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Clomipramine, Self-exposure and Therapist-aided Exposure for Obsessive–Compulsive Rituals

Published online by Cambridge University Press:  02 January 2018

I. M. Marks ,
P. Lelliott ,
M. Basoglu ,
H. Noshirvani ,
W. Monteiro ,
D. Cohen  and
Y. Kasvikis
I. M. Marks*
Affiliation:
Institute of Psychiatry, Bethlem and Maudsley Hospitals
P. Lelliott
Affiliation:
Institute of Psychiatry, Bethlem and Maudsley Hospitals
M. Basoglu
Affiliation:
Institute of Psychiatry
H. Noshirvani
Affiliation:
Institute of Psychiatry, Bethlem and Maudsley Hospitals
W. Monteiro
Affiliation:
Institute of Psychiatry, Bethlem and Maudsley Hospitals
D. Cohen
Affiliation:
Lady Chichester Hospital, Hove
Y. Kasvikis
Affiliation:
Institute of Psychiatry
*
∗Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF
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Abstract

A randomised treatment design for 49 chronically obsessive–compulsive ritualising patients was devised and three controlled comparisons were made. 1. During 7 weeks of self-exposure instructions, clomipramine treatment improved some measures of rituals and depression significantly more than did placebo medication; this effect was transient and disappeared as drug treatment and exposure were continued for a further 15 weeks. 2. During 11–16 weeks of clomipramine treatment, self-exposure instructions yielded highly significantly more patient improvement than did anti-exposure instructions on nearly all measures of rituals and some of social adjustment. 3. Adding therapist-aided exposure (1.3 hours) to self-exposure instructions (3 hours) after 8 weeks had a barely significant transient effect of dubious clinical value, which was lost by the end of exposure (at week 23) and during follow-up assessments to week 52. We conclude that of the three therapeutic factors tested, self-exposure was the most potent; clomipramine played a limited adjuvant role, and therapist-aided exposure a marginal one.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 152 , Issue 4 , April 1988 , pp. 522 - 534
Copyright
Copyright © Royal College of Psychiatrists, 1988 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.Google Scholar
Ananth, J., Pecknold, J. C., Van den Steen, N. & Engelsmann, F. (1981) Double-blind study of clomipramine and amitriptyline in obsessive neurosis. Progress in Neuropsychopharmacology, 5, 257–262.CrossRefGoogle ScholarPubMed
Basoglu, M., Marks, I. M., Lelliott, P. & Noshirvani, H. (1988) Patteras and predictors of outcome in OC rituals treated with clomipramine and exposure. Journal of Affective Disorders (in press).Google Scholar
Beck, A. T., Rial, W. Y. & Rickels, K. (1974) Short form of depression inventory: cross validation. Psychological Reports, 34, 1184–1186.CrossRefGoogle ScholarPubMed
Boersma, K., Den Hengst, S., Dekker, J. & Emmelkamp, P. M. G. (1976) Exposure vs response prevention in OC patients. Behaviour Research and Therapy, 14, 19–24.CrossRefGoogle Scholar
Emmelkamp, P. M. G. & Kraanen, J. (1978) Therapist-controlled vs self controlled exposure in vivo in obsessive–compulsive patients. Behaviour Research and Therapy, 15, 491–495.CrossRefGoogle Scholar
Flament, M. F., Rapoport, J. L., Berg, C. J. et al (1985) Clomipramine treatment of childhood OCD. A double-blind controlled study. Archives of General Psychiatry, 42, 977–983.CrossRefGoogle Scholar
Foa, E. B., Jameson, J. S., Turner, R. M. & Payne, L. L. (1980) Massed vs spaced exposure sessions in the treatment of agoraphobia. Behaviour Research and Therapy, 18, 333–338.CrossRefGoogle ScholarPubMed
Foa, E. B., Steketee, G., Kozak, M. J. & Dugger, D. (1987) Imipramine in OCD. Psychopharmacology Bulletin, 23, 8–11.Google Scholar
Gelder, M. G. & Marks, I. M. (1966) Severe agoraphobia: A controlled prospective trial of behaviour therapy. British Journal of Psychiatry, 112, 309–319.CrossRefGoogle ScholarPubMed
Greist, J., Marks, I. M., Berlin, F. & Noshirvani, H. (1980) Avoidance versus confrontation of fear. Behavior Therapy, 11, 1–14.CrossRefGoogle Scholar
Hamilton, M. (1969) Standardized assessment and recording of depressive symptoms. Psychiatrica Neurologia Neurochirurgia, 72, 201–205.Google ScholarPubMed
Hoogduin, C. A. L. (1985) Mislukking en success bij de ambulante behandeling van dwangneurose. PhD dissertation, University of Leiden.Google Scholar
Insel, T. R., Murphy, D. L., Cohen, R. M., Alterman, I., Kilts, C. & Llinnoila, M. (1983) Clomipramine and clorgyline in OCD. Archives of General Psychiatry, 40, 605–612.CrossRefGoogle Scholar
