Disorders - Obsessive Compulsive Disorder
Memik, N. C., Gundogdu, O. Y., Tural, U.
Information on the use of N-acetylcysteine (NAC) in neuropsychiatric disorders has increased in recent publications. Although there are positive reports on the use of NAC in obsessive-compulsive and related disorders (OCRD), such data have not yet been validated. This article aims to review the research, case series and case reports that have been published about the use of NAC in OCRD. Research papers and case reports on the use of NAC in OCRD published within the last five years have been reviewed using the search engines of "Pubmed" and "Medline Central" databases. The search was performed by matching the terms "obsessive-compulsive disorder (OCD)", "trichotillomania (TTM)", "nail biting", "skin picking", "hoarding disorder", and "body dysmorphic disorder" with "N-acetylcysteine". The search identified 4 papers on TTM, 3 papers on nail biting behavior, 1 paper on OCD and 1 paper on skin-picking behavior. Three of these papers were double-blind, placebo-controlled studies and four were case reports/series. The results of 2 papers out of the 7 that we reviewed showed that there was no difference between NAC and placebo, while 5 papers reported that the response to the NAC therapy was positive. We did not find any papers on the use of NAC in either hoarding disorder or body dysmorphic disorder. NAC is thought to be a promising psychopharmacologic agent in OCD, which is defined under OCRD due to its common etiology, similar clinical features and similar response to treatment, as well as in TTM, skin picking and nail biting. The effectiveness of glutamatergic modulators on repetitive behaviors or OCD has increased interest in NAC. Although there are a few studies in the area, many research projects are being planned, with some already in progress (www.clinicaltrials. gov), a fact that emphasizes the importance of NAC in OCRD treatment. NAC has been used in a broad spectrum of conditions such as paracetamol intoxication, doxorubicin cardiotoxicity, ischemia-reperfusion-induced injury of the myocardium, acute respiratory distress syndrome, bronchitis, chemotherapy intoxication and heavy metal intoxication. In recent years, there has been an increase in the number of studies exploring the use of NAC in neuropsychiatric disorders such as schizophrenia, autism, bipolar disorder and OCRD. In this review, we have seen that the results of studies assessing the efficacy of NAC in psychiatric disorders are promising; however, there is a need for further studies to evaluate its mechanism of action, appropriate dose range and duration of treatment.
Klinik Psikofarmakoloji Bulteni, 25(2) : 193-206
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Ivarsson, T., Skarphedinsson, G., Kornor, H., Axelsdottir, B., Biedilae, S., Heyman, I., Asbahr, F., Thomsen, P. H., Fineberg, N., March, J.
Serotonin reuptake inhibiting drugs (SRI) have been used in the treatment of paediatric obsessive-compulsive disorder over the past 30 years. We performed a systematic review and meta-analysis of the literature to discuss the place of and evidence for the use of SRI in paediatric OCD, based on 14 publications of methodologically sound, randomized and controlled studies. Both SRI and specific SRIs were examined and comparisons of SRI, placebo, cognitive behaviour therapy (CBT), combined (COMBO) treatments (SRI+CBT) made to investigate their relative efficacy. Using the Cochrane methodology, and as measures of effect size mean difference and Hedge's g, SRIs proved to be superior to drug placebo, with a modest effect size. From direct comparisons of CBT and SRI treatments, we conclude that CBT has the superior efficacy. COMBO versus CBT shows that SRI treatment adds little to concomitant CBT, while COMBO shows favourable outcome versus SRI alone. In pre-trial partial treatment responders, those who failed a SRI had better outcome from adding CBT as compared to continuing a SRI. Those who failed CBT treatment did as well with continued CBT as with switching to a SRI. The studies of combinations and sequences of treatments need to be developed further. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Psychiatry Research, 227(1) : 93-103
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Antidepressants (any)
Jonsson, H., Kristensen, M., Arendt, M.
