Predicting the therapeutic response to cognitive behavioural therapy in patients with pharmacoresistant obsessive-compulsive disorder.
ABSTRACT The aim of our study was to establish the efficacy of CBT on the sample of non-selected medication-resistant patients with OCD and to search for predictors of therapeutic response in such a group.
The treatment was carried out under usual conditions at the department for anxiety disorders. Systematic CBT steps were tailored to the needs of each patient. Pharmacology treatment remained grossly unchanged during the trial period. We used the following outcome measures in the study: Yale-Brown Obsessive Compulsive Scale, subjective version (S-Y-BOCS), the Clinical Global Impression - Severity of Illness scale (CGI-S), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatoform Dissociation Questionnaire (SDQ-20) and Dissociative Experience Scale (DES). The primary outcome measure was a decrease by 35% in Y-BOCS rating. Remission was defined as a 12 point score or lower in Y-BOCS and 1 or 2 points in CGI-S.
47 patients completed the study (19 male and 28 female). One female patient refused to participate. All patients completed at least 5 weeks of intensive CBT programme and showed significant improvement on Y-BOCS, CGI-S, and BDI scales. At the end of the treatment 40.4% of the patients achieved clinical remission according to the CGI-S scale. The main characteristics present at the beginning of the trial increasing probability of achieving improvement or remission during the treatment were a Y-BOCS score lower than 22, good insight, higher resistance to symptoms, low level of dissociation, and aggressive obsessions.
As negative predictors we identified higher scores in Y-BOCS, poorer insight, low resistance to symptoms, high level of dissociation, obsessions focused on control/symmetry and obsessive slowness/ambivalence as associated with poor improvement.
[show abstract] [hide abstract]
ABSTRACT: According to recent findings, certain clinical symptoms of patients suffering from affective and anxiety disorder can be related to dissociation. The aim of our study was to examine if the level of dissociation in bipolar affective disorder differed from the level of dissociation in healthy volunteers. 41 patients suffering from bipolar disorder (51.2% females), and 198 healthy controls ( 71.2% females) were included in the study. The patients with bipolar affective disorder in remission were recruited from the Outpatient department of the Department of Psychiatry of the University Hospital Olomouc. They were psychiatrically assessed and the state of the disorder was evaluated by an experienced psychiatrist. Only patients in remission, evaluated as 1 or 2 points of clinical global impression-severity scale, were included in the study. All participants were assessed with the Dissociative Experiences Scale (DES). There were no differences in the two groups in demographic variables like age, gender and education. Patients had a significantly higher mean score on the DES and pathological DES than healthy controls. Our results suggest that the level of psychological dissociation in bipolar affective patients is higher than in healthy controls.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 06/2011; 155(2):181-6.