Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-22T07:55:28.195Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of Obsessive-Compulsive Disorder

Published online by Cambridge University Press:  07 November 2014

Dan J. Stein ,
Jonathan C. Ipser ,
David S. Baldwin  and
Borwin Bandelow
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Many randomized controlled trials of the pharmacotherapy and psychotherapy of obsessive-compulsive disorder (OCD) have been undertaken. Several meta-analyses of these trials, and a number of expert consensus guidelines, have been published. This article summarizes these works, and suggests future research directions.

Methods: Meta-analyses of OCD were assessed with the QUORUM statement and the Oxman and Guyatt rating scale, and consensus guidelines on the treatment of OCD were assessed with the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Current principles in the treatment of OCD, and gaps in our knowledge, were reviewed.

Results: Selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy are currently viewed as the first-line treatments of choice for adult and pediatric OCD.There is also good evidence for the efficacy of atypical antipsychotics in the augmentation of patients refractory to SSRIs. Important questions remain for the field.

Conclusions: There have been significant advances in both the pharmacotherapy and psychotherapy of OCD. Nevertheless, there is a paucity of longer-term trials, data on symptom remission and functional improvement, and data on treatment effectiveness in wider clinical practice. It is hoped that improved understanding of the mechanisms underlying OCD will lead to future advances.

Type
Supplements
Information
CNS Spectrums , Volume 12 , supplement S3: From Obsessive-Compulsive Spectrum to Obsessive-Compulsive Disorders: The Cape Town Consensus Statement , February 2007 , pp. 28 - 35
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Cheyette, SR, Cummings, JL. Encephalitis lethargical Lessons for contemporary neuropsychiatry. J Neuropsych Clin Neurosci. 1995;7:125–135.Google ScholarPubMed
2. Fernandez-Cordoba, E, Lopez-Ibor Alino, J. La monoclorimipramina en enfermos psiquiatricos resistentes a otros tratamientos. Acta Luso-Esp Neuml Psiquiatr Ciene Afines. 1967;26:119–147.Google Scholar
3. Waxman, D. A clinical trial of clomipramine and diazepam in the treatment of phobic and obsessional illness. J Int Med Res. 1977;5:99–110.Google ScholarPubMed
4. Solyom, L, Sookman, D. A comparison of clomipramine hydrachloride (Anafranil) and behaviour therapy in the treatment of obsessive neurosis. J Int Med Res. 1977;5:49–61.Google ScholarPubMed
5. Thoren, P, Asberg, M, Cronholm, B, Jornestedt, L, Traskman, L. Clomipramine treatment of obsessive-compulsive disorder. I. A controlled clinical trial. Arch Gen Psychiatry. 1980;37:1281–1285.CrossRefGoogle Scholar
6. Flament, MF, Rapoport, JL, Kilts, C. A controlled trial of clomipramine in childhood obsessive compulsive disorder. Psychopharmacology Bull. 1985;21:150–152.Google ScholarPubMed
7. Stein, DJ, Stone, MH. Essential Papers on Obsessive-Compulsive Disorders. New York University Press: New York University Press: 1997.Google Scholar
8. Marks, I. Behaviour therapy for obsessive-compulsive disorder: a decade of progress. Can J Psychiatry. 1997;42:1021–1027.CrossRefGoogle ScholarPubMed
