Post-traumatic Obsessive-compulsive Disorder Research Articles

A Case of Comorbid PTSD and Posttraumatic OCD Treated with Sertraline-Aripiprazole Augmentation

Several studies report on traumatic history in Obsessive Compulsive Disorder (OCD) and comorbidity between Posttraumatic Stress Disorder (PTSD) and OCD. First-line pharmacological treatments for both OCD and PTSD are primarily based on antidepressants, including Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Noradrenaline Reuptake Inhibitors (SNRI) such as Venlafaxine for PTSD. Second-Generation Antipsychotic (SGA) augmentation has shown good outcomes for nonresponsive OCD cases. However, evidence on the use of SGA in PTSD is more limited. In the present paper, we report on comorbid OCD-PTSD successfully treated with aripiprazole augmentation of sertraline. Shared psychopathological and pharmacological aspects of the disorders are discussed.

A mixed approach: Posttraumatic obsessive compulsive disorder

IntroductionSeveral studies along the last two decades provide information indicating the relationship between posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). The particular features described in patients who developed OCD symptoms closely after the onset of PTSD, may suggest the existence of a specific subtype of OCD more likely to be suffered after a traumatic event. The few studies focused on evaluating treatment efficacy for the association between OCD and PTSD seem to predict poor response to pharmacologic or behavioral cognitive (BCT) monotherapy.ObjectivesDespite the evidence, most widely used guidelines propose the employment of either a psychotherapeutic or psychopharmacologic approach. We propose to combine intensive BCT and serotonin profile antidepressants in order to optimize PTSD-OCD subtype.Material and methodsWe present two detailed case reports offering the results of combining intensive BCT and serotonin profile antidepressants as soon as the comorbid diagnosis for both disorders was established. These two patients were recruited from outpatient care centers.ResultsOur limited experience supplied promising outcome results. Significant improvement regarding to functional impairment appeared from early stages of the treatment in both patients.DiscussionDespite logistic difficulties, an intensive and coordinated psychopharmacologic and psychotherapeutic approach might constitute another treatment choice which may be taken into account in those cases monotherapy fails to reduce PTSD-OCD subtype patients’ impairment.ConclusionsA mixed treatment approach might be taken into account as a first line treatment in PTSD-OCD disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Towards a post-traumatic subtype of obsessive–compulsive disorder

We evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive–compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. In contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. In addition, patients with post-traumatic OCD without a previous history of obsessive–compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS.

Cognitive Dysfunction in Post-Traumatic Obsessive–Compulsive Disorder

To investigate whether patients who develop obsessive-compulsive disorder (OCD) after posttraumatic stress disorder, i.e. post-traumatic OCD (PsT-OCD), display a distinctive neurocognitive pattern of dysfunction. Patients with PsT-OCD (n = 16), pre-traumatic OCD (PrT-OCD) (n = 18), non-traumatic OCD (NonT-OCD) (n = 67) and healthy controls (n = 17) had their performance compared on the following neuropsychological tests: the Wisconsin Card Sorting Test, the Iowa Gambling Task, the Wechsler Memory Scale Logical Memory, the Brief Visual Memory Test - Revised, and the Wechsler Abbreviated Scale for Intelligence. Patients with OCD, as a group, were characterized by poor set-shifting abilities and impaired verbal and visuospatial memories. Impaired set-shifting abilities were found to correlate with the severity of obsessive-compulsive symptoms in all groups of patients with OCD, with the exception of PsT-OCD. Only patients with PsT-OCD were characterized by impaired visuospatial recognition, which was found to correlate with poor set-shifting abilities in this particular group of patients, but not in individuals with other types of OCD or in healthy controls. Our study suggests that PsT-OCD is associated with a distinctive pattern of neurocognitive dysfunction, thus providing support for a different subtype of OCD.