Yale-Brown Obsessive Compulsive Score Research Articles

Anti-Androgen Drugs in the Treatment of Obsessive-Compulsive Disorder: A Systematic Review.

This study aimed to systematically investigate whether anti-androgens could significantly reduce Obsessive-Compulsive Disorder (OCD) symptoms compared to placebo or usual care in OCD patients. PubMed, EMBASE, CENTRAL and International Clinical Trials Registry Platform (ICTRP) databases were searched up to October 2018 using relevant keywords. All randomized and if not available non-randomized studies conducted on a population including OCD patients who were administered with anti-androgen, which reported changes in their symptoms, were included. The studies on compulsive hypersexuality were excluded. Required data were extracted from full-text of the included articles by two independent authors. One randomized and four non-randomized trials were found. The only randomized trial showed that flutamide, an anti-androgen agent, was effective in reducing compulsion scores in male OCD patients with comorbid Tourette syndrome, compared to placebo. Three out of four non-randomized trials showed that different anti-androgens including finasteride, cyproterone acetate and triptorelin were effective in reducing OCD symptoms. The only study, which failed to show the efficacy of an anti-androgen agent, administered OCD patients with flutamide. Despite the positive results, available studies provide the evidence with low quality based on the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach. Available studies are not sufficient for a precise answer to our study question. There is still a need for further large randomized blinded clinical trials to evaluate the effectiveness of antiandrogens in OCD patients. It is recommended that gender, comorbidities and subscales of Yale- Brown Obsessive-Compulsive Score (Y-BOCS) should be considered in designing the studies and interpreting their results.

BLOOD LEVELS OF TREATMENT RESISTANT OBSESSIVE-COMPULSIVE DISORDER PATIENTS PRESCRIBED SUPRA-NORMAL DOSAGES OF SERTRALINE

. Aims This study examined the blood levels of Sertraline in patients with profound, refractory Obsessive-Compulsive Disorder (OCD) and who were prescribed dosages in excess of recommended limits. Background Studies in patients with OCD have demonstrated that higher levels of serotonin reuptake inhibiting (SRI) drugs are usually needed to obtain remission that those required for depression. This observation led some workers to suggest that supra-normal doses of selective SRIs may prove beneficial in treatment refractory patients. Pampaloni et al. (2010) found that these high doses of selective SRIs were well tolerated in treatment refractory patients and led to clinical improvement. The aim of this study was to examine the blood levels of patients prescribed supra-normal doses of Sertraline. If the blood levels remained within therapeutic range, then this would suggest that these patients either have reduced absorption of the drug or were rapidly metabolising Sertraline. Methods Patients selected for the study had all been admitted to the National Inpatient Service for OCD/BDD based in South West London and St George’s NHS Trust. This Unit has been described elsewhere (Drummond et al., 2012). Owing to the wards admission criteria, all the patients had previously received at least two trials of different SSRIs or Clomipramine for a minimum of 3 months each without any resolution of symptoms. In addition, all patients had received augmentation with a dopamine blocker and also at least 2 trials of Exposure and response-prevention psychological therapy. Despite these treatments, all patients were admitted to the service with a Yale-Brown Obsessive Compulsive Score within the high end of the “profoundly ill” range (>35/40). Successively admitted patients who were prescribed Sertraline in doses greater than the recommended 200mg per day were included in the study. These patients who were initially unresponsive to 200mg Sertraline had their daily doses titrated upwards in 50mg increases every 2-4 weeks up to a maximum of 400mg (depending on efficacy and any side effects). Blood samples were taken shortly after their morning dose had been administered. This was after the patients had stabilised for at least 2 weeks on the higher doses. Results 7 patients were included in the study. Blood levels of Sertraline were found to be in therapeutic range for all patients. In general, the blood levels remained within the lower half of normal reference range despite being prescribed supra-normal Sertraline dosages ranging from 250mg to 400mg per day. Conclusion This study demonstrates that some patients who are refractory to standard doses have blood levels within the therapeutic range. This finding suggests that these patients either absorb the drug poorly or metabolise it rapidly.

Good news for allegedly bad studies. Assessment of psychometric properties may help to elucidate deception in online studies on OCD

Online surveys are gaining increasing momentum in clinical research. Ease of recruitment and low cost are two of the biggest advantages of Internet studies. There are, however, concerns about their reliability and validity.The present study compared the psychometric properties of self-report instruments measuring obsessive-compulsive disorder (OCD) across three samples: (1) participants with a confirmed diagnosis of OCD (n=66), (2) participants with a probable diagnosis of OCD (n=86) and (3) clinical experts on OCD and students who were asked to pretend to have OCD (n=121). Psychometric indices of the Yale-Brown Obsessive Compulsive Score (Y-BOCS) and the Obsessive Compulsive Inventory (OCI-R) served as indicators for reliability and validity.Both patient samples revealed good retest reliability scores and good correlations between Y-BOCS and OCI-R scores. In contrast, the expert group showed poor retest reliabilities and mixed results for the intercorrelations between OCI-R and Y-BOCS scores. Simulators display a marked tendency to over-report symptoms on the OCI-R.Good psychometric properties of online studies may serve as a proxy for the validity of diagnoses.