9. Zohar, J, Insel, TR. Obsessive-compulsive disorder: psychobiological approaches to diagnosis, treatment, and pathophysiology. Biol Psychiatry. 1987;22:667–687.CrossRefGoogle ScholarPubMed
10. Fineberg, NA, Gale, TM. Evidence-based pharmacotherapy of obsessive-compulsive disorder. Int J Neuropsychopharmacol. 2005;8:107–129.CrossRefGoogle ScholarPubMed
11. Pallanti, S, Hollander, E, Bienstock, C, et al. Treatment non-response in OCD: methodological issues and operational definitions. Int Clin Psychopharmacol. 2002;5:181–191.Google ScholarPubMed
12. McDougle, CJ, Goodman, WK, Leckman, JF. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder: A double-blind placebo-controlled study in patients with and without tics. Arch Gen Psychiatry. 1994;51:302–308.CrossRefGoogle ScholarPubMed
13. Baxter, LR, Schwartz, JM, Bergman, KS, et al. Caudate glucose metabolic rate changes with both drug and behavior therapy for OCD. Arch Gen Psychiatry. 1992;49:681–689.CrossRefGoogle Scholar
14. Brody, AL, Saxena, S, Schwartz, JM, et al. FDG-PET predictors of response to behavioral therapy and pharmacotherapy in obsessive compulsive disorder. Psychiatry Res. 1998;84:1–6.CrossRefGoogle ScholarPubMed
15. Denys, D, de Geus, F. Predictors of pharmacotherapy response in anxiety disorders. Curr Psychiatry Rep. 2005;7:252–257.CrossRefGoogle ScholarPubMed
16. Fallon, BA, Liebowitz, MR, Campeas, R, et al. Intravenous clomipramine for obsessive-compulsive disorder refractory to oral clomipramine: a placebo-controlled study. Arch Gen Psychiatry. 1998;55:918–924.CrossRefGoogle ScholarPubMed
17. Salkovskis, P M. Understanding and treating obsessive-compulsive disorder. Behav Res Ther. 1999;37(suppl 1):29–52.CrossRefGoogle ScholarPubMed
18. Nakagawa, A, Marks, IM, Park, JM, et al. Self-treatment of obsessive-compulsive disorder guided by manual and computer-conducted telephone interview. Journal Of Telemedicine And Telecare. 2000;6:22–26.CrossRefGoogle ScholarPubMed
19. Bystritsky, A, Munford, PR, Rosen, RM, et al. A preliminary study of partial hospital management of severe obsessive-compulsive disorder. Psychiatr Serv. 1996;47:170–174.Google ScholarPubMed
20. Greenberg, BD, Price, LH, Rauch, SL, et al. Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues. Neurosurg Clin North Am. 2003;14:199–212.CrossRefGoogle ScholarPubMed
21. Abelson, JL, Curtis, GC, Sagher, O, et al. Deep brain stimulation for refractory obsessive-compulsive disorder. Biol Psychiatry. 2005;57:510–516.CrossRefGoogle ScholarPubMed
22. Alonso, P, Pujol, J, Cardoner, N, et al. Right prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a double-blind, placebo-controlled study. Am J Psychiatry. 2001;158:1143–1145.CrossRefGoogle ScholarPubMed
23. Sackett, DL, Rosenberg, WMC, Muir Gray, JA, Richards, WS. Evidence-based medicine: What it is and what it isn't. BMJ. 1996;312:71–72.CrossRefGoogle ScholarPubMed
24. Ackerman, DL, Greenland, S. Multivariate meta-analysis of controlled drug studies for obsessive-compulsive disorder. J Clin Psychopharmacol. 2002;22:309–317.CrossRefGoogle ScholarPubMed
25. Cox, BJ, Swinson, RP, Morrison, B, Lee, PS. Clomipramine, fluoxetine, and behavior therapy in the treatment of obsessive-compulsive disorder: a meta-analysis. J Behav Ther Exp Psychiatry. 1993;24:149–153.CrossRefGoogle ScholarPubMed
26. Eddy, KT, Dutra, L, Bradley, R, Westen, D. A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clin Psychology Rev. 2004;24:1011–1030.CrossRefGoogle ScholarPubMed
