Three-Week Inpatient Treatment of Obsessive-Compulsive Disorder: A 6-Month Follow-Up Study.

Torun Grøtte,Patrick A. Vogel,Ismail C. Guzey,Stian Solem,Svein Haseth,Bjarne Hansen

doi:10.3389/fpsyg.2018.00620

Abstract

Background: Specialized inpatient or residential treatment might be an alternative treatment approach for patients with obsessive-compulsive disorder (OCD) that do not respond satisfactorily to the standard outpatient treatment formats.Method: The aim of this open trial was to investigate the 6-month effectiveness of a 3-week inpatient treatment of OCD, where exposure with response prevention (ERP) was the main treatment intervention. The sample consisted of 187 adult patients with OCD, all with previous treatment attempts for OCD.Results: The sample showed significant reductions in symptoms of OCD and depression. The effect sizes were large for obsessive-compulsive symptoms and moderate to large for depressive symptoms. At discharge, 79.7% of the intent-to-treat (ITT) group were classified as treatment responders (≥35% reduction in Y-BOCS scores). However, some participants experienced relapse, as 61.5% of the ITT group were classified as treatment responders at 6-month follow-up. Antidepressant use appeared not to influence the outcome. Only pre-treatment levels of obsessive-compulsive symptoms emerged as a significant predictor of relapse.Conclusion: The 3-week inpatient programme produced similar treatment effects as previous inpatient and residential studies of longer duration (2 – 3 months). The results suggest that patients with severe OCD can be treated efficiently using this brief inpatient format. However, better relapse prevention interventions are needed.

Highlights

The efficacy of cognitive-behavioral therapy (CBT) in treatment of obsessive-compulsive disorder (OCD) has been confirmed in numerous studies and meta-analyses (e.g., Eddy et al, 2004; Öst et al, 2015; Skapinakis et al, 2016)
Independent t-tests showed no significant differences between the two administration modes at baseline, neither in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, t(185) = 0.48, p = 0.634, OCI-R scores, t(185) = −0.05, p = 0.957, nor Beck Depression Inventory (BDI) scores, t(93.5) = −1.42, p = 0.160
Evidence-based treatments of OCD (i.e., exposure and response prevention (ERP) and CBT) were difficult to get in Norway due to few available ERP specialists

Summary

Introduction

The efficacy of cognitive-behavioral therapy (CBT) in treatment of obsessive-compulsive disorder (OCD) has been confirmed in numerous studies and meta-analyses (e.g., Eddy et al, 2004; Öst et al, 2015; Skapinakis et al, 2016). In intention-to-treat samples including treatment dropouts, about half of the patients experience 25–50% reduction in their obsessive-compulsive symptoms (Eddy et al, 2004). This leaves a subset of OCD patients failing to achieve satisfactory response to CBT, and many experience residual symptoms or relapse during follow-up (Simpson et al, 2005; Abramowitz, 2006). Specialized inpatient or residential treatment might be an alternative treatment approach for patients with obsessive-compulsive disorder (OCD) that do not respond satisfactorily to the standard outpatient treatment formats

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Conclusion