A mixed approach: Posttraumatic obsessive compulsive disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S411-S411
Author(s):  
R. Landera Rodríguez ◽  
M. Gómez Revuelta ◽  
M. Juncal Ruíz ◽  
O. Porta Olivares ◽  
R. Martín Gutiérrez ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Traumatic Event ◽  
Case Reports ◽  
Poor Response ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Psychotherapeutic Approach ◽  
Limited Experience ◽  
Competing Interest ◽  
Mixed Approach

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.

Duloxetine augmentation in resistant obsessive compulsive disorder: Surveying a new medication for challenges in treatment of OCD

2017 ◽  
Vol 41 (S1) ◽  
pp. S415-S415
Author(s):  
A. Mowla
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Primary Outcome Measure ◽  
Controlled Clinical Trial ◽  
Double Blind Study ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Compulsive Disorder ◽  
Significant Difference ◽  
Competing Interest ◽  
To Receive

IntroductionUp to 50% of patients with OCD have failed to respond in SSRI trials, so looking for pharmacological alternatives in treatment of obsessive compulsive disorder (OCD) seems necessary.ObjectivesSurveying duloxetine augmentation in treatment of resistant OCD.AimsStudy the effects of serotonin-norepinephrine enhancers for treatment of OCD.MethodsThis augmentation trial was designed as an 8-week randomized controlled, double blind study. Forty-six patients suffering from OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor (fluoxetine, citalopram or fluvoxamine) were randomly allocated to receive duloxetine or sertraline plus their current anti OCD treatment. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure.ResultsForty-six patients (24 of 30 in duloxetine group and 22 of 27 in sertraline group) completed the trial. Both groups showed improvement over the 8-week study period (mean Y-BOCS total score at week 8 as compared with baseline: P < 0.001 and P < 0.001) without significant difference (P = 0.861). Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0% in Y-BOCS score and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5% in Y-BOCS.ConclusionsOur double blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in resistant OCD patients. However, it needs to be noted that our study is preliminary and larger double blind placebo controlled studies are necessary to confirm the results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Schizophrenia with Obsessive Compulsive Symptoms: A Case Report

2019 ◽  
Vol 8 (1) ◽  
pp. 66-67
Author(s):  
A Jha ◽  
D Joshi
Keyword(s):  
Case Report ◽  
Obsessive Compulsive Disorder ◽  
Poor Response ◽  
Clinical Impact ◽  
Anti Psychotic ◽  
Obsessive Compulsive ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
Co Morbidity

Obsessive-compulsive disorder/ symptoms may be co-morbid in schizophrenia. The clinical impact of this co-morbidity is poor response to anti-psychotic medications. We present a case of 35 yr old female who presented with symptoms suggestive of schizophrenia and later co-morbid obsessive symptom responded well to addition of fluoxetine to antipsychotics. This case study reveals that the identification and treatment of OCD in schizophrenia is very crucial for optimistic outcome.

Application of Cognitive-behavioral Therapy in a Case of Obsessive-compulsive Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S644-S644
Author(s):  
L. Rodríguez Andrés ◽  
A. Rodriguez Campos ◽  
I. Sevillano Benito ◽  
H. De la Red Gallego ◽  
C. Noval Canga ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Behavioral Therapy ◽  
Obsessive Compulsive Disorder ◽  
Behavioral Therapy ◽  
Psychiatric Inpatient ◽  
Normal Function ◽  
Cognitive Behavioral ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Competing Interest

We present the case report of a 46-year-old woman who experienced obsessive-compulsive symptoms for over twenty years, with multiple relapses, severe depressive symptoms and many hospitalizations in the psychiatric Inpatient Unit. Treatment with different SSRIs, tricyclic antidepressants, atypical antipsychotics and even electroconvulsive therapy were administered with poor results.After her last hospitalization a Cognitive-Behavioral Therapy, including exposure and response prevention and cognitive therapy, is initiated combined with medication, improving depressive symptoms, the ritual behaviors and levels of anxiety.Modern treatments for Obsessive-Compulsive Disorder (OCD) have radically changed how the disorder is viewed. While in the past OCD was regarded as chronic and untreatable, a diagnosis of OCD may now be regarded with hope. Cognitive and behavior therapy and antidepressant medications are currently used to treat the disorder. They can be used to control the symptoms and enable people with OCD to restore normal function in their lives.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Changes of oscillatory activity in the subthalamic nucleus during obsessive-compulsive disorder symptoms: Two case reports

Cortex ◽  
2014 ◽  
Vol 60 ◽  
pp. 145-150 ◽  
Author(s):  
Julien Bastin ◽  
Mircea Polosan ◽  
Brigitte Piallat ◽  
Paul Krack ◽  
Thierry Bougerol ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Subthalamic Nucleus ◽  
Case Reports ◽  
Oscillatory Activity ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Antipsychotic Adjuvant Treatment in OCD

