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Treatment of Severe, Treatment-Refractory Obsessive-Compulsive Disorder: A Study of Inpatient and Community Treatment

Published online by Cambridge University Press:  07 November 2014

Mark J. Boschen ,
Lynne M. Drummond  and
Anusha Pillay
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Abstract

Introduction:

This research reports on a prospective outcome study of two cohorts of patients with severe, chronic, resistant obsessive-compulsive disorder (OCD).

Methods:

One cohort consisted of a total of 52 patients treated in an inpatient setting, while the second group comprised 65 patients treated in a community-outpatient setting. Treatment consistent primarily of intensive graded exposure and self-imposed response prevention augmented with cognitive restructuring.

Results:

The groups demonstrated significant improvement over the course of treatment. In the inpatient and community groups, there was significant improvement over the first 12 weeks of treatment, and further improvement between 12 and 24 weeks.

Conclusion:

These results suggest that even for patients who have demonstrated treatment-resistance, there may be benefit in intensive behavioral treatment of OCD. In addition it was found that even for those patients with the most profound refractory OCD and complicating factors inpatient stays of up to 24 weeks were effective in reducing symptoms.

Type
Original Research
Information
CNS Spectrums , Volume 13 , Issue 12 , December 2008 , pp. 1056 - 1065
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
2.Kessler, RC, Berglund, P, Demler, O, Jin, R, Walters, EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication. Arch Gen Psychiatry. 2005;62:593–602.Google Scholar
3.Andrews, G, Creamer, M, Crino, R, Hunt, C, Lampe, L, Page, A. The Treatment of Anxiety Disorders: Clinician Guides and Patient Manuals. 2nd ed. New York, NY: Cambridge University Press; 2002.Google Scholar
4.Hendersen, S, Andrews, G, Hall, W. Australia's mental health review: an overview of the general population survey. Aust N Z J Psychiatry. 2000;34:197–205.CrossRefGoogle Scholar
5.Riggs, DS, Hiss, H, Foa, EB. Marital distress and the treatment of obsessive-compulsive disorder. Behav Ther. 1992;23:585–597.Google Scholar
6.Leon, AC, Portera, L, Weissman, MM. The social costs of anxiety disorders. Br J Psychiatry Suppl. 1995;27:19–22.Google Scholar
7.Eisen, JL, Mancebo, MA, Pinto, A, et al.Impact of obsessive-compulsive disorder on quality of life. Compr Psychiatry. 2006;47:270–275.Google Scholar
8.Norberg, MM, Calamari, JE, Cohen, RJ, Riemann, BC. Quality of life in obsessive-compulsive disorder: an evaluation of impairment and a preliminary analysis of the ameliorating effects of treatment. Depress Anxiety. 2008;25:248–259.CrossRefGoogle Scholar
9.Olatunji, BO, Cisler, JM, Tolin, DF. Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev. 2007;27:572–581.CrossRefGoogle ScholarPubMed
10.Boschen, MJ. Publication trends in individual anxiety disorders: 1980-2015. J Anxiety Disord. 2008;22:570–575.Google Scholar
11.Eddy, KT, Dutra, L, Bradley, R, Westen, D. A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clin Psychol Rev. 2004;24:1011–1030.Google Scholar
12.Jacobsen, NS, Truax, P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychology. 1991;59:12–19.Google Scholar
13.Fisher, PL, Wells, A. How effective and cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis. Behav Res Ther. 2005;43:1543–1558.Google Scholar
14.Borkovec, TD, Castonguay, LG. What is the scientific meaning of empirically supported therapy? J Consult Clin Psychol. 1998;66:136–142.Google Scholar
15.Goldfried, MR, Wolfe, BE. Toward a more clinically valid approach to therapy research. J Consult Clin Psychol. 1998;66:143–150.Google Scholar
16.Persons, JB. Psychotherapy outcome studies do accurately represent current models of psychotherapy: a proposed remedy. Am Psychol. 1991;46:99–106.Google Scholar
