Clomipramine and Exposure for Chronic Obsessive-Compulsive Rituals: III. Two Year Follow-Up and Further Findings

1982 ◽  
Vol 140 (1) ◽  
pp. 11-18 ◽  
Author(s):  
D. Mawson ◽  
I. M. Marks ◽  
L. Ramm
Keyword(s):  
Social Adjustment ◽  
Age Of Onset ◽  
Drug Effect ◽  
Obsessive Compulsive ◽  
Exposure In Vivo

SummaryForty chronic ritualizers were given clomipramine or placebo from weeks 0 to 36; also all had exposure in vivo, half from weeks 4 to 10 (30 hours) and half from weeks 7 to 10 (15 hours). In the 37 patients available at week 114 there were substantial and maintained improvements in rituals, mood and social adjustment compared to week 0. Reduction of rituals was even greater in those who had 30 hours of exposure. There was no drug effect on rituals at two year follow-up. Greater initial anxiety or depression predicted the superiority of clomipramine over placebo from weeks 10 to 36 and more prescription of tricyclics in follow-up. However, two year outcome was not predicted by initial anxiety or depression, nor by sex, age, age of onset nor duration of rituals.

Clomipramine and Exposure for Obsessive-Compulsive Rituals: 1

1980 ◽  
Vol 136 (1) ◽  
pp. 1-25 ◽  
Author(s):  
I. M. Marks ◽  
R. S. Stern ◽  
D. Mawson ◽  
J. Cobb ◽  
R. McDonald
Keyword(s):  
Social Adjustment ◽  
Depressed Mood ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Exposure In Vivo ◽  
One Year ◽  
Interactional Effect

SummaryForty chronic obsessive-compulsive ritualizers were randomly assigned to treatment with oral clomipramine or placebo for 8 months. During weeks 4 to 7 these two groups were each randomly split into treatment by relaxation or by exposure in vivo, and during weeks 7 to 10 all patients had exposure in vivo. Double blind assessments were made at weeks 4, 7, 10, 18, 36, 62 and 114.Results are reported to one year. Clomipramine produced significant improvement in rituals, mood and social adjustment, but only in those patients who initially had depressed mood. The clomipramine effect was maximum from weeks 10 to 18 and diminished thereafter. On stopping clomipramine patients often relapsed and improved again on restarting the drug. Relaxation produced little change. Exposure produced significant lasting improvement in rituals, but less change in mood; improvement generalized to social adjustment at follow-up. Clomipramine plus exposure had a slight additive but not interactional effect. Clomipramine enhanced compliance both with exposure and with relaxation.Clomipramine is useful for compulsive ritualizers with depressed mood, but may need continuation for over a year and combination with exposure in vivo. Exposure in vivo remains the treatment of choice for rituals without depressed mood.

Slow versus Rapid Exposure in vivo of Phobics

1984 ◽  
Vol 12 (3) ◽  
pp. 249-256 ◽  
Author(s):  
Sahika Yuksel ◽  
Isaac Marks ◽  
Elizabeth Ramm ◽  
Anindya Ghosh
Keyword(s):  
Social Adjustment ◽  
Treatment Time ◽  
Final Outcome ◽  
Balanced Design ◽  
Exposure In Vivo

Twenty-eight chronically phobic patients had therapist-aided exposure either rapidly or slowly. During therapist-aided exposure move to the next hierarchy item occurred after subjective anxiety had dropped, on a scale of 0–8 by two points (rapid) or by four points (slow). Exposure began with the lowest of eight hierarchy items. All patients had self-exposure homework between sessions. In a balanced design 12 patients were treated in London and 16 in Istanbul. Peak anxiety during sessions was comparable in both groups. Compared to slow exposure patients, rapid exposure patients completed treatment to criterion in fewer sessions and less time (4·7 vs. 5·8 sessions P< 0·01; 360 vs. 484 min P< 0·005). Criterion for termination of treatment was toleration of the highest hierarchy item with minimal discomfort, or a maximum of eight sessions. Both in London and in Istanbul rapid and slow groups improved substantially and similarly in phobias, social adjustment and mood; gains continued to 6 months follow-up. Compared to slower exposure, rapid exposure does not enhance final outcome but does shorten treatment time without increasing peak anxiety during sessions.

scholarly journals Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder

1995 ◽  
Vol 33 (4) ◽  
pp. 379-390 ◽  
Author(s):  
Patricia Van Oppen ◽  
Else De Haan ◽  
Anton J.L.M. Van Balkom ◽  
Philip Spinhoven ◽  
Kees Hoogduin ◽  
...  
Keyword(s):  
Cognitive Therapy ◽  
Obsessive Compulsive Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Exposure In Vivo

Cognitive-Behavioral Therapy for Paruresis: A Case Report

1998 ◽  
Vol 83 (1) ◽  
pp. 187-196 ◽  
Author(s):  
Jan P. C. Jaspers
Keyword(s):  
Behavioral Therapy ◽  
Single Case ◽  
Treatment Model ◽  
Cognitive Approach ◽  
Social Phobias ◽  
Cognitive Interventions ◽  
Cognitive Components ◽  
Exposure In Vivo

This article reviews directive interventions for paruresis, the inability to urinate in the proximity of others. As in treatments for other anxiety disorders, historical interventions have included the use of paradoxical intention and several different forms of exposure. The results of pharmacological treatment have not proven promising. Although a multidimensional treatment model has been recommended, little attention has been paid to treating cognitive components of the problem. In this paper, a single case is described in which cognitive components of the problem of paruresis were evident. A cognitive approach and exposure in vivo were applied. Measures of successful trials were obtained over 18 weeks. The combination of cognitive interventions and gradual exposure was effective in reducing paruresis. At follow-up 6 mo. later results had been maintained. The results of this case suggest more attention to the cognitive components is appropriate in the treatment of paruresis, as was stated previously for other specific social phobias.

