New Pharmacotherapeutic Approaches to Obsessive-Compulsive Disorder

CNS Spectrums ◽  
2009 ◽  
Vol 14 (S3) ◽  
pp. 13-23 ◽  
Author(s):  
Martijn Figee ◽  
Damiaan Denys
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Response To Treatment ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Recent Developments ◽  
Patients At Risk ◽  
Treatment Refractory ◽  
Norepinephrine Reuptake

AbstractThis article summarizes results of all pharmacotherapy trials for obsessive-compulsive disorder (OCD) published from 2006 to 2008 as well as studies on markers for predicting response to treatment and neurobiological changes induced by pharmacotherapy. Results show that recent developments in the treatment of OCD have been modest and primarily involve evidence for the efficacy of escitalopram and other selective serotonin reuptake inhibitors (SSRIs); augmentation with antipsychotics in treatment-refractory patients and combination treatment with D-cycloserine and cognitive-behavioral therapy has also been effective. The efficacy of serotonin-norepinephrine reuptake inhibitors remains inconclusive. Studies on markers of clinical response have shown inconsistent results, however, duration and severity of OCD and the presence of comorbidities can often identify patients at risk for nonresponse. Lastly, successful treatment with an SSRI results in both serotonergic and dopaminergic changes, but more research is necessary in order to define the biological characteristics of responders and nonresponders.

Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder

2014 ◽  
Vol 121 (1) ◽  
pp. 123-130 ◽  
Author(s):  
Andre F. Gentil ◽  
Antonio C. Lopes ◽  
Darin D. Dougherty ◽  
Christian Rück ◽  
David Mataix-Cols ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Obsessive Compulsive Disorder ◽  
Limbic System ◽  
Sao Paulo ◽  
Response To Treatment ◽  
São Paulo ◽  
Obsessive Compulsive ◽  
Symptom Dimensions ◽  
Compulsive Disorder ◽  
Treatment Refractory

Object Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%–41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.

Cognitive-Behavioral Therapy and Integrated Approaches in the Treatment of Obsessive-Compulsive Disorder

CNS Spectrums ◽  
1999 ◽  
Vol 4 (S3) ◽  
pp. 35-40 ◽  
Author(s):  
Fritz Hohagen
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Obsessive Compulsive Disorder ◽  
Behavior Therapy ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Mental Condition ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

AbstractObsessive-compulsive disorder (OCD) has long been considered a treatment-refractory mental condition. Neither pharmacologic nor psychodynamic therapy has been proven to treat OCD effectively. Yet the prognosis for OCD has changed dramatically in recent years with the introduction of behavior therapy and the use of selective serotonin reuptake inhibitors (SSRIs). Many studies have shown that behavior therapy, especially exposure with response prevention, and SSRIs reduce obsessive-compulsive symptoms significantly. Still, many unanswered questions—including the role of cognitive therapy in the treatment of OCD, exposure therapy vs multimodal behavioral therapy, individual versus group therapy, outcome predictors in adults, adolescents, and children, and the role of combination treatment using an SSRI and cognitive-behavioral therapy—remain. This article will explore these issues as well as suggest directions for further research into OCD.

Obsessive-Compulsive Disorder, Body Dysmorphic Disorder, and Hypochondriasis: Three Variations on a Theme

CNS Spectrums ◽  
1996 ◽  
Vol 1 (2) ◽  
pp. 24-31 ◽  
Author(s):  
Stephen C. Josephson ◽  
Eric Hollander ◽  
Brian Fallon ◽  
Dan J. Stein
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Behavioral Treatment ◽  
Body Dysmorphic Disorder ◽  
Behavioral Therapy ◽  
Response To Treatment ◽  
Clinical Samples ◽  
Cognitive Behavioral Treatment ◽  
Analysis Model ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

AbstractBackground:Exaggerated illness and appearance concerns and related compulsive behaviors are seen in the psychiatric disorders of hypochondriasis (HYP), body dysmorphic disorder (BDD), and obsessive-compulsive disorder (OCD). It has been argued that these conditions may cluster in clinical samples and that our current categorical diagnostic policies, which assume independence of these disorders, are arbitrary and fail to capture the dimensional nature of these disorders.Methods:We present retrospective clinical data on 21 randomly selected patients who presented with symptoms that involved anxiety about illness and appearance and who were evaluated for cognitive-behavioral treatment or pharmacotherapy. We also review the symptoms, associated features, and response to treatment of three patients from the sample who were each diagnosed with all three of these disorders (HYP, BDD, and OCD).Results:Three patients met criteria for HYP, BDD, and OCD, and the other 18 patients met criteria for at least two of the above conditions. The most frequently reported source of anxiety had to do with one's hair. Nine out of the 12 patients treated with behavioral therapy were considered to be responders, and the one treated solely with medication was “very much improved.” Of the eight treated with a combination of behavioral therapy and medication, five were judged to be responders.Conclusions:Overlap in phenomenology, associated features, and treatment response suggests that these three disorders may be difficult to distinguish from each other and that a “cluster analysis” model may prove helpful in evaluating clinical samples.

