Pharmacotherapy for obessive-compulsive disorder

1998 ◽  
Vol 173 (S35) ◽  
pp. 64-70 ◽  
Author(s):  
John H. Greist ◽  
James W. Jefferson
Keyword(s):  
Monoamine Oxidase ◽  
Effective Treatment ◽  
Serotonin Reuptake ◽  
Randomised Controlled Trials ◽  
Case Reports ◽  
Controlled Trials ◽  
Behaviour Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Randomised Controlled

Background Pharmacotherapy for obsessive-compulsive disorder (OCD) was seldom beneficial before clomipramine, a potent selective serotonin reuptake inhibitor (SSRI), became available. Subsequent progress in pharmacotherapy for OCD has increased the possibility of effective treatment for most sufferers.Method Randomised controlled trials of pharmacotherapy for OCD were reviewed, as well as reports of beneficial pharmacotherapy found in open trials and case reports.Results SSRIs are well-tolerated by patients with OCD, even in large doses. Prose roto n erg i c augmentation is seldom helpful but antipsychotic augmentations seem beneficial for many OCD patients with comorbid tics.Conclusions Potent SSRIs are the pharmacotherapy of choice for OCD, with a more limited role reserved for monoamine oxidase inhibitors. If one SSRI is ineffective, others may be beneficial. Non-drug therapies are also important in OCD: behaviour therapy is frequently helpful but infrequently available and neurosurgery is sometimes helpful when all other treatments have failed.

scholarly journals Is Intensive Cognitive Behavioural Therapy an Efficacious and Acceptable Treatment Format for Adults with Obsessive Compulsive Disorder? A Systematic Review of Randomised Controlled Trials

2020 ◽  
Author(s):  
Josie Frances Adeline Millar ◽  
Andreas Bauer ◽  
Sarah Halligan ◽  
Sophie-Anne Purnell ◽  
Gemma Taylor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obsessive Compulsive Disorder ◽  
Cognitive Behavioural Therapy ◽  
Randomised Controlled Trials ◽  
Behavioural Therapy ◽  
Controlled Trials ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behavioural ◽  
Randomised Controlled

Background: Clinical guidelines recommend the use of an intensive version of cognitive behavioural therapy (iCBT) in obsessive compulsive disorder (OCD) when evidence-based treatment has previously failed. This systematic review aimed to 1) assess the efficacy of iCBT for adults with OCD; 2) assess the acceptability of iCBT for adults with OCD.Methods: PROSPERO ID: CRD42018106840. We searched the Cochrane Controlled Register of Trials (CENTRAL), Cochrane Library, PubMed, Embase and PsycINFO for articles published between 1966 and November 2018, and reference lists and other sources for registered or ongoing studies. We included Randomised Controlled Trials (RCTs) of adults with OCD comparing iCBT to active or non-active controls. iCBT was defined as: at least five hours of CBT delivered per week in no more than four weeks for at least 10 CBT hours. The primary outcome was change in OCD symptoms from baseline to follow-up; secondary outcome was attrition; risk of bias was assessed using the Cochrane Tool. Results: Searches retrieved 5125 records, with only four RCTs with a total of 313 participants meeting inclusion criteria. Large effect sizes in favour of iCBT relative to controls were found, range (1.35 to 3.18). Drop-out rate across studies was low. However, none of the included studies focused on participants with a specific history of treatment failure. Studies were highly heterogeneous, which precluded meta-analysis. Conclusions: There was evidence that iCBT may be efficacious and acceptable. Further high quality RCTs are required to assess the efficacy and acceptability of iCBT specifically for OCD non-responders.

scholarly journals Obsessive-compulsive disorder: does CBT with exposure and response (ERP) prevention work?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S284-S285
Author(s):  
Jemma Reid ◽  
Naomi A Fineberg ◽  
Lynne Drummond ◽  
Keith Laws ◽  
Matteo Vismara ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Effect Size ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Obsessive Compulsive ◽  
Related Factors ◽  
Psychological Treatments ◽  
Compulsive Disorder ◽  
Control Intervention ◽  
Randomised Controlled