Treatment of Obsessive-Compulsive Neurosis with History of Childhood Autism

1977 ◽  
Vol 130 (6) ◽  
pp. 592-597 ◽  
Author(s):  
Peter Lindley ◽  
Isaac Marks ◽  
Robin Philpott ◽  
John Snowden
Keyword(s):  
Social Skills Training ◽  
Skills Training ◽  
Childhood Autism ◽  
Obsessive Compulsive ◽  
Behavioural Treatment ◽  
History Of Childhood ◽  
History Of ◽  
Made In

SummaryA young man was followed-up over three years who had severe obsessive-compulsive rituals and ruminations, interpersonal deficits, complicating depression and a history of childhood autism. Intensive behavioural treatment was given in an operant framework, with exposure in vivo, modelling, response prevention and social skills training. Compulsive rituals improved markedly and lastingly, but ruminations and social defects persisted. When intercurrent depression occurred dothiepin facilitated behavioural treatment. Adjustment remained fragile. Minimum maintenance treatment in the community could not be adequately arranged, so that gains made in hospital were partly lost at follow-up, despite continuing improvement in rituals.

Follow-up of Agoraphobic Patients Treated with Exposure in Vivo or Applied Relaxation

1986 ◽  
Vol 149 (4) ◽  
pp. 486-490 ◽  
Author(s):  
L. Jansson ◽  
A Jerremalm ◽  
L. G. Öst
Keyword(s):  
Treatment Results ◽  
Cognitive Behavioural ◽  
End Of Treatment ◽  
Applied Relaxation ◽  
Response Systems ◽  
Exposure In Vivo ◽  
Clinically Significant ◽  
Made In

The present study describes the results of a 7-month and a 15-month follow-up of 32 agoraphobic patients treated with exposure in vivo or applied relaxation. During the followup period, all patients were given self-exposure instructions. Assessments were made in three response systems-subjective-cognitive, behavioural, and physiological-at the follow-up points. The study showed overall maintenance of treatment results in all three response systems for exposure-treated patients. For applied relaxation/self-exposure, there was a relapse on Δ heart-rate at 7 months for physiologically reactive patients, but the improvement was regained at the 15 month follow-up. Furthermore, a large proportion of the total improvement occurred during the follow-up period: 36% and 22% for exposure and applied relaxation/self-exposure respectively. The proportion of patients reaching a clinically significant improvement was 50% at the end of treatment and 66% at the 15 month follow-up.

Duration of untreated psychosis and its correlates in first episode psychosis: results of the prospective 5-year follow-up study

2011 ◽  
Vol 26 (S2) ◽  
pp. 1534-1534
Author(s):  
Y. Zaytseva ◽  
I. Gurovich ◽  
A. Dorodnova ◽  
L. Movina ◽  
A. Shmukler
Keyword(s):  
Social Adjustment ◽  
Verbal Memory ◽  
Visual Memory ◽  
Negative Symptoms ◽  
Age Of Onset ◽  
Brain Regions ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Duration Of Untreated Psychosis

IntroductionDuration of untreated psychosis (DUP) is a potentially changeable prognostic factor which can also indicate neurodegenerative process in schizophrenia.ObjectiveTo examine the association of DUP with various characteristics of the course of schizophrenia in first episode patients during 5-year follow-up.MethodsOne-hundred-fourteen patients with first psychotic episodes who have been treated in naturalistic setting within Early Intervention Centre (Moscow Research Institute of Psychiatry) were included. Clinical, social and neuropsychological parameters were assessed using standardized instruments.ResultsThe mean duration of untreated psychotic symptoms before admission was 298.66 ± 447.35 days. According to the analysis DUP was found to be significantly associated with the mode of onset (r = 0.51, p ≤ 0.001) level of remission (r = 0.21–0.30, p ≤ 0.05), severity of positive symptoms and negative symptoms in remission mostly at 2nd, 3d and 4th years of observation, poorer level of social adjustment at the 5th year (r = 0.19, p ≤ 0.05). The effect of DUP remained significant after controlling for age, gender and diagnostic variables.Moreover, DUP correlated with the parameters of verbal memory, visual memory and spatial functions during the follow-up (r = 0.29–0.36, p ≤ 0.05, r = 0.28–0.30, p ≤ 0.05, respectively). No correlations have been found between DUP and the age of onset, number of relapses and their duration during 5-year follow-up as well as with other neurocognitive parameters (executive functioning, gnosis, praxis, attention).ConclusionsThe results of the study underline the prognostic value of DUP for predicting clinical and functional outcomes. Association between DUP and poor memory domains supports the notion of neurotoxicity of DUP grasping specific brain regions in schizophrenia.

Treatment of an 11-year-old Obsessive-compulsive Ritualizer and Tiqueur Girl with in vivo Exposure and Response Prevention

1983 ◽  
Vol 11 (1) ◽  
pp. 75-81 ◽  
Author(s):  
P. Zikis
Keyword(s):  
Traumatic Event ◽  
Specific Treatment ◽  
Sudden Onset ◽  
Home Treatment ◽  
Response Prevention ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Primary Problem

A case is described of an 11-year-old schoolgirl with both obsessive-compulsive rituals and tics of sudden onset following a traumatic event at the age of five. Treatment consisted of exposure in vivo and response prevention directed mainly towards her obsessive-compulsive rituals as they were considered the primary problem. Following the initial therapist–patient out-patient session and home treatment with her mother, the obsessive-compulsive rituals disappeared and the tics decreased. Three weeks later the tics disappeared without specific treatment and the patient has maintained her improvement at follow-up, 52 weeks later. The actual therapist–patient time was about an hour.

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