27. Geller, DA, Biederman, J, Stewart, SE, et al. Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder. Am J Psychiatry. 2003;160:1919–1928.CrossRefGoogle ScholarPubMed
28. Greist, JH, Jefferson, JW, Kobak, KA, Katzelnick, DJ, Serlin, RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. A metaanalysis. Arch Gen Psychiatry. 1995;52:53–60.CrossRefGoogle ScholarPubMed
29. Kobak, KA, Greist, JH, Jefferson, JW, Katzelnick, DJ, Henk, HJ. Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis. Psychopharmacologia. 1998;136:205–216.CrossRefGoogle ScholarPubMed
30. Stein, DJ, Spadaccini, E, Hollander, E. Meta-analysis of pharmacotherapy trials for obsessive compulsive disorder. Int Clin Psychopharmacol. 1995;10:11–18.CrossRefGoogle ScholarPubMed
31. Bandelow, B, Zohar, J, Hollander, E, Kasper, S, Moller, H-J, and WFSBP Task Force on Treatment Guidelines for Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry. 2002;3:171–199.CrossRefGoogle ScholarPubMed
32. Baldwin, DS, Anderson, IM, Nutt, DJ, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005;19:567–596.CrossRefGoogle ScholarPubMed
33. Greist, JH, Bandelow, B, Hollander, E, et al. WCA recommendations for the long-term treatment of obsessive-compulsive disorder in adults. CNS Spectr. 2003;8:7–16.CrossRefGoogle ScholarPubMed
34. March, JS, Frances, A, Carpenter, D, Kahn, D. Treatment of obsessive-compulsive disorder. The Expert Consensus Panel for obsessive-compulsive disorder. J Clin Psychiatry. 1997;58(suppl 4):1–72.Google Scholar
35. American Academy of Child and Adolescent Psychiatry. Practice parameters for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 1998;37(suppl 10):27–45.CrossRefGoogle Scholar
36. NICE Clinical Guideline 31. Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. Available at: www.nice.org.uk. 2005. Accessed January 2007.Google Scholar
37. APA Work Group on Obsessive-Compulsive Disorder. Practice Guideline for the Treatment of Patients with Obsessive-Compulsive Disorder. Unpublished.Google Scholar
38. Canadian Psychiatric Association. Clinical Practice Guidelines: Management of anxiety disorders. Can J Psychiatry. 2006;51(suppl 2):S9–S91.Google Scholar
39. Jackson, R, Feder, G. Guidelines for clinical guidelines. BMJ. 1998;317:427–428.CrossRefGoogle ScholarPubMed
40. Moher, D, Cook, DJ, Eastwood, S, Olkin, I, Rennie, D, Stroup, DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet. 1999;354:1896–1900.Google Scholar
41. Biondi-Zoccai, GG, Lotrionte, M, Abbate, A, et al. Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: case study. BMJ. 2006;332:202–209.CrossRefGoogle ScholarPubMed
42. Hemels, ME, Vicente, C, Sadri, H, Masson, MJ, Einarson, TR. Quality assessment of meta-analyses of RCTs of pharmacotherapy in major depressive disorder. Curr Med Res Opin. 2004;20:477–484.CrossRefGoogle ScholarPubMed
43. Oxman, AD, Guyatt, GH. Validation of an index of the quality of review articles. J Clin Epidemiol. 1991;44:1271–1278.CrossRefGoogle ScholarPubMed
44. AGREE C. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Quality & Safety In Health Care. 2003;12:18–23.CrossRefGoogle Scholar
45. Martin, JL, Barbanoj, MJ, Perez, V, Sacristan, M. Transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder. Cochrane Database Syst Rev. 2003;CD003387.Google Scholar
46. Abramowitz, JS, Franklin, ME, Foa, EB. Empirical status of cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analytic review. Romanian Journal of Cognitive and Behavioral Psychotherapies. 2002;2:65–104.Google Scholar