AimsSince the 1970s treatment for obsessive Compulsive Disorder (OCD) has consisted of the the application of drugs acting on the serotonin system of the brain or psychological treatments using graded exposure. Although there is a large number of studies on psychological treatments, they often are underpowered. Other major methodological issues include ignoring the effects of medication during the trial, using a variety of techniques and using waiting list data as controls.We decided to systematically review and perform a meta-analysis on randomised controlled trials (RCTs) of CBT with ERP (abbreviated to ERP)1.MethodThe study was preregistered in PROSPERO (CRD42019122311). RCTs incorporating ERP were examined. The primary outcome was the end-of-trial symptoms scores for OCD. In addition, factors which may have influenced the outcome including patient-related factors, type of control intervention, researcher allegiance and other potential forms of bias were examined. The moderating effects of patient-related and study-related factors including type of control intervention and risk of bias were also examined.ResultOverall, 36 studies were included in the analyses, involving 537 children/adolescents and 1483 adults (total 2020 subjects). A total of 1005 received ERP and the remainder a variety of control treatments. Initial results showed that ERP had a large effect size compared with placebo treatments. This was more marked in younger than older persons. However, whereas ERP was markedly more effective than waiting list or psychological control, this positive effect size disappeared when it was compared with other psychological treatments.When ERP was compared against psychopharmacological treatment it initially appeared significantly superior but this reduced to marginal benefit when compared with adequate doses of appropriate medication.The majority of studies were performed where there may be expected to be researcher allegiance to ERP and in these studies the effect size was large. In contrast, in the 8 studies considered to have low risk of researcher bias, ERP was found to be ineffective.ConclusionAlthough on initial sight CBT incorporating ERP seems to be highly efficacious in the treatment of OCD, further analysis revealed that this varied depending on the choice of comparator control. In addition there are considerable concerns about methodological rigour and reporting of studies using CBT with ERP. Further studies examining the role of researcher bias and allegiance are needed.Ref : 1 Jemma E Reid, Keith R Laws, Lynne Drummond, Matteo Vismara, Benedetta Grancini , Davis Mpavaenda, Naomi A Fineberg (2021) Cognitive Behavioural Therapy with Exposure and Response Prevention in the treatment of Obsessive-Compulsive Disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive Psychiatry , in press.

Self-extrication and selective spinal immobilisation in a polytrauma patient with spinal injuries

Trauma ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 229-232
Author(s):  
Aidan Brown ◽  
Adam Low
Keyword(s):  
Randomised Controlled Trials ◽  
Case Reports ◽  
Evidence Base ◽  
Spinal Injuries ◽  
Controlled Trials ◽  
Safe Practice ◽  
Spinal Immobilisation ◽  
Multi Level ◽  
Randomised Controlled ◽  
Polytrauma Patient

Methods of extrication and spinal immobilisation following trauma remains controversial. There is a consensus shift towards encouraging patients to self-extricate from vehicles after collisions and reduced use of hard cervical collars. Difficulties in conducting randomised controlled trials in this area means that case reports are important in adding to the existing evidence base. This case of an 81-year-old female polytrauma patient suggests that self-extrication, and not using hard cervical collars is safe practice, even in the context of significant multi-level spinal injuries.

scholarly journals Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a meta-analysis of double-blind, randomized, placebo-controlled trials

2013 ◽  
Vol 16 (3) ◽  
pp. 557-574 ◽  
Author(s):  
Markus Dold ◽  
Martin Aigner ◽  
Rupert Lanzenberger ◽  
Siegfried Kasper
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Serotonin Reuptake ◽  
Serotonin Reuptake Inhibitors ◽  
Controlled Trials ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Compulsive Disorder ◽  
Number Of Patients ◽  
First Choice

Abstract Because of the high number of patients with obsessive–compulsive disorder (OCD) not responding satisfactorily to initial monotherapy with serotonin reuptake inhibitors (SRIs), the evaluation of additional treatment options is highly relevant. To examine efficacy of add-on pharmacotherapy with antipsychotics, a systematic literature search was applied to identify all double-blind, randomized, placebo-controlled trials (DB-PC-RCTs) determining the efficacy of antipsychotic augmentation of SRIs in treatment-resistant OCD. The primary outcome of the pooled meta-analytic data analysis was response to the adjunctive antipsychotic treatment measured by both the rates of participants achieving response [defined as ⩾35% reduction in Yale–Brown Obsessive–Compulsive Scale (YBOCS)] and mean changes in YBOCS total score. Twelve DB-PC-RCTs investigating quetiapine (N = 5), risperidone (N = 3), olanzapine (N = 2), aripiprazole (N = 1) and haloperidol (N = 1) with a total of 394 subjects were included. Significantly more patients responded to augmentation with antipsychotics than with placebo [relative risk = 2.10, 95% confidence intervals (CI) 1.16–3.80]. Additionally, the mean reduction of the YBOCS total score revealed an efficacy in favour of the antipsychotic medication [standardized mean difference (SMD) = 0.54, 95% CI 0.15–0.93]. Significant efficacy was identifiable only for risperidone, but not for quetiapine and olanzapine. The results regarding aripiprazole and haloperidol were inconsistent. Overall, about one-third of SRI-resistant OCD patients benefited from an augmentation strategy with antipsychotics. Based on the favourable risk:benefit ratio, risperidone can be considered as the agent of first choice and should be preferred to quetiapine and olanzapine. Further trials, mainly with higher antipsychotic doses, are required to optimize pharmacological treatment recommendations for SRI-refractory OCD.

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