P. van Oppen

A meta-analysis on the treatment of obsessive compulsive disorder: A comparison of antidepressants, behavior, and cognitive therapy

A meta-analysis was conducted to integrate treatment results from outcome research on the efficacy of antidepressants, behavior therapy, cognitive therapy, and the combination of these methods in obsessive compulsive disorder. The effect sizes for self-rated obsessive compulsive symptoms were found to be significantly smaller than for assessor-ratings. Because of the lack of overlap in use of measurement instruments in the respective studies, no common measurement instrument could be selected. Therefore, analyses were performed on both self- and assessor-ratings. On self- and assessor-rated obsessive-compulsive symptoms, the serotonergic antidepressants clomipramine, Fluoxetine, and fluvoxamine, behavior therapy, and the combination of serotonergic antidepressants with behavior therapy were significantly more effective than placebo treatment. Although scarce, follow-up data from 3 months to 6 years indicated that the short-term treatment effects remain stable. On self-ratings, behavior therapy was significantly more effective than serotonergic antidepressants. The combination treatment tended to be more effective than serotonergic antidepressants. On assessor-ratings, however, no difference could be demonstrated between these three treatments. Future research on antidepressants and behavior therapy should adopt the same standards for self and assessor-ratings. Moreover, research should focus on long-term efficacy of treatments offered.

Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls

Hovens JGFM, Wiersma JE, Giltay EJ, van Oppen P, Spinhoven P, Penninx BWJH, Zitman FG. Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls.

Prediction of outcome and early vs. late improvement in OCD patients treated with cognitive behaviour therapy and pharmacotherapy

In this study, follow‐up results of cognitive‐behaviour therapy and of a combination of cognitive‐behaviour therapy with a serotonergic antidepressant were determined. The study also examined factors that can predict this treatment effect, both in the long term and in the short term. In addition, it investigated whether differential prediction is possible for cognitive‐behaviour therapy vs. a combination of cognitive‐behaviour therapy with a serotenergic antidepressant. A total of 99 patients were included in the study. Treatment lasted 16 weeks, and a naturalistic follow‐up measurement was made 6 months later. Of the 70 patients who completed the treatment, follow‐up information was available for 61 subjects. Significant time effects were found on all outcome measures at both post‐treatment measurement and follow‐up. No differences in efficacy were found between the treatment conditions. Effectiveness at post‐treatment measurement appears to predict success at follow‐up. However, 17 of the 45 non‐responders at the post‐treatment measurement had become responders by the follow‐up. The severity of symptoms, motivation for treatment and the dimensional score on the PDQ‐R for cluster A personality disorder appear to predict treatment outcome. No predictors were found that related specifically to cognitive‐behaviour therapy or combined treatment. These results indicate that the effectiveness of cognitive‐behaviour therapy or a combination of cognitive‐behaviour therapy and fluvoxamine at the post‐treatment measurement is maintained at follow‐up. However, non‐response at post‐treatment does not always imply non‐response at follow‐up. Patients with more severe symptoms need a longer period of therapy to become responders. Although predictors for treatment success were found, no evidence was found to determine the choice of one of the treatment modalities.

Cognitive changes in patients with obsessive-compulsive rituals treated with exposure in vivo and response prevention

Publisher Summary This chapter investigates the cognitive changes in patients with obsessive compulsive rituals treated with exposure in vivo and response prevention. Obsessive compulsive disorder (OCD) is related to perfectionism, but it does seem more likely that perfectionism is a dispositional trait for the development of psycho-pathology in general, rather than for OCD in particular. Further, indecisiveness, magical thinking, aversion to risk-taking, and guilt have also been found to be related to OCD. Although some have proposed that cognitive therapy may be inappropriate for treating obsessive compulsives, because these patients already over-emphasize their thoughts, there is evidence that cognitive therapy may be effective in treating OCD. On the obsessive compulsive targets (Maudsley obsessional compulsive inventory and anxiety/discomfort scale), the results of cognitive therapy were about equally effective as self-controlled exposure in vivo. Both treatments led to a reduction of social anxiety. On depressed mood, cognitive therapy led to significant improvement, whereas self-controlled exposure did not.

The sensitivity to change of measures for obsessive-compulsive disorder

This study presents data on the sensitivity to change of the Padua Inventory-Revised (PI-R), the Yale Brown Obsessive Compulsive Scale (Y-BOCS), and the Anxiety Discomfort Scale (ADS) for obsessive-compulsive disorder. In a sample of obsessive-compulsives (n = 63) who received either behaviour therapy, cognitive therapy, or a combination of fluvoxamine and cognitive therapy or behaviour therapy, evidence was found for the sensitivity of these three measures. However, low correlations were found at pretreatment, and only moderate correlations on percentage difference score. These findings indicate that different measures assess relatively different features of the OCD. All three measures demonstrated highly significant treatment effects and large effect sizes. Although the PI-R, the Y-BOCS, and the ADS showed clinically significant changes, there was only a small overlap (57%) on this index. The ADS is the most sensitive treatment outcome measure. It is recommended to use all three measures in outcome studies of OCD.

