Management Of Obsessive-compulsive Disorder Research Articles

Remediating rigid rule-following in subclinical obsessive-compulsive disorder using a brief mindfulness task: A case-control pilot study

A pioneering experiment by Hayes et al. (1986a, b) demonstrated the influence of instructional control and rule-governed behaviour on sensitivity to alternating reinforcement schedules. Hassoulas et al. (2017) replicated the same experimental design in a sample of participants exhibiting obsessive-compulsive behavioural (OCB) traits, supporting the results reported by the original study but also providing further insights into the maintenance of rigid rule following in OCB. The current pilot study replicated the same experimental design and procedure once again, however in considering whether a brief mindfulness-based intervention would facilitate contact with schedule contingencies in a group of participants exhibiting OCB traits. A total of 78 participants were recruited, 38 of whom exhibited OCB traits as measured using the Maudsley Obsessive-Compulsive Inventory (MOCI). The results revealed a significant difference in sensitivity to changing schedules between the group of participants exhibiting OCB traits and those with few such traits (n = 40), dependent on the degree of instructional accuracy they were provided with. The findings of the current study provide insights into the proposed concomitant administration of mindfulness-based interventions, alongside traditional first-line therapeutic modalities currently administered in the management of obsessive-compulsive disorder.

Multimodal Augmentation Approach with Transcranial Direct Current Stimulation in Management of Obsessive-Compulsive Disorder with Depression and Comorbid Seizure Disorder: A Case Report

Multimodal Augmentation Approach with Transcranial Direct Current Stimulation in Management of Obsessive-Compulsive Disorder with Depression and Comorbid Seizure Disorder: A Case Report

The Role of Antioxidants in the Management of Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder that has a significant effect on the quality of life. The most effective treatment for OCD is the combination of selective serotonin reuptake inhibitors (SSRI) with cognitive behavior therapy (CBT). However, several adverse effects have been linked with this usual pharmacotherapy, and it is unsuccessful in many patients. The exact pathophysiology of OCD is not completely known, though the role of oxidative stress in its pathogenesis has been proposed recently. This review presents an overview of animal and human studies of antioxidant treatment for OCD. The use of antioxidants against oxidative stress is a novel treatment for several neurodegenerative and neuropsychiatric disorders. Among antioxidants, NAC was one of the most studied drugs on OCD, and it showed a significant improvement in OCD symptoms. Thus, antioxidants could be promising as an adjuvant treatment for OCD. However, a limited number of human studies are conducted on these agents, and for better judgment, human studies with a large sample size are necessary.

Management of obsessive–compulsive disorder with virtual reality-based exposure

Little information is available about use of virtual reality exposure for management of obsessive compulsive disorder (OCD). We present a patient with OCD, who presented with significant dysfunction related to his OC symptoms and was managed with virtual reality based exposure therapy. A 27-year-old male, presented with a history suggestive of OCD for last 8 years. His symptoms were characterized by obsessive images of known people, leading to significant anxiety and distress. To get rid of his anxiety and distress, he would repeat the acts at hand, multiple times till these images would subside or till he would be able to replace these images by desirable images. These symptoms led to marked socio-occupational dysfunction. The treatment history was suggestive of minimal response to adequate trials of multiple selective serotonin reuptake inhibitors and he was on capsule fluoxetine 80 mg/day at the time of presentation. Exposure and Response therapy was tried in the past by using imaginal exposure, but this was unsuccessful, as the patient would avoid imagining the anxiety-provoking images. Hence, he was exposed to the anxiety provoking images by using virtual reality which involved presenting him with videos containing pictures of known and unknown people arranged randomly, along with the anxiety-provoking images. Over a period of 2 months, 60 sessions of ERP were carried out and the whole hierarchy was completed. This case demonstrates that virtual reality can be used in behaviour therapy for OCD, by using virtual reality techniques, and there is a need to develop software and programs for assessment and management of OCD.

Metacognitions in Symptomatic and Remitted Patients with Obsessive Compulsive Disorder: Preliminary Evidence for Metacognitive State and Trait Markers.