Obsessive-Compulsive Disorder (OCD) is still an unrecognised disorder: A study on the recognition of OCD in psychiatric outpatients

Objective The study aims to investigate the recognition of patients with Obsessive-Compulsive Disorder (OCD) in psychiatric outpatients. Subjects and methods A total of 2282 outpatients seen at 14 different psychiatric clinics in South Germany were asked to participate in the study. Five hundred and eighty-nine (30%) of the original 2282 patients met screening criteria for OCD, and of those, 237 (42%) participated in the final interview including DSM-IV diagnosis, and comorbidity. Results Sixty-nine of 589 participating patients who screened positively for obsessive symptoms actually had an Obsessive-Compulsive Disorder. Only 19 (28%) of the outpatients diagnosed with OCD according to DSM-IV criteria were also given this diagnosis by their consultant. The psychopathology scores indicated that the OCD patients had clinically relevant OCD with a mean Yale-Brown Obsessive Compulsive Score (Y-BOCS) of 17.5 (± 5.4), and a mean Clinical Global Impression Score (CGI) of 5.2 (± 1.2). Conclusions In outpatient clinics over 70% of OCD patients remain unrecognised and thus untreated by consultants. Screening questions provide a rapid way of identifying those who may have OCD and should be incorporated into every mental state examination by consultants.

Sertraline and Fluoxetine Treatment of Obsessive-Compulsive Disorder: Results of a Double-Blind, 6-Month Treatment Study

The purpose of this study was to evaluate the comparative efficacy and tolerability of sertraline and fluoxetine in the treatment of obsessive-compulsive disorder (OCD). Outpatients meeting DSM-IV criteria for OCD, with a Yale-Brown Obsessive-Compulsive (Y-BOCS) total score >or= 17, an NIMH Global Obsessive-Compulsive (NIMH-OC) scale score >or= 7, and a CGI-Severity score >or= 4 were randomized to 24 weeks of double-blind treatment with sertraline (N = 77) or fluoxetine (N = 73). Primary efficacy measures consisted of the Y-BOCS, the NIMH-OC scale, and the CGI-Severity (CGI-S) and Improvement (CGI-I) scales. Equivalent and significant (p < 0.001) improvement was found at week 24 in Y-BOCS and NIMH-OC scale scores for sertraline and fluoxetine. After 12 weeks, 49.2% of patients on sertraline were rated on the CGI-S scale as being mildly ill or not ill compared to 24.6% on fluoxetine (p < 0.01). A Cox analysis found patients on sertraline to have a statistically nonsignificant 42% greater likelihood of achieving a response by week 12 (CGI-I, much or very much improved; 95% CI, 0.85, 2.38; p = 0.18). Sertraline treatment also resulted in a higher proportion of remissions than fluoxetine (defined as a CGI-I <or= 2 and a Y-BOCS score <or= 11), both at week 12 (20% vs. 8%; chi2, 3.95; df 1; p = 0.047) and week 24 (36% vs. 22%; chi2, 3.18; df, 1; p = 0.075). Both medications were well-tolerated and demonstrated significant efficacy in the treatment of outpatients with moderate to severe OCD with the subjects treated with sertraline showing a greater likelihood of remission as well as an earlier improvement on some but not all efficacy measures

Sequential administration of augmentation strategies in treatment-resistant obsessive-compulsive disorder: preliminary findings.

Given that an important proportion of patients with obsessive-compulsive disorder (OCD) fail to respond adequately to serotonin (5-HT) reuptake inhibitors (SRI), augmentation strategies aimed at enhancing further 5-HT transmission by different mechanisms were attempted sequentially in 13 SRI-resistant patients. Addition of the 5-HT1A l beta-adrenergic antagonist pindolol did not alter OCD symptomatology but produced a rapid improvement of depressive symptoms. The 5-HT1A agonist buspirone as well as 5-hydroxytryptophan, the immediate precursor of 5-HT, added to the SRI-pindolol regimen, were not effective in attenuating the intensity of OCD. Tryptophan, added to the SRI-pindolol regimen, produced a significant improvement after 4 weeks, with further amelioration after 6 weeks (36% decrease of the Yale-Brown Obsessive Compulsive Score), which was maintained with treatment prolongation.

The clinical characteristics of patients with obsessive compulsive disorder: a descriptive study of an Irish sample

AbstractObjective: To describe the clinical characteristics and demographic details of a sample of patients with a principal diagnosis of obsessive compulsive disorder (OCD). Method: A retrospective review of fifty patients with DSM-III-R OCD referred to the Department of Behaviour Therapy at St. Patrick's Hospital, Dublin, Ireland between 1990 and 1991. Standard clinical ratings were made before and after treatment. Ratings used included the Maudsley Obsessive Compulsive Inventory (MOCI), the Fear Questionnaire (FQ), and the Yale-Brown obsessive compulsive score (YBOCS). Results: The male to female ratio was almost equal and the mean duration of illness was 6.1 (SD 11 years). OCD presented in isolation in a minority of cases (14%). A life time history of at least one other DSM-III-R axis I diagnosis, especially depression, was found in 72% of patients. Co-morbid Gilles de la Tourettes syndrome or epilepsy was rare. The majority of patients were on medication prior to presentation (78%). Levels of symptomatology were reduced in 91% of patients who completed treatment. Conclusions: Epidemiological research into the mass aspects of this disorder is required.