SRI and specific SRIs were examined and comparisons of SRI, placebo, cognitive
behaviour therapy (CBT), combined (COMBO) treatments (SRI+CBT) made to investigate their relative efficacy. Using the Cochrane methodology, and as
measures of effect size mean difference and Hedge's g, SRIs proved to be superior to drug placebo, with a modest effect size. From direct
comparisons of CBT and SRI treatments, we conclude that CBT has the superior efficacy. COMBO versus CBT shows that SRI treatment adds little to
concomitant CBT, while COMBO shows favourable outcome versus SRI alone. In pre-trial partial treatment responders, those who failed a SRI had better
outcome from adding CBT as compared to continuing a SRI. Those who failed CBT treatment did as well with continued CBT as with switching to a SRI.
The studies of combinations and sequences of treatments need to be developed further. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
(journal abstract).
Psychiatry Research, 227(1) : 93-
103
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Antidepressants
(any)
Jonsson, H., Kristensen, M., Arendt, M.
Despite promising results from intensive formats of cognitive-behavioural therapy (CBT) for obsessive-compulsive
disorder (OCD) the format is rarely used. The aim of the study was to systematically review the literature within this area of research and provide a
meta-analysis of the effectiveness of intensive CBT for youths or adults with OCD. The meta-analysis was based on 17 trials (11 adult and 6 youth)
including a total of 646 participants. Large overall pre-post effect sizes (ES) of 2.44 (95% CI 2.03-2.85) for clinical ratings (n = 16) and 1.23
(95% CI 1.01-1.45) for self-reports (n = 5) were found (Hedges g). Based on two comparative nonrandomized studies and one RCT, a larger post-
treatment effect of intensive treatment compared to standard weekly or twice weekly CBT was found (between group ES = 0.39 (95% CI 0.05-0.74) for
clinical ratings). This difference was no longer present at 3 month follow-up, mainly due to slight deterioration among patients who had received
intensive CBT while patients from weekly conditions changed little. In sum, the meta-analysis indicates that intensive CBT is an effective treatment
for youths and adults with OCD, and could be a promising format to enhance immediate treatment effects compared to standard CBT. Focus on how to
maintain superior post-treatment effects of intensive CBT could be a promising research area. (PsycINFO Database Record (c) 2016 APA, all rights
reserved) (journal abstract).
Journal of Obsessive-Compulsive & Related Disorders, 6 : 83-
96
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)