Background:The phenomenon of metacognition is instrumental in the conceptualization and management of obsessive compulsive disorder (OCD). Studies on the comparison between metacognitions in OCD patients and healthy controls or those with other clinical conditions have been conducted. We aimed to compare metacognitions among currently symptomatic OCD (S-OCD) patients, currently remitted OCD patients (R-OCD), and healthy controls (HC).Method:This cross-sectional research was conducted in the Department of Psychiatry of a tertiary care hospital in North India. Purposive sampling method was used to recruit 40 OCD patients, including an equal number of R-OCD and S-OCD patients, and 20 HC matched for age and education. Meta-Cognition Questionnaire and Thought Control Questionnaire were used to assess metacognitive functions.Results:The findings showed a gradient of highest maladaptive metacognitions in the S-OCD group and lowest in HC. In the OCD subgroups, specific metacognitive beliefs (negative beliefs F = 65.52; need to control thoughts F = 61.03) and strategies (worry F = 83.55; low distraction F = 105.61) remained significantly different (P ≤ 0.001) between S-OCD and R-OCD patients. Certain other metacognitions remained consistently more or less stable between S-OCD and R-OCD patients, that is, metacognitive beliefs (cognitive confidence F = 11.43; cognitive self-consciousness F = 37.12) and strategies (punishment F = 17.45; low social control F = 12.89). This finding is further corroborated by positive correlations of severity of OCD with need to control thoughts (r = 0.66, P < 0.001), negative beliefs (r = 0.63, P < 0.001), and worry (r = 0.76, P < 0.001), and negative correlations with distraction (r = – 0.79, P < 0.001).Conclusion:The study provides preliminary evidence for specific metacognitions distinguished as potential state and trait markers for OCD, which needs to be established on a larger sample using a longitudinal study design.

Third Generation Antipsychotic as add-on therapy inIntractable Obsessive-Compulsive Disorder

According to the guidance of National Institute for Health and Clinical Excellence (NICE) respecting management of obsessivecompulsive disorder (OCD), and based on a ‘stepped care’ approach

Optimal treatment for obsessive compulsive disorder: a randomized controlled feasibility study of the clinical-effectiveness and cost-effectiveness of cognitive-behavioural therapy, selective serotonin reuptake inhibitors and their combination in the management of obsessive compulsive disorder.

Established treatments for obsessive compulsive disorder (OCD) include cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication. Combined treatment may outperform monotherapy, but few studies have investigated this. A total of 49 community-based adults with OCD were randomly assigned to CBT, SSRI, or SSRI+CBT. Sertraline (50–200 mg/day) was given as the SSRI for 52 weeks. A 16-h-manualized individual CBT was delivered over 8 weeks with four follow-up sessions. Assessors were ‘blinded’ to treatment allocation. A preliminary health economic evaluation was conducted. At week 16, combined treatment (n=13) was associated with the largest improvement, sertraline (n=7) the next largest and CBT (n=9) the smallest on the observed case analysis. The effect size (Cohen’s d) comparing the improvement in Yale Brown Obsessive Compulsive Scale on CBT versus combined treatment was −0.39 and versus sertraline was −0.27. Between 16 and 52 weeks, the greatest clinical improvement was seen with sertraline, but participant discontinuation prevented reliable analysis. Compared with sertraline, the mean costs were higher for CBT and for combined treatment. The mean Quality Adjusted Life Year scores for sertraline were 0.1823 (95% confidence interval: 0.0447–0.3199) greater than for CBT and 0.1135 (95% confidence interval: ‑0.0290–0.2560), greater than for combined treatment. Combined treatment appeared the most clinically effective option, especially over CBT, but the advantages over SSRI monotherapy were not sustained beyond 16 weeks. SSRI monotherapy was the most cost-effective. A definitive study can and should be conducted.

From Treatment Response to Recovery: A Realistic Goal in OCD.

Despite longitudinal studies reporting symptomatic remission rates ranging from 32% to 70%, Obsessive-Compulsive Disorder is considered a persistent and very disabling disorder. However, these studies suggest that recovery can be a realistic goal for a subgroup of the Obsessive-Compulsive Disorder population and that a clear definition of recovery is timely in Obsessive-Compulsive Disorder. The aim of this paper is to discuss the dimensions of and propose an operational definition of recovery in Obsessive-Compulsive Disorder. Considering the impact generated by the definition of recovery for other mental disorders, this article discusses how this concept may shape the future of research and clinical practice in Obsessive-Compulsive Disorder. Ultimately, the hope is that the management of Obsessive-Compulsive Disorder may parallel, and expand upon, some of the current approaches implemented in the care of schizophrenia, so that early diagnosis, stepped-care techniques, and a personalized approach can be used to create recovery-oriented treatment programs and influence policy making for Obsessive-Compulsive Disorder.

