DSM-3 obsessive-compulsive out-patients were randomly assigned to fluvoxamine with antiexposure (F), fluvoxamine with exposure (Fe), or placebo with exposure (Pe) for 24 weeks. Of 65 patients offered treatment 60 entered the trial, 50 reached week 8, 44 completed treatment to week 24, and 37 reached follow up to week 48. On average the patient had depressed mood (mean Hamilton depression rating scale = 19). Drop-out numbers, clinical status and behavioural measures were comparable across groups. Most F patients did not do antiexposure, but Fe and Pe patients complied in doing exposure. All three groups improved in rituals and depression from week 0 to week 24 and 48, with a slight but non-significant superiority for combined treatment up to week 24. At week 8 there was a drug between-group effect on rituals, but not on depression. At week 24 there was a drug between-group effect on depression, but not on rituals. The drug superiority was short-lived. At week 48 there was no between-group difference in rituals or depression. Depression was related to ritual outcome at week 24 in F, and tended to be so in Fe.
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"PCBT was less efficacious than PCCT, but its response rate (53%–68%) is higher than pharmacotherapy alone (40%–51%). The response rate of PCBT reported in this study was lower than previous reports on CBT efficacy (Cottraux et al. 1990; Stanley and Turner 1995; Foa et al. 2005; Sousa et al. 2006; Simpson et al. 2008; Maher et al. 2010). Also, after 10–12 weeks of treatment, pharmacotherapy only treatment has a lower response rate than the 40%–60% seen in OCD pharmacologic trials (Greist et al. 1995). "
[Show abstract][Hide abstract] ABSTRACT: Pharmacotherapy and cognitive-behavioral therapy (CBT) are currently the most effective interventions for treating obsessive-compulsive disorder (OCD). These treatments, however, are time consuming and in some cases the patients do not show significant improvement. In all, 30%-60% of OCD patients do not respond adequately to pharmacotherapy and 20%-40% of OCD patients who complete CBT do not improve significantly, suggesting a more efficacious approach is needed. The objectives of this study are to demonstrate an efficacious pharmacotherapy plus psychotherapy, named cognitive-coping therapy (CCT), for OCD and to investigate the efficacy of this approach in a larger sample size. Therefore, a total of 108 patients with OCD were randomly allocated into three groups: pharmacotherapy (N = 38), pharmacotherapy plus CBT (PCBT, N = 34), and pharmacotherapy plus CCT (PCCT, N = 36). The severity of symptoms and the patients' functioning were assessed pretreatment and after 7, 14, 21 days, and 1-, 3-, 6-, and 12-month treatment using the Yale-Brown Obsessive Compulsive Scale and Global Assessment of Functioning (GAF). Compared with the pharmacotherapy and PCBT groups, the severity of OCD symptoms was significantly reduced (P < 0.001), the rates of response (100%) and remission (85.0%) were significantly higher (P < 0.001), and relapse rate was lower (P = 0.017) in PCCT group during the 1-year follow-up. In addition, the GAF score was significantly higher in the PCCT group than in the other two groups (P < 0.001). Our preliminary data suggest that PCCT is a more efficacious psychotherapy for OCD patients than pharmacotherapy or PCBT.
Brain and Behavior 07/2012; 2(4):443-54. DOI:10.1002/brb3.67 · 2.24 Impact Factor
"Active treatment N Duration (weeks) Outcome Cottraux et al. (1990) a Fluvoxamine + exposure therapy ( r 300 mg) 50 8 Fluvoxamine superior to placebo in follow-up phase, but only for depression 44 24 37 48 Katz et al. (1990) "
[Show abstract][Hide abstract] ABSTRACT: Convincing evidence from placebo-referenced randomized controlled trials supports efficacy for clomipramine and selective serotonin reuptake inhibitors for acute treatment of obsessive-compulsive disorder. It remains less conclusively understood whether these agents maintain efficacy over the longer term. This paper systematically reviews long-term medication studies in obsessive-compulsive disorder. Studies of clomipramine, fluoxetine and sertraline investigated 'responders' from acute treatment trials and extended treatment up to 12 months versus placebo. Responses to medication were sustained. A 24-week placebo-controlled trial of escitalopram (10 mg or 20 mg/day) and paroxetine (40 mg/day) demonstrated ongoing efficacy for all three treatments. Studies that randomized treated cases to placebo demonstrated reemergence of symptoms in the placebo-treated cohort. Six relapse prevention trials were found by systematic search. Some, but not all, revealed significant advantages for remaining on medication. Paroxetine (20-60 mg/day) and escitalopram (10 or 20 mg/day) were each found to outperform placebo in preventing relapse during 24 weeks of double-blind, randomized follow-up. Meta-analysis, using Review Manager software (4.2.8), detected overall superiority of selective serotonin reuptake inhibitors to placebo in preventing relapse among adult treatment-responders. Worsening by five Yale-Brown Obsessive Compulsive Scale points emerged from the review as a suggested threshold for relapse. Viewed collectively, these results suggest that selective serotonin reuptake inhibitors are effective long-term treatments and relapse prevention represents the treatment target for obsessive-compulsive disorder.
International Clinical Psychopharmacology 12/2007; 22(6):313-22. DOI:10.1097/YIC.0b013e32825ea312 · 2.46 Impact Factor
"Small studies with as few as 20 patients have shown fluvoxamine to be effective by weeks 8 to 10 in some (Cottraux et al. 1990, Perse et al. 1987) but not all (Jenike et al. 1990) clinical trials. In the study by Cottraux et al. (1990) fluvoxamine also showed superiority over placebo in spite of concurrent exposure therapy in the placebo group. Goodman (1989a) demonstrated similar response profiles in depressed and non-depressed patients and showed improvements in both OCD and depressive symptoms as early as week 2 compared to placebo. "
[Show abstract][Hide abstract] ABSTRACT: Advances in our understanding of neurobiology have been slow to translate into new, effective treatments for obsessive compulsive disorder (OCD). Serotonin re-uptake inhibitors (SRIs) remain the cornerstone of pharmacological treatment and lead to substantial clinical improvement in the majority of cases if continued for long enough. Extensive data suggests they are effective and well-tolerated in the longer term and can improve quality of life measures and protect against symptomatic relapse. However, for the majority of psychiatric patients with OCD, symptoms respond only partially to SRIs and for around one third of cases the response is poor. Increasing dosages or switching between SRIs are practical next steps, but the evidence-base for these strategies is not strong. Growing evidence supports the efficacy of adding first or second generation antipsychotic agents, but long-term data is lacking and for many the response still remains unsatisfactory. This paper critically examines the evidence for pharmacological treatment options in OCD, including novel strategies for treatment refractory individuals.