47. Abramowitz, JS. Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: a quantitative review. J Consult Clin Psychol. 1997;65:44–52.CrossRefGoogle ScholarPubMed
48. Greist, JH, Jefferson, JW, Kobak, KA, Katzelnick, DJ, Serlin, RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. A metaanalysis. Arch Gen Psychiatry. 1995;52:53–60.CrossRefGoogle ScholarPubMed
49. Piccinelli, M, Pini, S, Bellantuono, C, Wilkinson, G. Efficacy of drug treatment in obsessive-compulsive disorder. A meta-analytic review. Br J Psychiatry. 1995;166:424–443.CrossRefGoogle ScholarPubMed
50. Stein, DJ, Spadaccini, E, Hollander, E. Meta-analysis of pharmacotherapy trials for obsessive-compulsive disorder. Int Clin Psychopharmacol. 1995;10:11–18.CrossRefGoogle ScholarPubMed
51. van Balkom, A, van Oppen, P, Vermeulen, A, van Dyck, R. A meta-analysis on the treatment of obsessive compulsive disorder: A comparison of antidepressants, behavior, and cognitive therapy. Clin Psychol Rev. 2006;14:359–381.CrossRefGoogle Scholar
52. QAP. Treatment outlines for the management of obsessive-compulsive disorders. The Quality Assurance Project. Aust N Z J Psychiatry. 1985;19:240–253.CrossRefGoogle Scholar
53. Goodman, WK, Price, LH, Rasmussen, SA, Delgado, PL, Heninger, GR, Charney, DS. Efficacy of fluvoxamine in obsessive-compulsive disorder. A double-blind comparison with placebo. Arch Gen Psychiatry. 1989;46:36–44.CrossRefGoogle ScholarPubMed
54. Goodman, WK, Kozak, MJ, Liebowitz, M, White, KL. Treatment of obsessive-compulsive disorder with fluvoxamine: a multicentre, double-blind, placebo-controlled trial. Int Clin Psychopharmacol. 1996;11:21–29.CrossRefGoogle ScholarPubMed
55. Hollander, E, Koran, LM, Goodman, WK, et al. A double-blind, placebo-controlled study of the efficacy and safety of controlled-release fluvoxamine in patients with obsessive-compulsive disorder. J Clin Psychiatry. 2003;64:640–647.CrossRefGoogle ScholarPubMed
56. Kronig, MH, Apter, J, Asnis, G, et al. Placebo-controlled, multicenter study of sertraline treatment for obsessive-compulsive disorder. J Clin Psychopharmacol. 1999;19:172–176.CrossRefGoogle ScholarPubMed
57. Greist, J, Chouinard, G, DuBoff, E, et al. Double-blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive-compulsive disorder. Arch Gen Psychiatry. 1995;52:289–295.CrossRefGoogle ScholarPubMed
58. Montgomery, SA, Mclntyre, A, Osterheider, M, et al. A double-blind, placebo-controlled study of fluoxetine in patients with DSM-III-R obsessive-compulsive disorder. The Lilly European OCD Study Group. Eur Neumpsychopharmacol. 1993;3:143–152.CrossRefGoogle ScholarPubMed
59. Tollefson, GD, Rampey, AH Jr., Potvin, JH, et al. A multicenter investigation of fixed-dose fluoxetine in the treatment of obsessive-compulsive disorder. Arch Gen Psychiatry. 1994;51:559–567.CrossRefGoogle ScholarPubMed
60. Zohar, J, Judge, R. Paroxetine versus clomipramine in the treatment of obsessive-compulsive disorder. OCD Paroxetine Study Investigators. Br J Psychiatry. 1996;169:468–474.CrossRefGoogle ScholarPubMed
61. Montgomery, SA, Kasper, S, Stein, DJ, Bang Hedegaard, K, Lemming, OM. Citalopram 20 mg, 40 mg and 60 mg are all effective and well tolerated compared with placebo in obsessive compulsive disorder. Int Clin Psychopharmacol. 2001;16:75–86.CrossRefGoogle ScholarPubMed
62. Yaryura-Tobias, JA, Neziroglu, FA, Bergman, L. Clomipramine for obsessive-compulsive neurosis - an organic approach. Curr Ther Res. 1976;20:541–548.Google Scholar