Despite promising results from intensive formats of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) the format is rarely used. The aim of the study was to systematically review the literature within this area of research and provide a meta-analysis of the effectiveness of intensive CBT for youths or adults with OCD. The meta-analysis was based on 17 trials (11 adult and 6 youth) including a total of 646 participants. Large overall pre-post effect sizes (ES) of 2.44 (95% CI 2.03-2.85) for clinical ratings (n = 16) and 1.23 (95% CI 1.01-1.45) for self-reports (n = 5) were found (Hedges g). Based on two comparative nonrandomized studies and one RCT, a larger post-treatment effect of intensive treatment compared to standard weekly or twice weekly CBT was found (between group ES = 0.39 (95% CI 0.05-0.74) for clinical ratings). This difference was no longer present at 3 month follow-up, mainly due to slight deterioration among patients who had received intensive CBT while patients from weekly conditions changed little. In sum, the meta-analysis indicates that intensive CBT is an effective treatment for youths and adults with OCD, and could be a promising format to enhance immediate treatment effects compared to standard CBT. Focus on how to maintain superior post-treatment effects of intensive CBT could be a promising research area. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Journal of Obsessive-Compulsive & Related Disorders, 6 : 83-96
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Gorenstein, G., Gorenstein, C., de-Oliveira, M. C., Asbahr, F. R., Shavitt, R. G.
This study aimed to investigate the impact of child-focused pediatric OCD treatment on parental anxiety, family accommodation and family environment. Forty-three parents (72.1% female, mean age+/-SD = 43.1+/-5.6 years) were evaluated at baseline and after their children's (n =33, 54.5% female, mean age+/-SD =12.9+/-2.7 years) randomized treatment with Group Cognitive-Behavioral Therapy or fluoxetine for 14 weeks. Validated instruments were administered by trained clinicians. Parents were assessed with the State-Trait Anxiety Inventory (STAI), the Family Accommodation Scale (FAS) and the Family Environment Scale (FES). The Yale-Brown Obsessive-Compulsive Scale was administered to children. Significant findings after the children's treatment include decreased family accommodation levels (participation, modification and distress/consequences domains); increased cohesion and active-recreational components of the family environment. In addition, changes in the FAS distress/consequences and the FES cohesion subscores were correlated with the children's clinical improvement. These results suggest that child-focused OCD treatment may have a positive impact on family accommodation and family environment. Future studies should further clarify the reciprocal influences of pediatric OCD treatment and family factors. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Psychiatry Research, 229(1-2) : 161-166
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Skarphedinsson, G., Hanssen-Bauer, K., Kornor, H., Heiervang, E. R., Landro, N. I., Axelsdottir, B., Biedilae, S., Ivarsson, T.
Background: Previous meta-analyses of paediatric obsessive-compulsive disorder (OCD) have shown much higher effect size for standard individual cognitive behaviour therapy (SI-CBT) compared with control conditions than for serotonin reuptake inhibitors (SRIs) compared with placebo. Other factors, such as systematic differences in the provided care or exposure to factors other than the interventions of interest (performance bias) may be stronger confounders in psychotherapy research than in pharmacological research. Aims: These facts led us to review SI-CBT studies of paediatric OCD with the aim to compare the effect estimates across different comparisons, including active treatments. Method: We included only randomized controlled trials (RCTs) or cluster RCTs with treatment periods of 12-16 weeks. Outcome was post-test score on the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS). Results: Thirteen papers reporting from 13 RCTs with 17 comparison conditions were included. SI-CBT was superior to wait-list and placebo therapy but not active treatments. Effect estimates for SI-CBT in wait-list comparison studies were significantly larger than in placebo-therapy comparison studies. In addition, the SI-CBT effect estimate was not significantly different when compared with SRIs alone or combined SRIs and CBT. Conclusions: Performance bias may have inflated previous effect estimates for SI-CBT when comparison contingencies included wait-list. However, the calculated SI-CBT effect estimate was lower but significant when compared with placebo therapy. The effects of SI-CBT and active treatments were not significantly different. In conclusion, our data support the current clinical guidelines, although better comparisons between SI-CBT and SRIs are needed. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Nordic Journal of Psychiatry, 69(2) : 81-92
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Rosa-Alcazar, A. I., Sanchez-Meca, J., Rosa-Alcazar, A., Iniesta-Sepulveda, M., Olivares-Rodriguez, J., Parada-Navas, J. L.
