Article

Response Versus Remission in Obsessive-Compulsive Disorder

New York State Psychiatric Institute, New York, NY 10032, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 02/2006; 67(2):269-76. DOI: 10.4088/JCP.v67n0214
Source: PubMed

ABSTRACT To investigate rates of response and remission in adults with obsessive-compulsive disorder (OCD) after 12 weeks of evidence-based treatment.
Post hoc analyses of response and remission were conducted using data from a multisite, randomized, controlled trial comparing the effects of 12 weeks of exposure and ritual prevention (EX/RP), clomipramine (CMI), their combination (EX/RP+CMI), or pill placebo (PBO) in 122 adults with OCD (DSM-III-R or DSM-IV criteria). Response was defined as a decrease in symptoms; remission was defined as minimal symptoms after treatment. Different response and remission definitions were constructed based on criteria used in prior studies. For each definition, the proportion of responders or remitters in each treatment group was then compared.
There were significant differences (p<.05) among the 4 treatment groups in the proportion of responders and remitters. In pairwise comparisons, EX/RP+CMI and EX/RP each produced significantly more responders and remitters than PBO; CMI produced significantly more responders and remitters than PBO for some definitions but not for others. When remission was defined as a Yale-Brown Obsessive Compulsive Scale (YBOCS) score of 12 or less, significantly more EX/RP+CMI (18/31 [58%]) and EX/RP (15/29 [52%]) patients entering treatment achieved remission than either CMI (9/36 [25%]) or PBO (0/26 [0%]) patients. However, even in treatment completers, many CMI and some EX/RP+CMI and EX/RP patients did not achieve remission (remission rates for YBOCS<or=12: EX/RP+CMI=13/19 [68%]; EX/RP=15/21 [71%]; CMI=8/27 [30%]; PBO=0/20 [0%]).
EX/RP (with or without CMI) can lead to superior treatment outcome compared with CMI alone in OCD patients without comorbid depression. However, many OCD patients who receive evidence-based treatment do not achieve remission.

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    • "The definition of a meaningful clinical response or remission and the concept of 'relapse' continue to spark debate and can be difficult to apply to an illness that usually has a chronic fluctuating course or a progressively worsening course when untreated, and shows only partial response to long-term pharmacological treatment (Simpson et al., 2006; Farris et al., 2013). Plausible relapse criteria include a worsening of post-baseline Y–BOCS of Z50%, a five-point worsening of the total Y–BOCS score, a, total Y–BOCS score Z19, and CGI-I scores of 'much' or 'very much worse' (Fineberg et al., 2007a, 2007b). "
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    ABSTRACT: This narrative review gathers together a range of international experts to critically appraise the existing trial-based evidence relating to the efficacy and tolerability of pharmacotherapy for obsessive compulsive disorder in adults. We discuss the diagnostic evaluation and clinical characteristics followed by treatment options suitable for the clinician working from primary through to specialist psychiatric care. Robust data supports the effectiveness of treatment with selective serotonin reuptake inhibitors (SSRIs) and clomipramine in the short-term and the longer-term treatment and for relapse prevention. Owing to better tolerability, SSRIs are acknowledged as the first-line pharmacological treatment of choice. For those patients for whom first line treatments have been ineffective, evidence supports the use of adjunctive antipsychotic medication, and some evidence supports the use of high-dose SSRIs. Novel compounds are also the subject of active investigation. Neurosurgical treatments, including ablative lesion neurosurgery and deep brain stimulation, are reserved for severely symptomatic individuals who have not experienced sustained response to both pharmacological and cognitive behavior therapies. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Psychiatry Research 02/2015; 227(1). DOI:10.1016/j.psychres.2014.12.003 · 2.68 Impact Factor
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    • "Cognitive behavior therapy (CBT) for obsessive– compulsive disorder (OCD) has been investigated in clinical trials for more than 40 years (Rachman et al. 1971), and results have shown that this treatment is effective, in both group and individual format, with response rates averaging 50–70% (Abramowitz, 2006; Simpson et al. 2006). In recent years, Internet-based CBT (ICBT) with therapist guidance, a treatment format that has increasing empirical support (Andersson, 2009), has also shown promise in the treatment of OCD. "
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    ABSTRACT: Background. As relapse after completed cognitive behavior therapy (CBT) for obsessive–compulsive disorder (OCD) is common, many treatment protocols include booster programs to improve the long-term effects. However, the effects of booster programs are not well studied. In this study, we investigated the long-term efficacy of Internet-based CBT (ICBT) with therapist support for OCD with or without an Internet-based booster program. Method. A total of 101 participants were included in the long-term follow-up analysis of ICBT. Of these, 93 were ran-domized to a booster program or no booster program. Outcome assessments were collected at 4, 7, 12 and 24 months after receiving ICBT. Results. The entire sample had sustained long-term effects from pre-treatment to all follow-up assessments, with large within-group effect sizes (Cohen's d = 1.58–2.09). The booster group had a significant mean reduction in OCD symptoms compared to the control condition from booster baseline (4 months) to 7 months, but not at 12 or 24 months. Participants in the booster group improved significantly in terms of general functioning at 7, 12 and 24 months, and had fewer relapses. Kaplan–Meier analysis also indicated a significantly slower relapse rate in the booster group. Conclusions. The results suggest that ICBT has sustained long-term effects and that adding an Internet-based booster program can further improve long-term outcome and prevent relapse for some OCD patients.
    Psychological Medicine 02/2014; 44(13). DOI:10.1017/S0033291714000543 · 5.43 Impact Factor
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    • "Combination treatment with CBT (ERP) and pharmacotherapy is supported by meta-analytic and randomized controlled trials (RCTs) (Foa et al., 2005; Koran et al., 2007; Van Balkom et al., 1994). Recent studies have shown that combination treatment is superior to SRI monotherapy but equivocal to CBT (with ERP) alone (Simpson et al., 2006). Other strategies cited in the OCD literature include continuing with the chosen SRI for an extended period of time, raising the dose to the highest tolerated level, switching to another firstline treatment agent, or augmenting the SRI with an agent from a different drug class (Bandelow et al., 2008; Fineberg and Craig, 2007; Fineberg and Gale, 2005; Stein et al., 2012). "
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