Rocco Crino

Obsessive-compulsive disorder and axis I comorbidity

Obsessive compulsive disorder (OCD) patients often have lifetime comorbid anxiety and depressive disorders. Incidence of lifetime OCD in other anxiety disorder patients, however, has not been fully investigated. In the current study, a structured diagnostic interview was administered to 454 patients with OCD, panic agoraphobia, or social phobia. Results indicated a relatively high level of lifetime anxiety disorders in OCD subjects but a much lower rate of lifetime OCD in other anxiety-disorder patients. Lifetime depression was not found to be different across the groups. The results are discussed in terms of possible vulnerability factors associated with OCD.

The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling.

This exploratory study investigated the effect of interventions designed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic. Forty subjects (29 males, 11 females, mean age = 37.6) meeting DSM-IV criteria (APA, 1994) for pathological gambling were randomly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions designed to improve treatment compliance. Compliance was indicated by the completion of all treatment sessions. Outcome measures were DSM-IV criteria assessed by structured clinical interview, South Oaks Gambling Screen scores, and percentage of income gambled. Logistic regression analyses identified pretreatment characteristics predicting compliance and outcome. Compliance-improving interventions significantly reduced dropout rates, resulting in superior outcomes at posttreatment compared to the cognitive behavioural treatment alone. At 9-month follow-up, there was no difference in outcome between treatments, although both produced clinically significant change. Comorbid problem drinking, drug use, and problem gambling duration predicted poor compliance. Poor outcome was predicted by comorbid problem drinking. The clinical implications of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance, outcome, and comorbidity issues.

Randomized controlled trial of an early intervention programme for adolescent anxiety disorders.

Objective: To assess the effectiveness of an indicated early intervention and prevention programme for anxiety disorders when conducted by school staff. Method: A total of 260 students in their first year of high school with self-reported anxiety symptoms >1 SD above the mean score of a normative sample were randomly allocated on the basis of their school to an intervention condition led by school staff or to a monitoring condition. Results: There was little difference between conditions at the 2 year and 4 year follow up on self-reported symptoms, and no difference on diagnosis or health-care use. Conclusions: Outcomes associated with indicated prevention programmes led by school staff may not be as strong as those produced by specialist mental health staff. More work is needed to delineate models by which evidence-based treatments can be effectively used in schools.

Eye-movement desensitisation: a simple treatment for post-traumatic stress disorder?

Eye-movement desensitisation has been identified in a number of case studies to be an effective treatment for post-traumatic stress disorder (PTSD). A further case study reporting success is presented. The treatment appears rapid and may represent a potentially cost-effective treatment for PTSD. However, no treatment study to date has conformed to the ideal methodology of a double-blind placebo controlled trial and therefore its efficacy remains to be demonstrated. A minimal but stringent set of criteria for identification of treatment efficacy are outlined. The implications of eye-movement desensitisation being identified as an effective treatment for PTSD are discussed.

Pre-existing antidepressants and the outcome of group cognitive behaviour therapy for social phobia

OBJECTIVE This is a naturalistic treatment outcome study investigating the impact of pre-existing antidepressant use on the effectiveness of group cognitive behaviour therapy (CBT) for social phobia. METHOD Of the 133 participants who completed the CBT program, 49 reported taking antidepressants (CBT + AD group), while 84 reported not taking antidepressants (CBT group). The treatment program involves 40 h of structured, group-based CBT over 7 weeks. The dependent measures included the Social Phobia Scale and Social Interaction Anxiety Scale, the Fear of Negative Evaluation Scale, the Depression, Anxiety and Stress Scale and the Short Form-12. RESULTS Both the CBT + AD group and the CBT group improved significantly across treatment on all dependent measures. There were no significant differences between the groups on any outcome measure and the rate of improvement from pre- to post-treatment for both groups did not differ. CONCLUSIONS Pre-existing antidepressants did not significantly enhance or detract from the positive treatment outcome of a structured, group-based CBT program for social phobia.

Obsessive compulsive disorder

In the last three decades effective treatments for Obsessive Compulsive Disorder (OCD) have become available. Pharmacotherapy of OCD results in a significant reduction of symptoms. Behaviour therapy, while producing similar or better results, has the added advantage that some patients remain well in the absence of continuing treatment. Despite significant advances in the treatment of OCD, aetiological and prognostic factors remain unclear. The relationship of OCD to other disorders also remains uncertain. It is clear that considerably more research is warranted before any conclusions regarding the development of OCD and its relationship to other disorders can be drawn.

Posttraumatic stress disorder: Treatment

The Post-Traumatic Stress Disorder (PTSD) Group Treatment Program is a time limited mental health outpatient service that the Agent can approve for workers who experience post traumatic psychological distress as a result of a work-related injury or illness. The PTSD Group Treatment Program aims to assist eligible workers by:  reducing the burden of post-traumatic psychological distress  facilitating access to timely and effective psychological treatment, and  improving return to health and return to work outcomes. Following a Pre-Program Psychological Assessment a worker participates in a range of modules covering education, symptom management, skill development and return to work. A worker’s partner or other first degree relative may be given the opportunity to be involved in an accompanying Partner and Family Support Module as this forms part of the injured worker’s treatment. If required, accommodation may be arranged for a worker participating in the PTSD Group Treatment Program.

Posttraumatic stress disorder: Syndrome

© The Author 2015 L. Miller, PTSD and Forensic Psychology, SpringerBriefs in Psychology, DOI 10.1007/978-3-319-09081-8_2 One of the themes that informs this book derives from Thibault’s (1984) observation that “the first step to making an accurate diagnosis is to think of it.” That is, no psychometric test or printed decision tree can substitute for solid scholarship and experience in the field that the clinical therapist or forensic examiner practices in. Unfortunately, many psychological “experts,” not to mention attorneys, judges, case managers, and the ordinary people that form the juror pools that many posttraumatic stress disorder (PTSD) cases depend on, have an incomplete or erroneous understanding of exactly what PTSD, is and what it is not. Remember, if you are conducting a forensic psychological evaluation in a PTSD case, you will probably be called upon to explain the basis for your findings in a written report and/or testimony at deposition or trial (Chap. 7). This chapter will explain the phenomenology, diagnostic criteria, and theoretical models of PTSD and associated syndromes. The next chapter will place PTSD in the context of a variety of mental disorders that may be confused with PTSD or that may comorbidly complicate its diagnosis, treatment, and forensic analysis.