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"Obsessive-Compulsive Disorder - therapy"
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Gray matter volumes in obsessive-compulsive disorder before and after fluoxetine or cognitive-behavior therapy: a randomized clinical trial
Serotonin reuptake inhibitors and cognitive-behavior therapy (CBT) are considered first-line treatments for obsessive-compulsive disorder (OCD). However, little is known about their modulatory effects on regional brain morphology in OCD patients. We sought to document structural brain abnormalities in treatment-naive OCD patients and to determine the effects of pharmacological and cognitive-behavioral treatments on regional brain volumes. Treatment-naive patients with OCD (n=38) underwent structural magnetic resonance imaging scan before and after a 12-week randomized clinical trial with either fluoxetine or group CBT. Matched-healthy controls (n=36) were also scanned at baseline. Voxel-based morphometry was used to compare regional gray matter (GM) volumes of regions of interest (ROIs) placed in the orbitofrontal, anterior cingulate and temporolimbic cortices, striatum, and thalamus. Treatment-naive OCD patients presented smaller GM volume in the left putamen, bilateral medial orbitofrontal, and left anterior cingulate cortices than did controls (p<0.05, corrected for multiple comparisons). After treatment with either fluoxetine or CBT (n=26), GM volume abnormalities in the left putamen were no longer detectable relative to controls. ROI-based within-group comparisons revealed that GM volume in the left putamen significantly increased (p<0.012) in fluoxetine-treated patients (n=13), whereas no significant GM volume changes were observed in CBT-treated patients (n=13). This study supports the involvement of orbitofronto/cingulo-striatal loops in the pathophysiology of OCD and suggests that fluoxetine and CBT may have distinct neurobiological mechanisms of action.
Journal Article
Subthalamic Nucleus Stimulation in Severe Obsessive–Compulsive Disorder
In this 10-month, crossover, double-blind study of 16 patients with severe, refractory obsessive–compulsive disorder (OCD), stimulation of the subthalamic nucleus reduced the symptoms of OCD. Eleven patients had serious adverse events, including one intracerebral hemorrhage and two infections requiring electrode removal.
Stimulation of the subthalamic nucleus reduced the symptoms of OCD in 16 patients; however, 11 patients had serious adverse events.
Severe obsessive–compulsive disorder (OCD) is characterized by intrusive, anxious thoughts and repetitive, ritualized behaviors. It is one of the most disabling of the chronic psychiatric disorders and has considerable repercussions on family relationships, social life, and the ability to function at work.
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The current treatment of OCD consists of a combination of serotonin-reuptake inhibitors and cognitive–behavioral therapy; with this treatment, however, 25 to 40% of patients have persistent symptoms and lasting functional repercussions.
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In the hope of reducing the disability and debilitation of patients whose OCD is highly refractory, ablative neurosurgical stereotactic treatments have been attempted, but the efficacy of . . .
Journal Article
EFFECTS OF HOMEWORK COMPLIANCE ON COGNITIVE-BEHAVIORAL THERAPY WITH D-CYCLOSERINE AUGMENTATION FOR CHILDREN WITH OBSESSIVE COMPULSIVE DISORDER
Background The present study examined the effects of homework compliance on outcome from cognitive behavioral therapy (CBT) for children with obsessive‐compulsive disorder (OCD) and the extent to which these effects differ as a function of augmentation of CBT with D‐cycloserine (DCS). Methods Twenty‐seven youth with OCD were randomized to either 50 mg DCS or placebo (PBO) administered immediately after each of 10 CBT sessions, primarily consisting of exposure and ritual prevention (ERP). Independent evaluators assessed OCD severity using the Children's Yale–Brown Obsessive–Compulsive Scale (CY‐BOCS) at the start of each session. Compliance with between‐session ERP assignments was also assessed at the start of each session using the Patient ERP Adherence Scale (PEAS). Results Greater homework compliance between the previous session and the current session was related to lower CY‐BOCS at the current session. However, the relation between homework compliance and CY‐BOCS varied by treatment condition. Higher homework compliance was related to lower CY‐BOCS for participants in the DCS condition, but not for participants in the PBO condition. Furthermore, participants receiving DCS were estimated to have significantly lower CY‐BOCS than those given PBO among those with the highest levels of homework compliance. Conclusions DCS may more effectively facilitate the effects of CBT for youth with OCD when patients are compliant with prescribed homework. Theoretical and clinical implications are discussed.
Journal Article
Obsessive-compulsive disorder
\"A clear summary of what is known about a highly prevalent and debilitating disorder that affects nearly as many people as does asthma. Expert authors review the biological basis for the disorder and describe both pharmacological and psychological approaches to treatment\"--Provided by publisher.
eBook
Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?
A consensus has yet to emerge whether deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD) can be considered an established therapy. In 2014, the World Society for Stereotactic and Functional Neurosurgery (WSSFN) published consensus guidelines stating that a therapy becomes established when “at least two blinded randomized controlled clinical trials from two different groups of researchers are published, both reporting an acceptable risk-benefit ratio, at least comparable with other existing therapies. The clinical trials should be on the same brain area for the same psychiatric indication.” The authors have now compiled the available evidence to make a clear statement on whether DBS for OCD is established therapy. Two blinded randomized controlled trials have been published, one with level I evidence (Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score improved 37% during stimulation on), the other with level II evidence (25% improvement). A clinical cohort study (N = 70) showed 40% Y-BOCS score improvement during DBS, and a prospective international multi-center study 42% improvement (N = 30). The WSSFN states that electrical stimulation for otherwise treatment refractory OCD using a multipolar electrode implanted in the ventral anterior capsule region (including bed nucleus of stria terminalis and nucleus accumbens) remains investigational. It represents an emerging, but not yet established therapy. A multidisciplinary team involving psychiatrists and neurosurgeons is a prerequisite for such therapy, and the future of surgical treatment of psychiatric patients remains in the realm of the psychiatrist.
Journal Article