Management of obsessive compulsive disorder induced by the use of clozapine

The second generation antipsychotic of clozapine has superior efficacy compared to other antipsychotics especially for treatment-resistant schizophrenia. In up to 20% of patients receiving clozapine treatment, the side effect of obsessive compulsive symptoms or obsessive compulsive disorder occurs. These obsessive compulsive side effects sometimes cause cessation of the use of clozapine and sometimes causes difficulties in treating the psychotic symptoms due to dose reductions. This manuscript presents a case with resistant schizophrenia who developed obsessive compulsive disorder secondary to clozapine treatment and was successfully treated with clomipramine and aims to discuss the case accompanied by the literature.

A Case study on the management of Obsessive Compulsive Disorder (OCD) in Ayurveda

      Obsessive-compulsive disorder (OCD) is a type of anxiety disorder in which a person has unreasonable thoughts and fears (obsessions) that lead him to engage in repetitive behaviors (compulsions). A person affected with OCD may realize that his obsessions are not reasonable and may try to ignore or stop them, but he is driven to perform compulsive acts in an effort to ease his distress. OCD usually centers on themes which lead to ritualistic behaviour that ultimately affects the person's life. In this paper a case study of OCD with the symptoms of obsessions of contamination associated with mild depression and Parkinson’s disease is discussed which was successfully treated with some Ayurvedic formulations for about 2 months.Â

Role of Lamotrigine Augmentation in Treatment-Resistant Obsessive Compulsive Disorder: A Retrospective Case Review from South Asia

Background:Resistance to pharmacotherapy is one of the major challenges in the management of obsessive-compulsive disorder (OCD). OCD being a quite prevalent disorder, this resistance adds to the disability. Different strategies are being employed to counter this resistance, one of them being augmentation with glutamatergic modulators. Lamotrigine is being used for same since the recent past with mixed results.Objective:The aim was to study the role of lamotrigine augmentation in serotonin reuptake inhibitor (SRI) resistant OCD patients.Methodology and Results:This study was carried by studying the case sheets of SRI resistant cases having already completed the treatment. A total of 22 cases sheets over 2 years met the study criteria with a mean age of mean age of 34.14 years. Over a period of 16 weeks, with a mean lamotrigine dose of 150 mg/day, 20 out of 22 patients had shown a significant response. The mean decrease in Yale-Brown Obsessive Compulsive Scale score was 67.23% with a baseline score of 28.87. There was a similar change on different domains of World Health Organization quality of life (P = 0.00564).Conclusion:Lamotrigine augmentation to on-going treatment with SRIs may be an effective move in case of SRI resistant OCD patients.

Management of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a common, often debilitating disorder characterized by the presence of obsessions and compulsions. Obsessions are repetitive thoughts or images which are experienced as intrusive and unwanted; they cause marked anxiety and distress. Compulsions (also known as rituals) are repetitive behaviors or mental acts that individuals with OCD perform in an attempt to decrease their anxiety. Patients tend to hide their symptoms due to shame; the amount of time between onset of symptoms and appropriate treatment is often many years. The disorder likely results from several etiological variables; functional imaging studies have consistently shown hyperactivity in the orbitofrontal cortex, anterior cingulate, thalamus, and striatum. The mainstays of treatment include cognitive-behavioral therapy in the form of exposure and response prevention (ERP) and serotonin reuptake inhibiting medications. Several pharmacological augmentation strategies exist for treatment-resistant OCD, with addition of antipsychotics being most commonly employed. Radio and neurosurgical procedures, including gamma knife radiation and deep brain stimulation, are reserved for severe, treatment-refractory disease that has not responded to multiple treatments, and some patients may benefit from transcranial magnetic stimulation.