63. Pato, MT, Hill, JL, Murphy, DL. A clomipramine dosage reduction study in the course of long-term treatment of obsessive compulsive disorder patients. Psychopharmacol Bull. 1990;26:211–214.Google ScholarPubMed
64. Dunbar, G, Steiner, M, Bushnell, W, Gergel, I, Wheadon, DE. Long-term treatment and prevention of relapse of obsessive compulsive disorder with paroxetine. Eur Neumpsychopharmacol. 1995;5:372.CrossRefGoogle Scholar
65. Romano, S, Goodman, W, Tamura, R, Gonzales, J. Long-term treatment of obsessive-compulsive disorder after an acute response: a comparison of fluoxetine versus placebo. J Clin Psychopharmacol. 2001;21:46–52.CrossRefGoogle ScholarPubMed
66. Koran, LM, Hackett, E, Rubin, A, Wolkow, R, Robinson, D. Efficacy of sertraline in the longterm treatment of obsessive-compulsive disorder. Am J Psychiatry. 2002;159:88–95.CrossRefGoogle ScholarPubMed
67. Hollander, E, Allen, A, Steiner, M, Wheadon, DE, Oakes, R, Burnham, DB. Paroxetine, OC. Study G: Acute and long-term treatment and prevention of relapse of obsessive-compulsive disorder with paroxetine. J Clin Psychiatry. 2003;64:1113–1121.CrossRefGoogle Scholar
68. Eddy, DM. Clinical Decision-Making: From Theory to Practice. Sudbury, MA: Jones and Bartless: 1996.Google ScholarPubMed
69. POTS. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial. JAMA. 2004;292:1969–1976.CrossRefGoogle Scholar
70. Bloch, MH, Landeros-Weisenberger, A, Kelmendi, B, Coric, V, Bracken, MB, Leckman, JF. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry. 2006;11:622–632.CrossRefGoogle ScholarPubMed
71. Ipser, JC, Carey, P Dhansay, Y, Fakier, N, Seedat, S, Stein, DJ. Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders. Cochrane Database Syst Rev. 2006;(4):CD00547.Google Scholar
72. Fineberg, N, Stein, DJ, Carey, P, et al. Adjunctive quetiapine for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: a meta-analysis of randomized controlled treatment trials. Int Clin Psychopharmacol. 2006;21:337–343.CrossRefGoogle ScholarPubMed
73. Ipser, JC, Carey, P, Dhansay, Y Fakier, N, Seedat, S, Stein, DJ. Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders. Cochrane Database Syst Rev. 2006;CD005473.Google Scholar
74. Trivedi, MH, Rush, JA, Crismon, ML, et al. Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project. Arch Gen Psychiatry. 2004;61:669–680.CrossRefGoogle ScholarPubMed
75. Gaebel, W, Riesbeck, M, Janssen, B, et al. Atypical and typical neuroleptics in acute schizophrenia and related delusional disorders. Drug choice, switching and outcome under naturalistic treatment conditions. Eur Arch Psychiatry Clin Neurosci. 2003;253:175–184.CrossRefGoogle ScholarPubMed
76. Ressler, KJ, Rothbaum, BO, Tannenbaum, L, et al. Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine In phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry. 2004;61:1136–1144.CrossRefGoogle ScholarPubMed
77. Hoffman, ML. Empathy and Moral Development: Implications for Caring and Justice. Cambridge University Press; 2000.CrossRefGoogle Scholar
78. Snider, LA, Lougee, L, Slattery, M, Grant, P, Swedo, SE. Antibiotic prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders. Biol Psychiatry. 2005;57:788–792.CrossRefGoogle ScholarPubMed
79. Swedo, SE, Leonard, HL, Rapoport, JL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) subgroup: separating fact from fiction. Pediatrics. 2004;113:907–911.CrossRefGoogle ScholarPubMed