Response Versus Remission in Obsessive-Compulsive Disorder

ArticleinThe Journal of Clinical Psychiatry 67(2):269-76 · February 2006with37 Reads
DOI: 10.4088/JCP.v67n0214 · Source: PubMed
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.
    • "Unlike iCBT programs which instruct on self-exposure, the current program allows participants to practice ERP in the online environment. The anxiety invoked by ERP is often cited as a barrier to in vivo exposure (Foa et al., 1983; Simpson, Huppert, Petkova, Foa, & Liebowitz, 2006; Vogel, Stiles, & Götestam, 2004), and higher adherence rates have been reported for virtual reality relative to in vivo exposure in spider fear (Garcia-Palacios, Botella, Hoffman, & Fabregat, 2007). As such, this program may be particularly useful for those who are unwilling to engage with exposure exercises, and may be useful as a precursor to ERP. "
    [Show abstract] [Hide abstract] ABSTRACT: Background and objectives: Computer-aided vicarious exposure (CAVE) for obsessive-compulsive disorder (OCD) is an intervention in which participants learn and rehearse exposure with response prevention (ERP) by directing a character around a virtual world. This study aimed to pilot an online CAVE program for OCD in a community sample with high OCD symptomatology. Methods: Participants (n = 78) were allocated to an intervention group (three 45-min weekly CAVE sessions) or to a waitlist control group. The treatment group were asked to complete three 45-min sessions over a four week period. Results: Those who completed at least one CAVE session showed greater improvement on measures of OCD symptomatology at one-month post-treatment (d = 0.49-0.81) compared to waitlist (d = 0.01-0.1). Older age, past treatment and higher symptom severity were associated with non-adherence. Limitations: These findings should be considered preliminary due to sample size limitations and an absence of an active control group. However, the findings suggest that further development and evaluation of the program is warranted. Conclusions: Preliminary findings suggest that online CAVE programs have potential to bridge treatment gaps among those reluctant to attend treatment or engage with in vivo exposure exercises. These programs may also have potential applications as an adjunct to face-to-face or online cognitive behavioural therapy.
    Full-text · Article · Jun 2016
    • "p = 0.187). Clinical response rate, defined as Y-BOCS reduction of ě25% [35], was 80% (8 out of 10) in ACTIVE and 8% (1 out of 12) in SHAM. Of the 10 participants in the ACTIVE group, two from the Turkey site failed to respond to treatment (showed an increase in YBOCs scores), one of which dropped out after Visit 3 (two rTMS treatments). "
    [Show abstract] [Hide abstract] ABSTRACT: Recently, strategies beyond pharmacological and psychological treatments have been developed for the management of obsessive-compulsive disorder (OCD). Specifically, repetitive transcranial magnetic stimulation (rTMS) has been employed as an adjunctive treatment in cases of treatment-refractory OCD. Here, we investigate six weeks of low frequency rTMS, applied bilaterally and simultaneously over the sensory motor area, in OCD patients in a randomized, double-blind placebo-controlled clinical trial. Twenty-two participants were randomly enrolled into the treatment (ACTIVE = 10) or placebo (SHAM = 12) groups. At each of seven visits (baseline; day 1 and weeks 2, 4, and 6 of treatment; and two and six weeks after treatment) the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was administered. At the end of the six weeks of rTMS, patients in the ACTIVE group showed a clinically significant decrease in Y-BOCS scores compared to both the baseline and the SHAM group. This effect was maintained six weeks following the end of rTMS treatment. Therefore, in this sample, rTMS appeared to significantly improve the OCD symptoms of the treated patients beyond the treatment window. More studies need to be conducted to determine the generalizability of these findings and to define the duration of rTMS' clinical effect on the Y-BOCS. Clinical Trial Registration Number (NCT) at NCT00616486.
    Full-text · Article · Mar 2016
    • "Paired sample t-tests were applied to (1) pre-treatment and post-treatment scores for the CY-BOCS- SR and BDI-II to evaluate treatment outcome and (2) to post-treatment and follow-up scores for participants with available follow-up data. We calculated the proportion of patients at discharge who met response criteria defined as a CY-BOCS-SR decrease of 25% (Simpson, Huppert, Petkova, Foa, & Liebowitz, 2006; Storch, Lewin, De Nadai, & Murphy, 2010). We also examined the proportion of participants who demonstrated excellent response with mild-tominimal symptoms defined by a discharge CY- BOCS-SR of 10 or less. "
    [Show abstract] [Hide abstract] ABSTRACT: We examined outcomes from a residential treatment program emphasizing exposure and response prevention (ERP) to determine if the typically robust response to this treatment in outpatient settings extends to patients treated in this unique context. One hundred and seventy-two adolescents with primary Obsessive-compulsive disorder (OCD) completed measures at admission and discharge. Almost all (92.4%) participants had at least two diagnoses and nearly half (44.2%) had three or more. Treatment consisted of intensive ERP (i.e., approximately 26.5 hr per week), additional cognitive behavioral therapy interventions, and medication management within a residential setting. In contrast to the samples reported on in the vast majority of other pediatric OCD trials, participants in the current study were living apart from their families and were immersed within the treatment setting, with staff members available at all times. Paired sample t-tests revealed significant decreases in OCD and depression severity. Results suggest that residential treatment for adolescents with OCD using a multimodal approach emphasizing ERP can be effective for complex cases with significant comorbidity. Results were comparable with several randomized controlled trials.
    Full-text · Article · Aug 2015
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