EPA-1569 - The pharmacological management of obsessive compulsive disorder: The evidence from published meta-analyses

Background The aim of this presentation is to summarize the results of the published systematic reviews / meta-analyses of the randomized controlled trials that have investigated the effectiveness of medications for the treatment of obsessive compulsive disorder (OCD) in children/adolescents and adults and to present preliminary results from a new review study using network meta-analytical techniques Methods Medline, Cochrane database, and the register of controlled trials maintained by the Cochrane Collaboration Depression, Anxiety & Neurosis Group (CCDAN) were searched for relevant trials, systematic reviews and/or meta-analyses. Results Regarding the new review study we were able to extract 103 pharmacological arms (preliminary results: 9 for Fluoxetine, 16 for Fluvoxamine, 11 for Paroxetine, 10 for Sertraline, 16 for Clomipramine, 7 for Citalopram / escitalopram, 2 for Venlafaxine, and 32 for Placebo) with a total number of 6572 patients randomized. The previous meta-analyses have confirmed the efficacy for all SSRIs and Clomipramine in all age groups while for other drugs further evidence is required. In the context of this presentation preliminary results of the relative efficacy of each drug, using network meta-analysis techniques will also be reported. Conclusions Several antidepressants have established their efficacy and acceptability for the management of non-resistant OCD. The major weakness of the literature so far is that head to head comparisons between antidepressants are few and therefore it is difficult to establish a clear hierarchy of the efficacy and acceptability of the various agents. This gap in the present literature will be filled by the present review.

Holistic Approach for Management of Obsessive Compulsive Disorder

Obsessive Compulsive Disorder is one of the least understood, least diagnosed, most disabling of the anxiety disorders. The aim of present study was to evaluate the effectiveness of holistic approach on Obsessive Compulsive Disorder patients. Holistic approach is an integration of Psychology, Ayurveda and Yogic techniques. Sixty participants with a diagnosis of Obsessive Compulsive Disorder were selected though quota sampling. Participants were received 45 individual sessions of therapeutic interventions of holistic approach. Severity of disorder was measured before and after intervention. The obtained data were statistically analyzed through paired t-test. Results: There where a significant reduction in obsession as well as in compulsion of participants. Conclusion: Holistic Approach is effective intervention and positively associated with durable improvement in obsession and compulsion of participants.

Current management of obsessive and phobic states

Obsessional states show an average point prevalence of 1%–3% and a lifetime prevalence of 2%–2.5%. Most treatment-seeking patients with obsessions continue to experience significant symptoms after 2 years of prospective follow-up. A significant burden of impairment, distress, and comorbidity characterize the course of the illness, leading to an increased need for a better understanding of the nature and management of this condition. This review aims to give a representation of the current pharmacological and psychotherapeutic strategies used in the treatment of obsessive-compulsive disorder. Antidepressants (clomipramine and selective serotonin reuptake inhibitors) are generally the first-line choice used to handle obsessional states, showing good response rates and long-term positive outcomes. About 40% of patients fail to respond to selective serotonin reuptake inhibitors. So far, additional pharmacological treatment strategies have been shown to be effective, ie, administration of high doses of selective serotonin reuptake inhibitors, as well as combinations of different drugs, such as dopamine antagonists, are considered efficacious and well tolerated strategies in terms of symptom remission and side effects. Psychotherapy also plays an important role in the management of obsessive-compulsive disorder, being effective for a wide range of symptoms, and many studies have assessed its long-term efficacy, especially when added to appropriate pharmacotherapy. In this paper, we also give a description of the clinical and psychological features likely to characterize patients refractory to treatment for this illness, with the aim of highlighting the need for greater attention to more patient-oriented management of the disease.

P.4.c.001 Efficacy of repetitive transcranial magnetic stimulations in the management of obsessive compulsive disorder

Major depression is a significant contributor to the global burden of disease, and its pathophysiology is largely unknown. The serotonin hypothesis is, however, the model with most supporting data, although the details are only worked out to some extent. Recent clinical imaging measurements indeed imply a role in major depressive disorder (MDD) for the inhibitory serotonin autoreceptor 5-hydroxytryptamine1B (5-HT1B). The aim of the current study was to examine 5-HT1B receptor binding in the brain of MDD patients before and after psychotherapy. Ten patients with an ongoing untreated moderate depressive episode were examined with positron emission tomography (PET) and the 5-HT1B receptor selective radioligand [11C]AZ10419369, before and after treatment with internet-based cognitive behavioural therapy. All of the patients examined responded to treatment, and 70% were in remission by the time of the second PET measurement. A statistically significant 33% reduction of binding potential (BPND) was found in the dorsal brain stem (DBS) after treatment. No other significant changes in BPND were found. The DBS contains the raphe nuclei, which regulate the serotonin system. This study gives support for the importance of serotonin and the 5-HT1B receptor in the biological response to psychological treatment of MDD.