2017 ◽  
Vol 41 (S1) ◽  
pp. S642-S642
Author(s):  
L. Monte. Reula ◽  
H. Saiz García ◽  
A. Portilla Fernández
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Serotonin Reuptake ◽  
Partial Agonist ◽  
Antidepressant Drugs ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Low Mood ◽  
Component Traits ◽  
Potential Risks ◽  
Competing Interest

Antidepressant drugs selective inhibitors of serotonin reuptake (IRS) are the drugs effective in obsessive compulsive disorder. It has not been proven more effective none of them except clomipramine. Around 40–60% of the Patients with obsessive-compulsive disorder (OCD) remain unimproved by serotonin reuptake inhibitors (SRIs).Two cases are presented in relation to this disorder and its treatment.Twenty-three year old woman begins to present anhedonia, apathy, isolation and low mood. Treatment was initiated with escitalopram with partial improvement.Obsessive component traitsThirty year old man with obsessive clinic of years of evolution, with worsening in recent months treatment with 200 mg sertraline.In both cases treatment with oral aripiprazole it was associated with a dose of 5 mg daily with improvement in obsessive symptoms.ResultsThe efficacy of aripiprazole as adjunctive drug treatment and obsessive anxiety is observed. However, we must take into account the potential risks posed as neuroleptic malignant syndrome and QTc prolongation.ConclusionAripiprazole is an antipsychotic which has a novel mechanism of action to be a partial agonist of dopamine D2 receptors. This fact has led to its inclusion in the group of antipsychotics called third generation, also called partial dopamine agonists, dopamine stabilizers or “dopamine-serotonin modulators system.” Its most common side effects such as nausea, headaches, agitation and akathisia were observed in studies on schizophrenia, schizoaffective disorder and bipolar disorder. Unlike other atypical antipsychotics, is considered a relatively neutral drug to weight gain, hyperprolactinemia, changes in metabolic parameters and sedation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cognitive Behavioral Therapy Added to Pharmacotherapy in Patients Suffering from Pharmacoresistant Obsessive-compulsive Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S643-S644
Author(s):  
J. Vyskocilova ◽  
J. Prasko ◽  
J. Sipek ◽  
M. Slepecky
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Initial Level ◽  
Behavioral Therapy ◽  
Behavioural Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Somatoform Dissociation ◽  
Cognitive Behavioural ◽  
Competing Interest ◽  
Intensive Group

BackgroundThe objective of investigation was to determine whether patients with obsessive-compulsive disorder (OCD) resistant to drug therapy may improve their condition using intensive, systematic cognitive behavioural therapy (CBT) lasting six weeks and whether it is possible to predict treatment outcome using clinical and selected psychological characteristics.MethodFrom 66 OCD patients fifty-seven completed program. The diagnosis was confirmed using the structured mini international neuropsychiatric Interview. Patients were rated using the objective and subjective forms of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), objective and subjective forms of the Clinical Global Impression (CGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), dissociative experiences scale, 20-item Somatoform dissociation questionnaire and sheehan disability scale before treatment, and with subjective Y-BOCS, objective and subjective CGI, BAI and BDI at the end of treatment. Patients were treated with antidepressants and daily intensive group CBT for six weeks.ResultsDuring 6-week intensive CBT program in combination with pharmacotherapy, there was significant improvement in patients suffering from OCD resistant to drug treatment. There were statistically significantly decreased scores of scales assessing severity of OCD symptoms, anxiety, and depressive feelings. A lower treatment effect was achieved specifically in patients who (a) showed fewer OCD themes in symptomatology, (b) showed higher level of somatoform dissociation, (c) had poor insight and (d) had a higher initial level of overall severity of the disorder. Remission of the disorder was more likely in patients who (a) had good insight, (b) had a lower initial level of anxiety and (c) had no comorbid depressive disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

An Approach to Comorbidity Between Obsessive-Compulsive Disorder and Schizophrenia

2016 ◽  
Vol 33 (S1) ◽  
pp. S495-S495
Author(s):  
A. Gomez Peinado ◽  
S. Cañas Fraile ◽  
P. Cano Ruiz
Keyword(s):  
Mental Health ◽  
Obsessive Compulsive Disorder ◽  
Negative Symptoms ◽  
Behavioral Therapy ◽  
Psychotic Symptoms ◽  
Simultaneous Presence ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Salud Mental ◽  
Competing Interest

