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Clomipramine and Exposure for Obsessive-Compulsive Rituals: 1

Published online by Cambridge University Press:  29 January 2018

I. M. Marks ,
R. S. Stern ,
D. Mawson ,
J. Cobb  and
R. McDonald
I. M. Marks
Affiliation:
Institute of Psychiatry, London, Honorary Consultant Psychiatrist, Maudsley and Bethlem Hospital
R. S. Stern
Affiliation:
Institute of Psychiatry and Bethlem–Maudsley Hospital, London; now Consultant Psychiatrist, St George's Hospital, London
D. Mawson
Affiliation:
Bethlem–Maudsley Hospital and Institute of Psychiatry, London
J. Cobb
Affiliation:
Institute of Psychiatry and Bethlem–Maudsley Hospital; Consultant Psychiatrist, Department of Psychiatry, St George's Hospital, London; Senior Lecturer in Psychotherapy, University of London
R. McDonald
Affiliation:
Institute of Psychiatry, London
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Summary

Forty 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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 136 , Issue 1 , January 1980 , pp. 1 - 25
Copyright
Copyright © The Royal College of Psychiatrists 

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