Although several meta-analyses have investigated the efficacy of psychological treatments for pediatric obsessive-compulsive disorder (OCD), there is not yet a consensus on the most efficacious treatment components. A meta-analysis was carried out to examine the efficacy of the different treatment techniques used in the psychological interventions of pediatric OCD. An exhaustive literature search from 1983 to February 2014 enabled us to locate 46 published articles that applied some kind of cognitive-behavioral therapy (CBT). For each group the effect size was the standardized pretest-posttest mean change, and it was calculated for obsessive-compulsive symptoms and for other outcome measures. The results clearly showed large effect sizes for CBT in reducing obsessive-compulsive symptoms and, to a lesser extent, other outcome measures (d + = 1.860; 95% CI: 1.639; 2.081). The most promising treatments are those based on multicomponent programs comprising ERP, cognitive strategies, and relapse prevention. The analysis of other potential moderator variables and the implications for clinical practice are discussed.;
Spanish Journal of Psychology, 18 : E20-E20
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Exposure therapy, Exposure and response prevention
Vakili, Y., Gharaee, B., Habibi, M.
Background: Selective serotonin reuptake inhibitors (SSRIs) and exposure with response prevention for treatment of obsessive-compulsive disorder (OCD) have demonstrated empirical support; however, a substantial number of patients remain with clinically significant OCD symptoms after such treatments. Objectives: The aim of this study was to compare the effectiveness of acceptance and commitment therapy (ACT), selective serotonin reuptake inhibitors (SSRIs) and combination of ACT and SSRIs in the treatment of adults with obsessive-compulsive disorder (OCD). Patients and Methods: Thirty-two outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for OCD were randomly assigned to one of the three treatment conditions: ACT, SSRIs and combined treatment. The Yale-Brown Obsessive-Compulsive Scale and Acceptance and Action Questionnaire were administered at pre-treatment and post-treatment. Twenty-seven patients completed the study. Data was analyzed using one-way analysis of variance (ANOVA) and one-way analysis of covariance (ANCOVA), clinically significant change (CSC) and complete remission status. Results: ANCOVA revealed that patients treated with ACT and combined treatment experienced a significantly greater improvement in obsessive-compulsive (OC) symptoms and experiential avoidance (EA) at post-treatment compared to those treated with SSRIs alone. However, there were no significant differences between ACT and combined treatment on OC symptoms and EA. CSC and complete remission status results showed that unlike SSRI, ACT and combined treatment led to more improvement in OC symptoms. Conclusions: ACT and combined treatment are more effective than SSRIs alone in treating OC symptoms and EA. However, it appears that adding SSRIs to ACT does not increase the effectiveness of ACT in the treatment of adults with OCD in the short-term.
Iranian Journal of Psychiatry & Behavioral Sciences, 9(2) : 16-20
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Acceptance & commitment therapy (ACT)
Skarphedinsson, G., Weidle, B., Thomsen, P. H., Dahl, K., Torp, N. C., Nissen, J. B., Melin, K. H., Hybel, K., Valderhaug, R., Wentzel-Larsen, T., Compton, S. N., Ivarsson, T.
