Obsessive-compulsive disorder: Evidence-based treatments and future directions for research

Caleb W Lack, Department of Psychology, University of Central Oklahoma, Edmond, OK 73034, United States.
World journal of psychiatry 12/2012; 2(6):86-90. DOI: 10.5498/wjp.v2.i6.86
Source: PubMed


Over the past three decades, obsessive-compulsive disorder (OCD) has moved from an almost untreatable, life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments (which appears to be only a portion of the overall population) are not effectively treated. Suggestions for future avenues of research are also presented. These are primarily focused on (1) increased dissemination of effective therapies; (2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and (3) the impact of comorbid disorders on treatment outcome.

Download full-text


Available from: Caleb W Lack, Jul 02, 2014
  • Source
    • "al.Exposure and response prevention & ERP is similar to traditional exposure therapy, except that special attention is paid to the prevention of escape responses. & Therapy employs in vivo and imaginal exposure and is most efficacious when patients remain in the exposure situation until the compulsive rituals and the obsessional distress reduce spontaneously[44,45]. & Cognitive therapy (CT) techniques can augment ERP by assisting patients to confront maladaptive thought patterns or mistaken beliefs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Anxiety disorders are prevalent and represent an important focus of treatment within the field of psychiatry as well as within medicine more broadly. First-line pharmacotherapy treatment for anxiety disorders is serotonin selective reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). For patients who do not responsd to an initial first-line treatment, clinicians should ensure that there has been adequate exposure to the medication by assessing compliance and optimizing the prescribed dose. Non-response to a treatment trial should also prompt a re-evaluation of the diagnosis and a search for occult psychiatric, substance, or general medical disorders. Laboratory tests and other components of a diagnostic work-up should be considered if they have not already been completed. Following confirmation of the diagnosis, the clinician should consider a switch to an agent from a different class, for example a tricyclic antidepressant or monoamine oxidase inhibitor. Combination treatments with an antidepressant plus a benzodiazepine, second-generation antipsychotic, anticonvulsant, β-blocker, or other medication may be considered but data is limited. Psychotherapy is an important treatment component for anxiety disorders and should be implemented whenever feasible. Variants of cognitive behavioral therapy (CBT) in particular are effective in reducing anxiety symptoms, and data suggest that the combination for CBT plus medication may be particularly beneficial for patients. Obsessive-compulsive disorder (OCD), while sharing many clinical features with anxiety disorders, represents its own unique clinical challenge and has been removed from the category of anxiety disorders in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). SSRIs are first-line therapy for OCD and higher doses are often required compared with anxiety disorders or major depressive disorder. Exposure and response prevention may be a particularly helpful form of psychotherapy for this patient population. For severe, intractable OCD, deep brain stimulation may be an appropriate therapeutic option.
    Full-text · Article · Sep 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: The European Union Free Movement Directive gives professionals the opportunity to work and live within the European Union, but does not give specific requirements regarding how the specialists in medicine have to be trained, with the exception of a required minimum of 4 years of education. Efforts have been undertaken to harmonize post-graduate training in psychiatry in Europe since the Treaty of Rome 1957, with the founding of the European Union of Medical Specialists (UEMS) and establishment of a charter outlining how psychiatrists should be trained. However, the different curricula for post-graduate training were only compared by surveys, never through a systematic review of the official national requirements. The published survey data still shows great differences between European countries and unlike other UEMS Boards, the Board of Psychiatry did not introduce a certification for specialists willing to practice in a foreign country within Europe. Such a European certification could help to keep a high qualification level for post-graduate training in psychiatry all over Europe. Moreover, it would make it easier for employers to assess the educational level of European psychiatrists applying for a job in their field.
    No preview · Article · Feb 2014 · European Psychiatry
  • Source

    Full-text · Chapter · Feb 2015