17.Kessler, RC, Chiu, WT, Demler, O, Walters, EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Servey replication. Arch Gen Psychiatry. 2005;62:617–627.Google Scholar
18.Jacobsen, NS, Roberts, LJ, Berns, SB, McGlinchey, JB. Methods for defining and determining the clinical significance of treatment effects: Description, applications, and alternatives. J Consult Clin Psychol. 1999;67:300–307.Google Scholar
19.Drummond, LM. The treatment of severe, chronic, resistant obsessive-compulsive disorder. An evaluation of an in-patient programme using behavioural psychotherapy in combination with other treatments. Br J Psychiatry. 1993;163:223–229.Google Scholar
20.Thornicroft, G, Colson, L, Marks, I. An in-patient behavioural psychotherapy unit: description and audit. Br J Psychiatry. 1991;158:362–367.Google Scholar
21.Stewart, SE, Stack, DE, Farrell, C, Pauls, DL, Jenike, MA. Effectiveness of intensive residential treatment (IRT) for severe, refractory obsessive-compulsive disorder. J Psychiatr Res. 2005;39:603–609.Google Scholar
22.Goodman, WK, Price, LH, Rasmussen, SA, et al.The Yale–Brown Obsessive Compulsive Scale: II. Validity. Arch Gen Psychiatry. 1989;46:1012–1016.Google Scholar
23.Goodman, WK, Price, LH, Ramussen, SA, et al.The Yale–Brown Obsessive–Compulsive Scale: I. Development, use and reliability. Arch Gen Psychiatry. 1989b;46:1006–1011.Google Scholar
24.Pallanti, S, Hollander, E, Bienstock, C, et al.Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol. 2002;5:181–191.Google Scholar
25.Drummond, LM, Pillay, A, Rani, RS, Kolb, P. Specialised Inpatient treatment for severe, chronic, resistant obsessive-compulsive disorder (OCD): a naturalistic study of clinical outcomes. Psychiatr Bull. 2007;31:49–52.Google Scholar
26.Drummond, LM, Fineberg, NA, Heyman, I, et al.Description of progress in the development of a national service for adolescents and adults with the most severe, refractory obsessive-compulsive and body dysmorphic disorders. Psychiatr Bull. 2008;32:333–336.Google Scholar
27.Sanavio, S. Obsessions and compulsions: the Padua Inventory. Behav Res Ther. 1988;26:169–177.Google Scholar
28.Beck, AT. Beck Depression Inventory Manual. San Antonio, TX: Psychological Corporation; 1993.Google Scholar
29.Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erlbaugh, J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:53–61.Google Scholar
30.Beck, AT, Steer, RA, Garbin, MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1998;3:77–100.Google Scholar
31.Drummond, LM, Pillay, A, Kolb, P, et al.The introduction of a community model for the treatment of obsessive-compulsive and body dysmorphic disorders. Psychiatr Bull. 2008;32:336–340.CrossRefGoogle Scholar
32.British Psychological Society, Royal College of Psychiatrists. Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. London, UK: 2006. National Clinical Practice Guideline Number 31.Google Scholar
33.Westbrook, D, Kirk, J. The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated in routine practice. Behav Res Ther. 2005;43:1243–1261.Google Scholar
34.McLean, PD, Whittal, ML, Thordarson, DS, et al.Cognitive versus behavior therapy in the group treatment of obsessive-compulsive disorder. J Consult Clin Psychol. 2001;69:205–214.Google Scholar
35.Cottraux, J, Note, I, Yao, SN, et al.A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive-compulsive disorder. Psychother Psychosom. 2001;70:288–297.Google Scholar
36.van Oppen, P, De Haan, E, van Balkom, AJLM, Spinhoven, P, Hoogduin, K, van Dyck, R. Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behav Res Ther. 1995;33:379–390.Google Scholar
37.Franklin, ME, Abramowitz, JS, Kozak, MJ, Levitt, JT, Foa, EB. Effectiveness of exposure and ritual prevention for obsessive–compulsive disorder: randomized compared with nonrandomized samples. J Consult Clin Psychol. 2000;68:594–602.Google Scholar
38.Lindsay, M, Crino, R, Andrews, G. Controlled trial of exposure and response prevention in obsessive–compulsive disorder. Br J Psychiatry. 1997;171:135–139.CrossRefGoogle ScholarPubMed