scholarly journals Thermocoagulation as a Surgical Approach for the Treatment of Obsessive-Compulsive Disorder in Refractory Patients: Systematic Review

2021 ◽  
Author(s):  
Lucas Praxedes Chaves ◽  
Álef Ribeiro Souza ◽  
Ledismar José da Silva ◽  
Laura de Lima Crivellaro ◽  
Marina Ferreira da Silva
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Therapeutic Option ◽  
High Morbidity ◽  
Obsessive Compulsive ◽  
Noninvasive Treatment ◽  
Compulsive Disorder

AbstractObsessive-compulsive disorder (OCD), a disabling chronic neuropsychiatric disease, entails high economic costs to society and has high morbidity and mortality rates. The first-line treatments for OCD are selective serotonin reuptake inhibitors and cognitive-behavioral therapy. However, this disorder has the highest refractory index to noninvasive treatment. Alternatively, ablative thermocoagulation neurosurgical techniques have shown efficacy and few adverse effects. The present systematic review aimed to identify validated protocols to observe the effectiveness of ablative procedures in the treatment of severe and refractory OCD, as well as their possible adverse effects and benefits. This review supports the effectiveness of ablative methods by presenting them as a safe non-experimental therapeutic option for cases of highly-refractory OCD. Additional relevant findings were the improvement in cognitive function, functional capacity, affective orientation, and quality of life, which contribute to the destigmatization of this surgical technique. Further controlled studies may lead to the individualization of recommendations of targets for ablative thermocoagulation.

scholarly journals Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)

2019 ◽  
Vol 17 (8) ◽  
pp. 710-736 ◽  
Author(s):  
Antonio Del Casale ◽  
Serena Sorice ◽  
Alessio Padovano ◽  
Maurizio Simmaco ◽  
Stefano Ferracuti ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Clinical Guidelines ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Mood Stabilizers ◽  
Obsessive Compulsive ◽  
Global Functioning ◽  
Comprehensive Overview ◽  
Compulsive Disorder ◽  
Pubmed Database

Background:Obsessive-compulsive disorder (OCD) is associated with affective and cognitive symptoms causing personal distress and reduced global functioning. These have considerable societal costs due to healthcare service utilization.Objective:Our aim was to assess the efficacy of pharmacological interventions in OCD and clinical guidelines, providing a comprehensive overview of this field.Methods:We searched the PubMed database for papers dealing with drug treatment of OCD, with a specific focus on clinical guidelines, treatments with antidepressants, antipsychotics, mood stabilizers, off-label medications, and pharmacogenomics.Results:Prolonged administration of selective serotonin reuptake inhibitors (SSRIs) is most effective. Better results can be obtained with a SSRI combined with cognitive behavioral therapy (CBT) or the similarly oriented exposure and response prevention (ERP). Refractory OCD could be treated with different strategies, including a switch to another SSRI or clomipramine, or augmentation with an atypical antipsychotic. The addition of medications other than antipsychotics or intravenous antidepressant administration needs further investigation, as the evidence is inconsistent. Pharmacogenomics and personalization of therapy could reduce treatment resistance.Conclusion:SSRI/clomipramine in combination with CBT/ERP is associated with the optimal response compared to each treatment alone or to other treatments. New strategies for refractory OCD are needed. The role of pharmacogenomics could become preponderant in the coming years.

Anxiety, Obsessive-Compulsive, and Stress Disorders

2014 ◽  
Author(s):  
Franklin R. Schneier ◽  
Hilary B. Vidair ◽  
Leslie R. Vogel ◽  
Philip R. Muskin
Keyword(s):  
Anxiety Disorder ◽  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Stress Disorders ◽  
Panic Attacks ◽  
Social Situations ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Patients with generalized anxiety disorder experience anxiety related to multiple areas, such as work, finances, and illness. Discrete, unexpected panic attacks and anticipatory anxiety characterize patients with panic disorder. Patients with social anxiety disorder have fear of embarrassment in social situations. Patients with obsessive-compulsive disorder are preoccupied with and distressed by inappropriate thoughts, urges, and images. The four cardinal features of posttraumatic stress disorder are intrusive reexperiencing of the initial trauma, avoidance, persistent negative alterations in cognitions and mood, and alterations in arousal and activity. One element common to patients suffering from most of the anxiety disorders is an elevated sensitivity to threat, which appears to involve brain systems identified to mediate “fear” responses, including the amygdala. The selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the first-line pharmacotherapy treatment for obsessive-compulsive disorder and most of the anxiety and stress disorders. Cognitive-behavioral therapy for anxiety, obsessive-compulsive, and stress disorders is an empirically validated time-limited treatment.

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