Insel, T. R., Mueller, E. A., Alterman, I. et al (1985) Obsessive–compulsive disorder and serotonin: is there a connection? Biological Psychiatry, 20, 1174–1188.CrossRefGoogle ScholarPubMed
Jones, R. B. & Luscombe, D. K. (1976) Plasma levels of clomipramine and its N-desmethylmetabolite following oral administration of clomipramine in man. British Journal of Pharmacology, 57, 4308.Google Scholar
Kasvikis, G. Y., Taskiris, F., Marks, I. M., Basoglu, M. & Noshirvani, H. R. (1986) Women with OCD frequently had past anorexia nervosa. International Journal of Eating Disorders, 5, 1069–1075.3.0.CO;2-U>CrossRefGoogle Scholar
Kasvikis, G. Y. & Marks, I. M. (1988) Clomipramine and exposure for OC rituals: relations between dose, plasma levels, outcome and side-effects. Psychopharmacology (in press).Google Scholar
Lelliott, P., Marks, I. M., Noshirvani, H. (1987) 5-year follow-up of agoraphobics after imipramine and exposure. Journal of Nervous and Mental Disease, 175, 599–605.CrossRefGoogle Scholar
Lelliott, P., Basoglu, M., Marks, I. M. & Noshirvani, H. (1988) Psychophysiological aspects of obsessive–compulsive disorder. Psychological Medicine (in press).Google Scholar
Marks, I. M. (1981) Cure and Care of Neuroses. New York: Wiley; Washington, DC: American Psychiatric Press.Google Scholar
Marks, I. M. (1987) Fears, Phobias and Rituals. New York: Oxford University Press.Google Scholar
Marks, I. M., Connolly, J., Hallam, R. S. & Philpott, R. (1977) Nursing in Behavioural Psychotherapy. London: Royal College of Nursing.Google Scholar
Marks, I. M., Hodgson, R. & Rachman, S. (1975) Treatment of chronic OCD 2 years after in vivo exposure. British Journal of Psychiatry, 127, 349–364.CrossRefGoogle Scholar
Marks, I. M., Stern, R. S., Mawson, D., Cobb, J. & McDonald, R. (1980) Clomipramine and exposure for obsessive–compulsive rituals: I. British Journal of Psychiatry, 136, 1–25.CrossRefGoogle Scholar
Mavissakalian, M., Turner, S. M. Michelson, L. & Jacob, R. (1985) Tricyclic anti-depressants in OCD: II. American Journal of Psychiatry, 142, 572–576.Google Scholar
Mawson, D., Marks, I. M. & Ramm, E. (1982) Clomipramine and exposure for chronic oc rituals: III. Two-year follow-up. British Journal of Psychiatry, 140, 11–18.CrossRefGoogle Scholar
Monteiro, W., Marks, I. M., Noshirvani, H. & Lelliott, P. (1987) Anorgasmia from clomipramine in OCD. British Journal of Psychiatry, 151, 107–112.CrossRefGoogle Scholar
Montgomery, S. A. (1980) Clomipramine in obsessional neurosis: A placebo-controlled trial. Pharmacological Medicine, 1, 189–195.Google Scholar
Ptachcinski, R. D., Venkataraman, R. & Burckart, G. J. (1986) Clinical pharmacokinetics of cyclosporin. Clinical Pharmacokinetics, 11, 107–132.CrossRefGoogle ScholarPubMed
Rapoport, J., Elkins, R. & Mikkelsen, E. (1980) Chlorimipramine in adolescents with obsessive–compulsive disorder. Psychopharmacology Bulletin, 16, 61–63.Google ScholarPubMed
Snaith, R. P., Ahmed, S. N., Mehta, S. & Hamilton, M. (1971) Assessment of the severity of primary depressive illness. Wakefield Self-Assessment Depression Inventory. Psychological Medicine, 1, 143–9.CrossRefGoogle ScholarPubMed
Stern, R. S., Marks, I. M., Mawson, D. & Luscombe, D. K. (1980) Clomipramine and exposure for compulsive rituals: II Plasma levels, side effects and outcome. British Journal of Psychiatry, 136, 161–166.CrossRefGoogle ScholarPubMed
Telch, M., Agras, W. S., Taylor, C. B. et al (1985) Imipramine and behavioral treatment for agoraphobia. Behaviour Research and Therapy, 13, 375–383.Google Scholar
Thoren, P., Asberg, M., Cronholm, B. et al (1980) Clomipramine treatment of obsessive–compulsive disorder. I. Archives of General Psychiatry, 37, 1281–1294.CrossRefGoogle ScholarPubMed
Volavka, J., Neziroglu, F. & Yaryura-Tobias, J. A. (1985) Clomipramine and imipramine in obsessive–compulsive disorder. Psychiatry Research, 14, 83–91.CrossRefGoogle ScholarPubMed
World Health Organization (1978) Mental Disorders: Glossary and Guide to Their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). Geneva: WHO.Google Scholar
Yargura-Tobias, J. A. & Neziroglu, F. A. (1983) Obsessive–compulsive disorders: Pathogenesis-diagnosis-treatment. Basel: Marcel Dekker AG.Google Scholar
Yargura-Tobias, J. A., Neziroglu, F. A. & Bergman, L. (1976) Chlorimipraminine for obsessive–compulsive neurosis. Current Therapy Research, 20, 541–547.Google Scholar
Zitrin, C. M., Klein, D. F. & Woerner, M. G. (1980) Treatment of agoraphobia with group exposure in vivo and imipramine. Archives of General Psychiatry, 37, 63–72.CrossRefGoogle ScholarPubMed
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