Positive and negative life events and personality traits in predicting course of depression and anxiety

Spinhoven P, Elzinga BM, Hovens JGFM, Roelofs K, van Oppen P, Zitman FG, Penninx BWJH. Positive and negative life events and personality traits in predicting course of depression and anxiety.

Cognitive Interventions in Behavioral Medicine

In this report an overview is given of the contribution of cognitive approaches to behavioral medicine. The (possible) contribution of cognitive therapy is reviewed in the area of coronary heart disease, obesity, bulimia nervosa, chronic pain, benign headache, cancer, acquired immunodeficiency syndrome/human immunodeficiency virus and asthma. Although the relative contribution of cognitive therapy varies across these various disorders, its positive effects are now well established and new advances undoubtedly will be made in the next few years.

Predictors of health-related quality of life in patients treated with auto- and allo-SCT for hematological malignancies

Identifying factors that predict health-related quality of life (QOL) following hematopoietic SCT, is important in estimating patients’ abilities to adjust to the consequences of their disease and treatment. As the studies that have been published on this subject are scattered, the present study aimed to systematically review prognostic factors for health-related QOL after auto- and allo-SCT in hematological malignancies. A systematic, computerized search in Medline, EMBASE, PsycINFO and the Cochrane Library was conducted from 2002 to June 2010. The methodological quality of the studies was assessed using an adaptation of Haydens criteria list. Qualitative data synthesis was performed to determine the strength of the scientific evidence. In all, 35 studies fulfilled the selection criteria. Strong–moderate evidence was found for GVHD, conditioning regimen, being female, younger age, receiving less social support and pre-transplant psychological distress as predictors of various aspects of health-related QOL following hematopoietic SCT. The results of this review may help transplant teams in selecting patients at risk for experiencing a diminished health-related QOL following hematopoietic SCT. Follow-up treatment can be provided in order to promote QOL.

Age of onset in obsessive–compulsive disorder: admixture analysis with a large sample

BACKGROUND Research into age of onset in obsessive-compulsive disorder (OCD) has indicated significant differences between patients with early and late onset of the disorder. However, multiple criteria have been used arbitrarily for differentiating between early- and late-onset OCD, rendering inconsistent results that are difficult to interpret. METHOD In the current study, admixture analysis was conducted in a sample of 377 OC patients to determine the number of underlying populations of age of onset and associated demographic and clinical characteristics. Various measures of anxiety, depression, co-morbidity, autism, OCD, tics and attention deficit hyperactivity disorder (ADHD) symptoms were administered. RESULTS A bimodal age of onset was established and the best-fitting cut-off score between early and late age of onset was 20 years (early age of onset ≤19 years). Patients with early age of onset were more likely to be single. Early age of onset patients demonstrated higher levels of OCD severity and increased symptoms on all OCD dimensions along with increased ADHD symptoms and higher rates of bipolar disorder. CONCLUSIONS It is suggested that 20 years is the recommended cut-off age for the determination of early versus late age of onset in OCD. Early age of onset is associated with a generally graver OCD clinical picture and increased ADHD symptoms and bipolar disorder rates, which may be related to greater functional implications of the disorder. We propose that age of onset could be an important marker for the subtyping of OCD.

Frequent attenders in general practice: problem solving treatment provided by nurses [ISRCTN51021015]

BackgroundThere is a need for assistance from primary care mental health workers in general practice in the Netherlands. General practitioners (GPs) experience an overload of frequent attenders suffering from psychological problems. Problem Solving Treatment (PST) is a brief psychological treatment tailored for use in a primary care setting. PST is provided by nurses, and earlier research has shown that it is a treatment at least as effective as usual care. However, research outcomes are not totally satisfying. This protocol describes a randomized clinical trial on the effectiveness of PST provided by nurses for patients in general practice. The results of this study, which currently being carried out, will be presented as soon as they are available.Methods/designThis study protocol describes the design of a randomized controlled trial to investigate the effectiveness and cost-effectiveness of PST and usual care compared to usual care only.Patients, 18 years and older, who present psychological problems and are frequent attenders in general practice are recruited by the research assistant. The participants receive questionnaires at baseline, after the intervention, and again after 3 months and 9 months. Primary outcome is the reduction of symptoms, and other outcomes measured are improvement in problem solving skills, psychological and physical well being, daily functioning, social support, coping styles, problem evaluation and health care utilization.DiscussionOur results may either confirm that PST in primary care is an effective way of dealing with emotional disorders and a promising addition to the primary care in the UK and USA, or may question this assumption. This trial will allow an evaluation of the effects of PST in practical circumstances and in a rather heterogeneous group of primary care patients. This study delivers scientific support for this use and therefore indications for optimal treatment and referral.