In response to the emerging crisis and growing calls from patients and clinicians for guidance 5, a working group of clinical experts from the International College of Obsessive Compulsive Spectrum ...Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network of the European College of Neuropsychopharmacology (OCRN) have produced this consensus statement with the aim of delivering pragmatic guidance at the earliest opportunity to clinicians for managing this complex challenge. Based on the risks associated with exposure and response prevention (ERP) in the pandemic (see below), and uncertainty as to which of the two evidence-based treatments, pharmacotherapy or cognitive behaviour therapy (CBT), represents the most efficacious first line treatment modality 11, pharmacotherapy should be the first option for adults and children with OCD with contamination, washing or cleaning symptoms during the COVID-19 pandemic. Consider A) type of medication; most patients should receive an SSRI, or if not responsive, another SSRI and as a third choice clomipramine (for which an ECG may be required in certain patient groups); Note US Food and Drug Administration "black box" warnings or advice from equivalent national regulatory authorities regarding increased risk in young people and other vulnerable patient groups. Check for adverse effects and be available for any concerns related to "activation" or newly emergent or increased suicidal ideation, which in the young can be mitigated by starting treatment at a low dose and titrating more gradually; B) dosage; if the patient is on a suboptimal dose, consider increasing it, paying attention to any contraindications; C) SSRI-resistance; consider a low dose of adjunctive antipsychotic (aripiprazole, risperidone, quetiapine, olanzapine), especially if a tic is present; D) adherence; ensure the patient is able to obtain an adequate supply and is taking the treatment regularly.
Established treatments for Obsessive Compulsive Disorder (OCD) include cognitive behavioural psychotherapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication. Combining CBT with SSRI ...may be superior to either monotherapy, but few studies have addressed this question in adults with OCD.
Optimal Treatment for OCD (OTO) is a feasibility study aimed to inform the design of a definitive trial of sufficient size to provide accurate information about the cost-effectiveness of each treatment approach.
The study took place at three centres. Participants were community-based service-users aged 18-65y with OCD of at least moderate severity and a duration of symptoms >1 year. Out of 258 potential participants, 66 were screened and 49 entered the study and were randomly assigned to CBT (n=16), SSRI (n=18) or SSRI+ CBT (combination; n=15). Sertraline (50-200mg/d) was given as the SSRI for 52 weeks. Sixteen hours’ manualised individual CBT was delivered over 8 weeks with 4 additional hour-long follow-up sessions. Regular assessments were made by researchers ‘blinded’ to the treatment allocation for 52 weeks. A preliminary health economic evaluation was made using standardised measures of resource use and the EQ-5D-3L.
At baseline the mean total Y-BOCS across all groups was 26.7 (SD =5.9). 29 patients completed 16 weeks of treatment, with adequate adherence to allocated treatments. At week 16, for participants remaining in the study, there was evidence of improvement (all patients’ mean total YBOCS =18.4 (8.9)). Combination treatment (n=13) was associated with the largest improvement, sertraline (n=7) the next largest and CBT (n=9) the smallest. Symptomatic improvement continued to 52 weeks, but participant discontinuation made it not possible to perform further reliable between-treatment comparisons.
Compared to sertraline monotherapy, the mean costs were higher for the CBT monotherapy, and the combined group. The mean QALY score was greater for sertraline monotherapy when compared with CBT monotherapy and when compared with the combined group.
Eleven of a total of 288 adverse events were considered to be severe. Three serious adverse events were reported. One was a suicide attempt, which was considered to be possibly related to treatment, and 2 were hospital admissions for termination of pregnancy which were not related.
SSRI with CBT may offer the most clinically effective treatment (especially over CBT), and SSRI monotherapy the most cost-effective treatment.
If the superiority of SSRI in OCD were to be replicated in a future study, there would be potential for large cost savings to health services. However the small size of the current study means that the conclusions drawn have to be treated with caution, and further research would thereby be of value. Our study confirms that a definitive study can be conducted.
In recent years, many assessment and care units for obsessive-compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no ...consensus regarding the key functions that these units should perform. The International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a standards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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