Expert guidelines recommend cognitive-behavior therapy (CBT) as a first-line treatment in pediatric obsessive-compulsive disorder (OCD) and the addition of selective serotonin reuptake inhibitors when CBT is not effective. However, the recommendations for CBT non-responders are not supported by empirical data. Our objective was to investigate the effectiveness of sertraline (SRT) versus continued CBT in children and adolescents that did not respond to an initial course of CBT. Randomized controlled trial conducted in five sites in Denmark, Sweden and Norway, 54 children and adolescents, age 7-17 years, with DSM-IV primary OCD were randomized to SRT or continued CBT for 16 weeks. These participants had been classified as non-responders to CBT following 14 weekly sessions. Primary outcomes were the CY-BOCS total score and clinical response (CY-BOCS <16). The study was a part of the Nordic Long-Term OCD Treatment Study (NordLOTS). Intent-to-treat sample included 50 participants, mean age 14.0 (SD = 2.7) and 48 % (n = 24) males. Twenty-one of 28 participants (75 %) completed continued CBT and 15 of 22 participants (69.2 %) completed SRT. Planned pairwise comparison of the CY-BOCS total score did not reveal a significant difference between the treatments (p = .351), the response rate was 50.0 % in the CBT group and 45.4 % in the SRT group. The multivariate chi 2 test suggested that there were no statistically significant differences between groups (p = .727). Within-group effect sizes were large and significant across both treatments. These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial. However, there was no significant between-group differences in SRT or continued CBT at post-treatment. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
European Child & Adolescent Psychiatry, 24(5) : 591-602
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
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Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Salemink, E., Wolters, L., de-Haan, E.
Background and objectives: Cognitive Behavioral Therapy for children and adolescents with Obsessive Compulsive Disorder (OCD) is effective. However, since almost half of patients remain symptomatic after treatment, there remains room for improvement. Cognitive Bias Modification training of Interpretations (CBM-I) is a promising new intervention, as it targets misinterpretation of intrusions, which is seen as an important characteristic in OCD. To date, there have been no published studies of CBM-I in adolescents with OCD. The aim of the current pilot study was to examine the added value of online CBM-I training as an adjunctive treatment to the Treatment As Usual (TAU; that included CBT and pharmacotherapy) in adolescents with OCD. Methods: Patients receiving TAU were randomly assigned to either an additional CBM-I training (n = 9), or to an additional placebo variant of this procedure (n = 7). Results: Immediate, on-line interpretations changed in response to the CBM-I training, while no such effects were observed on slower retrospective off-line interpretations. Patients in the CBM-I training condition reported fewer obsessive compulsive symptoms after training, and clinicians rated them as having fewer obsessive symptoms (corresponding to medium-large effect sizes). No such changes were observed in the placebo group. Limitations: The small sample size precludes strong conclusions and replication is necessary to test the robustness of the findings. Conclusions: This small randomized controlled trial is suggestive, although not conclusive, regarding the promising additive value of OC-related CBM-I training as an adjunctive intervention to TAU in an adolescent clinical population. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of Behavior Therapy & Experimental Psychiatry, 49(Part A) : 112-119
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Attention/cognitive bias modification
, Technology, interventions delivered using technology (e.g. online, SMS)
Schumer, M. C., Panza, K. E., Mulqueen, J. M., Jakubovski, E., Bloch, M. H.
Objective: To examine long-term outcome in children with trichotillomania. Method: We conducted follow-up clinical assessments an average of 2.8 +/- 0.8 years after baseline evaluation in 30 of 39 children who previously participated in a randomized, double-blind, placebo-controlled trial of N-acetylcysteine (NAC) for pediatric trichotillomania. Our primary outcome was change in hairpulling severity on the Massachusetts General HospitalHairpulling Hospital Hairpulling Scale (MGH-HPS) between the end of the acute phase and follow-up evaluation. We also obtained secondary measures examining styles of hairpulling, comorbid anxiety and depressive symptoms, as well as continued treatment utilization. We examined both correlates and predictors of outcome (change in MGH-HPS score) using linear regression. Results: None of the participants continued to take NAC at the time of follow-up assessment. No significant changes in hairpulling severity were reported over the follow-up period. Subjects reported significantly increased anxiety and depressive symptoms but improvement in automatic pulling symptoms. Increased hairpulling symptoms during the follow-up period were associated with increased depression and anxiety symptoms and increased focused pulling. Older age and greater focused pulling at baseline assessment were associated with poor long-term prognosis. Conclusions: Our findings suggest that few children with trichotillomania experience a significant improvement in trichotillomania symptoms if behavioral treatments are inaccessible or have failed to produce adequate symptom relief. Our findings also confirm results of previous cross-sectional studies that suggest an increased risk of depression and anxiety symptoms with age in pediatric trichotillomania. Increased focused pulling and older age among children with trichotillomania symptoms may be associated with poorer long-term prognosis. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Depression & Anxiety, 32(10) : 737-743
- Year: 2015
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Romanelli, R. J., Wu, F. M., Gamba, R., Mojtabai, R., Segal, J. B.