IntroductionAn association has been observed between obsessive symptoms in Obsessive Compulsive Disorder (OCD) and psychotic symptoms in schizophrenia, being sometimes difficult to establish a clear limit between them. The term “schizo-obsessive disorder” was proposed to describe the resulting disorder of comorbidity of OCD and schizophrenia, although it has not been definitely settled.ObjectiveTo analyze the incidence of coexistence of OCD and schizophrenia symptoms and the way it modifies the treatment and prognosis of the illness.MethodReview of some articles published in Mental Health journals such as “Salud Mental” and “Actas Españolas de Psiquiatría”.ResultsSome studies about psychotic patients have determined 15% as the average of comorbidity of OCD and schizophrenia. The probability of having OCD is six times bigger if there is psychotic pathology associated.The fact that obsessive and psychotic symptoms get together in some patients shades the prognosis bringing more negative symptoms, more depressive humor, a larger cognitive impairment, more resistance to treatment and more relapses than we can observe in OCD and schizophrenia isolated.The pharmacological treatment usually consists in neuroleptic plus anti-obsessive drugs, together with cognitive-behavioral therapy. Sometimes, when there is a very bad evolution, it is required to consider psychosurgery as one necessary option, even though its use in this context is not much widespread.ConclusionsThe simultaneous presence of OCD and schizophrenia is more common than we could expect only by chance and makes the prognosis worse, being difficult to find a truly effective treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Schizophrenia and obsessive compulsive disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. s844-s844
Author(s):  
K. Vrbova ◽  
J. Prasko ◽  
A. Cinculova ◽  
B. Krnacova ◽  
B. Talova ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Early Recognition ◽  
Obsessive Compulsive ◽  
Course Of Illness ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
Additional Information ◽  
Second Generation Antipsychotics ◽  
Competing Interest ◽  
Anxiety Depression

IntroductionA recent reviews of published researchers suggest, that up to 25% of schizophrenia patients suffer from obsessive-compulsive symptoms (OCs) and about 12% fulfill the diagnostic criteria for obsessive-compulsive disorder (OCD). Recently, the interest in this issue has significantly increased, probably due to the finding, that second generation antipsychotics, especially clozapine, might induce or aggravate OCs.ObjectiveThe aim of our study was to investigate and clarify the literature data about the extent to which comorbid OCs affects the severity and course of schizophrenia.MethodsThe articles were identified by the keywords “schizophrenia comorbidity” and “obsessive compulsive disorder”, using the medline and web of science search. Additional information was obtained by studying the references of summaries of relevant articles.ResultsObsessive-compulsive symptoms or fully expressed obsessive-compulsive disorder leads to more severe overall psychopathology and poorer treatment outcomes in patients with schizophrenia. This comorbidity is accompanied by increased neurocognitive impairment, high levels of anxiety, depression, and suicidality, less favorable levels of social and vocational functioning, and greater social and health service utilization.ConclusionsIn clinical practice, schizophrenia patients should be carefully monitored for OCs, which may occur at any time during the schizophrenia disease. Early recognition and targeted treatment of this comorbidity reduce patient's distress; positively influence the course of illness and overall treatment outcome.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical characteristics and treatment response in poor and good insight obsessive–compulsive disorder

2004 ◽  
Vol 19 (4) ◽  
pp. 202-208 ◽  
Author(s):  
V. Ravi Kishore ◽  
R. Samar ◽  
Y.C. Janardhan Reddy ◽  
C.R. Chandrasekhar ◽  
K. Thennarasu
Keyword(s):  
Drug Treatment ◽  
Treatment Response ◽  
Obsessive Compulsive Disorder ◽  
Poor Response ◽  
Severe Illness ◽  
Obsessive Compulsive ◽  
Good Insight ◽  
Compulsive Disorder ◽  
Clinical Correlates ◽  
Dsm Iv

AbstractThe DSM-IV criteria recognize the existence of obsessive–compulsive disorder (OCD) with poor insight. However, there is paucity of literature on the clinical correlates and treatment response in poor and good insight OCD. In this study, insight is measured by using the Brown Assessment of Beliefs Scale (BABS) developed specifically to assess insight. One hundred subjects with DSM-IV OCD were ascertained from the OCD clinic of a large psychiatric hospital in India. All subjects were evaluated extensively by using structured instruments and established measures of psychopathology. The subjects were treated with adequate doses of drugs for adequate period. The results showed that 25% of the subjects had poor insight. Poor insight was associated with earlier age-at-onset, longer duration of illness, more number of obsessive–compulsive symptoms, more severe illness and higher comorbidity rate, particularly major depression. Of the subjects who were treated adequately (N = 73), 44 (60%) were treatment responders. Poor insight was associated with poor response to drug treatment. In the step-wise logistic regression analysis, baseline BABS score was highly predictive of poor treatment response. Poor insight appears to be associated with specific clinical correlates and poor response to drug treatment. Further studies are needed in larger samples to replicate our findings.

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