Management of obsessive-compulsive disorder with fluvoxamine extended release

The pharmacodynamic properties of fluvoxamine maleate include the modulation of different populations of serotonergic, dopaminergic, and sigma receptors and/or transporters, a complex pattern of activity that may account for its efficacy in the treatment of obsessive-compulsive disorder (OCD). Nevertheless, its pharmacokinetic profile and its pattern of side effects may hinder a rapid dose escalation, a therapeutic strategy that might be utterly desirable in patients with OCD. In preclinical studies, the maximum plasma concentration and bioavailability of an extended-release (CR) formulation of fluvoxamine were, respectively, 38% and 16% lower than those of the standard (ie, non-CR) formulation. Recently, the US Food and Drug Administration approved the fluvoxamine CR formulation for the treatment of OCD in adults. This approval was based on the results of a double-blind, placebo-controlled study with 253 OCD patients in which fluvoxamine CR showed a consistently earlier onset of therapeutic effects than other selective serotonin reuptake inhibitors, as reported in previous studies. The use of the CR formulation of fluvoxamine allowed a particularly aggressive dosing strategy at the beginning of the titration phase, ie, treatment could be started with a single dose of fluvoxamine CR 100 mg at bedtime, while keeping the occurrence of side effects and the rate of compliance at levels comparable to those reported for the use of immediate-release fluvoxamine.

Long-Term Follow-Up Study of Patients With Refractory Obsessive-Compulsive Disorder

Long-Term Follow-Up Study of Patients With Refractory Obsessive-Compulsive Disorder

School Psychologists' Views and Management of Obsessive-Compulsive Disorder in Children and Adolescents

Over the past decade, an increasing body of research has been conducted on evidence-based psychological and psychiatric treatment for pediatric obsessive-compulsive disorder (OCD). Despite this improved understanding, however, these treatments are not being performed. This study descriptively examined the practices and views of school psychologists on the management of pediatric OCD. Two hundred twenty-seven clinicians responded to a survey adapted from previous work by Valderhaug, Gotestam, and Larsson. Results suggested that school psychologists preferred cognitive-behavioral, medical, and family/systemic orientations relative to psychodynamic and humanistic approaches. Although respondents reported an adherence to evidence-based treatment, only 7% reported using behavioral exposure. Many respondents reported only moderate treatment success and expressed an overwhelming need for further training in both the assessment and treatment of pediatric OCD. Our results suggest that school psychologists are not adequately trained to assess and provide evidence-based treatment of pediatric OCD.

New treatment options for OCD

Pharmacological management of obsessive-compulsive disorder (OCD) is achieved using drugs that inhibit the synaptic uptake of serotonin, such as clomipramine, a tricyclic antidepressant, and the selective serotonin reuptake inhibitors (SSRIs). Recent studies suggest that the improved tolerability profile of the SSRIs relative to clomipramine may offer a more suitable treatment choice. Escitalopram, the therapeutically active S-enantiomer of citalopram, is the most selective SSRI currently available. In a 24-week randomized, placebo-controlled, double-blind study, escitalopram (20 mg) was associated with significantly lower symptom scores at 12 weeks (P<0.01) and increased response rate (Yale-Brown Obsessive-compulsive Scale [Y-BOCS]) (70.2%) compared with placebo (50.4%). Escitalopram (10 mg) was more effective in reducing symptom scores than placebo at 24 weeks (P=0.052). Escitalopram 20 mg was also associated with improved remitter status (Y-BOCS total score ≤10) compared with paroxetine (40 mg) or placebo from week 12. In a relapse-prevention study, 10 and 20 mg escitalopram showed a statistically significant superior effect relative to placebo on time to relapse of OCD with a hazard ratio of 2.74. Escitalopram was well-tolerated by patients with OCD. In conclusion, escitalopram provides significant symptom relief and prevention of relapse during long-term use and deserves consideration as a first-line agent in the long-term pharmacotherapy of OCD.