Background: Effective treatments for obsessive-compulsive disorder (OCD) include behavioral therapy (exposure and response/ritual prevention and cognitive behavioral therapy) and serotonin-reuptake inhibitors (SRIs); however, the relative efficacy of these treatments is not well established. We sought to review evidence from head-to-head randomized-controlled trials (RCTs) of behavioral therapy and SRIs in the treatment of OCD.; Methods: A systematic search of multiple databases was conducted from first available date to June 30, 2012, for RCTs in the treatment of OCD among outpatients, comparing behavioral therapy and SRIs, alone or combined. Two independent reviewers evaluated studies for eligibility and risk of bias. The main outcome measure was posttreatment mean Yale-Brown Obsessive-Compulsive Scale (YBOCS) score.; Results: We identified 2,186 unique articles. Fifteen articles were included, describing 13 RCTs. Pooled standardized mean difference (SMD; 95% confidence intervals) in YBOCS score significantly favored behavioral therapy over SRIs (0.37; 0.10, 0.64; P = .007), but not in a subset of trials that used selective SRIs (0.22; -0.02, 0.47; P = .070). Within individual trials, effect sizes significantly favored the combination of behavioral therapy plus an SRI over an SRI, but not behavioral therapy, alone.; Conclusions: This review provides evidence that, among outpatients with OCD, behavioral therapy is more effective than SRIs, overall, but not selective SRIs. Furthermore, the combination of behavioral therapy plus an SRI is more effective than an SRI alone. These data may be used to inform the development of evidence-based treatment guidelines; however, more studies are also needed to further evaluate the relative efficacy of these interventions.; © 2014 Wiley Periodicals, Inc.
Depression & Anxiety, 31(8) : 641-652
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Exposure therapy, Exposure and response prevention
Turner, CM, Mataix-Cols, D: Lovell, K, Krebs, G, Lang, K, Byford, S, Heyman, I.
Objective Many adolescents with obsessive-compulsive disorder (OCD) do not have access to evidence-based treatment. A randomized controlled non-inferiority trial was conducted in a specialist OCD clinic to evaluate the effectiveness of telephone cognitive-behavioral therapy (TCBT) for adolescents with OCD compared to standard clinic-based, face-to-face CBT.
Method Seventy-two adolescents, aged 11 through 18 years with primary OCD, and their parents were randomized to receive specialist TCBT or CBT. The intervention provided differed only in the method of treatment delivery. All participants received up to 14 sessions of CBT, incorporating exposure with response prevention (E/RP), provided by experienced therapists. The primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Blind assessor ratings were obtained at midtreatment, posttreatment, 3-month, 6-month, and 12-month follow-up.
Results Intent-to-treat analyses indicated that TCBT was not inferior to face-to-face CBT at posttreatment, 3-month, and 6-month follow-up. At 12-month follow-up, there were no significant between-group differences on the CY-BOCS, but the confidence intervals exceeded the non-inferiority threshold. All secondary measures confirmed non-inferiority at all assessment points. Improvements made during treatment were maintained through to 12-month follow-up. Participants in each condition reported high levels of satisfaction with the intervention received.
Conclusion TCBT is an effective treatment and is not inferior to standard clinic-based CBT, at least in the midterm. This approach provides a means of making a specialized treatment more accessible to many adolescents with OCD. Clinical trial registration information-Evaluation of telephone-administered cognitive-behaviour therapy (CBT) for young people with obsessive-compulsive disorder (OCD); http://www.controlled-trials.com; ISRCTN27070832.
Journal of the American Academy of Child & Adolescent Psychiatry, 53(12) : 1298-1307.e2
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions