N-Acetyl Cysteine in the Treatment of Obsessive Compulsive and Related Disorders: A Systematic Review Remission status after long-term sertraline treatment of pediatric obsessive-compulsive disorder. A randomized clinical trial to examine enhancing cognitive-behavioral group therapy for obsessive-compulsive disorder with motivational interviewing and thought mapping. Long-term course and outcome of obsessive-compulsive patients after cognitive-behavioral therapy in combination with either fluvoxamine or placebo: a 7-year follow-up of a randomized double-blind trial. No Effect of Adding Brief Dynamic Therapy to Pharmacotherapy in the Treatment of Obsessive-Compulsive Disorder with Concurrent Major Depression The treatment of substance abusers diagnosed with obsessive-compulsive disorder: an outcome study. Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder Cognitive behavior therapy in treatment-naive children and adolescents with obsessive-compulsive disorder: an open trial. Predictors of drug treatment response in obsessive-compulsive disorder. Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. Randomized, placebo-controlled trial of cognitive-behavioral therapy alone or combined with sertraline in the treatment of pediatric obsessive-compulsive disorder. Quetiapine augmentation of serotonin reuptake inhibitors in obsessive-compulsive disorder Clomipramine in obsessive-compulsive disorder N-Acetylcysteine in the Treatment of Pediatric Tourette Syndrome: Randomized, Double-Blind, Placebo-Controlled Add-On Trial. Age and Remission of Psychiatric Disorders Guidelines for the pharmacological treatment of anxiety disorders, obsessive–compulsive disorder and posttraumatic stress disorder in primary care Perinatal factors affecting expression of obsessive compulsive disorder in children and adolescents. Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: a controlled trial. Behavioural group therapy for obsessive-compulsive disorder in Norway. An open community-based trial. Sertraline and Fluoxetine Treatment of Obsessive-Compulsive Disorder: Results of a Double-Blind, 6-Month Treatment Study Double-blind, placebo-controlled, pilot trial of paliperidone augmentation in serotonin reuptake inhibitor-resistant obsessive-compulsive disorder. Anorexia nervosa with excessive exercise: A phenotype with close links to obsessive-compulsive disorder World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision
Objective Obsessive compulsive and related disorders are a collection of debilitating psychiatric disorders in which the role of glutamate dysfunction in the underpinning neurobiology is becoming well established . N-acetyl cysteine ( NAC ) is a glutamate modulator with promising therapeutic effect . This paper presents a systematic review of clinical trials and case reports exploring the use of NAC for these disorders . A further objective was to detail the methodology of current clinical trials being conducted in the area . Methods PubMed , Web of Science and Cochrane Library Data base were search ed for human clinical trials or case reports investigating NAC in the treatment of obsessive compulsive disorder ( OCD ) or obsessive compulsive related disorders . Research ers with known involvement in NAC studies were contacted for any unpublished data . Results Four clinical trials and five case reports/series were identified . Study duration s were commonly 12-weeks , using 2,400–3,000 mg/day of NAC . Overall , NAC demonstrates activity in reducing the severity of symptoms , with a good tolerability profile and minimal adverse effects . Currently there are three ongoing r and omized controlled trials using NAC for OCD ( two adults and one pediatric ) , and one for excoriation . Conclusion Encouraging results have been demonstrated from the few pilot studies that have been conducted . These results are detailed , in addition to a discussion of future potential research BACKGROUND Despite its high chronicity , few studies have evaluated the effectiveness of long-term treatment for pediatric obsessive-compulsive disorder ( OCD ) . The goal of the current analysis is to evaluate remission among children and adolescents with OCD treated with sertraline  for 12 months . METHODS Children ( 6 - 12 years old , n = 72 ) and adolescents ( 13 - 18 years old , n = 65 ) with Diagnostic and Statistical Manual of Mental Disorders ( third edition , revised ) OCD , who had completed a 12-week , double-blind , placebo-controlled sertraline study , were administered open-label sertraline  50 - 200 mg for 52 weeks . Full remission was defined by a Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) score of 8 or less , and partial remission was defined as a CY-BOCS score of 15 or less . RESULTS Using an last observation carried forward analysis , 47 % of patients achieved a full remission , and an additional 25 % achieved a partial remission . Among study completers , full remission was achieved by 55 % of patients and partial remission by 31 % . Two thirds of patients with severe OCD at baseline ( CY-BOCS of 26 or greater ) achieved full or partial remission . Children were more likely to achieve a full remission than adolescents . CONCLUSION Sertraline is effective in the treatment of childhood and adolescent OCD , with initial acute response converting to remission and improved functional status in a substantial proportion of patients . More research is needed to develop pharmacologic and psychotherapeutic strategies that facilitate the achievement of full remission in the remaining patients suffering from this chronic and disabling illness BACKGROUND Obsessive-compulsive disorder ( OCD ) is characterized by repeated and persistent attempts to control thoughts and actions with rituals . These rituals are used in order to prevent feared or personally distressing outcomes . Cognitive behavioral group therapy ( CBGT ) has been reported to be effective for treating OCD patients . However , about one-third ( 30 % ) of patients do not benefit from CBGT . Some of these patients do not show significant improvement and continue to use rituals following CBGT , partially because they fail to complete the exposure and ritual prevention ( ERP ) exercises . Consequently , it is important to motivate patients to fully engage in CBGT treatment and complete the ERP exercises . AIMS A r and omized behavioral trial examined 12 weeks of manual directed CBGT , with the addition of individual sessions of Motivational Interviewing ( MI ) and Thought Mapping ( TM ) , and compared treatment outcome to the effectiveness of CBGT group alone . METHOD Subjects were r and omized ( n=93 ) into a CBGT group or a CBGT group with MI+TM .  RESULTS When the two groups were compared , both groups reduced OCD symptoms . However , symptom reduction and remission were significantly higher in the MI+TM CBGT group . Positive outcomes were also maintained , with additional symptom reduction at the 3-month follow-up for the MI+TM CBGT group . CONCLUSIONS Adding two individual sessions of MI and TM before CBGT successfully reduced OCD symptoms and was more effective than using CBGT group alone Longitudinal studies with very long follow-up periods of patients with obsessive-compulsive disorder ( OCD ) who have received adequate treatment are rare . In the current study , 30 of 37 in patients ( 81 % ) with severe OCD were followed up 6 - 8 years after treatment with cognitive-behavioral therapy ( CBT ) in combination with either fluvoxamine or placebo in a r and omized design . The significant improvements ( with large effectsizes ) in obsessive-compulsive symptoms from pre- to post-treatment ( 41 % reduction on the Y-BOCS ) remained stable at follow-up ( 45 % ) . Responder rates , defined as > or = 35 % reduction on the Y-BOCS , were 67 % and 60 % , respectively . Depressive symptoms decreased significantly not only from pre- to post-treatment but also during follow-up . Re-hospitalization , which occurred in 11 patients ( 37 % ) , was associated with more severe depressive symptoms at pre-treatment and living without a partner . Full symptom remission at follow-up , defined as both Y-BOCS total score < or = 7 and no longer meeting diagnostic criteria for OCD , was achieved by 8 patients ( 27 % ) . Patients without full remission at follow-up had a significantly longer history of OCD , assessed at pretreatment , compared to remitted patients . The shortterm treatment outcome had no predictive value for the long-term course . Throughout the naturalistic follow-up , nearly all patients ( 29 patients ) received additional  psychotherapy  and /or medication . This might indicate that such chronic OCD patients usually need additional therapeutic support after effective inpatient treatment to maintain their improvements over long periods Background : Until now no studies have investigated the benefits of adding brief dynamic therapy ( BDT ) to medication in obsessive-compulsive disorder ( OCD ) , while a number of recent investigations have demonstrated the efficacy of supplemental BDT among patients with major depressive disorders ( MDD ) . The objective of the present study was to explore the efficacy of BDT combined with pharmacotherapy in comparison with pharmacotherapy alone in the treatment of OCD with concurrent MDD . Methods : A 12-month r and omized clinical trial compared a st and ard selective serotonin reuptake inhibitor treatment with ( n = 27 ) or without  ( n = 30 ) supplemental BDT in patients with OCD and concurrent MDD .  Supplemental BDT was added during the first 16-week trial ; all patients continued to be treated with only pharmacotherapy in the following continuation phase . The primary efficacy assessment s were the Yale-Brown Obsessive Compulsive Scale and the 17-item Hamilton Rating Scale for Depression ; the secondary efficacy measures included the Clinical Global Impression scale and the Global Assessment of Functioning . The data analysis was conducted on the ‘ intent-to-treat ( ITT ) efficacy patient sample ’ . Results : Fifty patients completed the study . No difference between the 2 treatment groups was found at any point by any assessment method in the ITT study sample . Conclusions : Supplemental BDT in the treatment of patients with OCD with concurrent MDD who are receiving effective medication has no significant clinical effect on both obsessive and depressive symptoms Sixty substance abusers dually diagnosed with obsessive-compulsive disorder ( OCD ) and voluntarily admitted to a drug-free therapeutic community were r and omly assigned to one of three treatment conditions . One group received a combined intervention that addressed their obsessive-compulsive symptoms and substance abuse ; a second group received only substance abuse treatment ; and an attention control group received treatment for their substance abuse and training in progressive muscle relaxation . Patients who received treatment for their OCD and substance abuse stayed in treatment longer , showed greater reductions in OCD symptom severity , and had higher overall abstinence rates at 12-month follow-up Background Obsessive-Compulsive Disorder ( OCD ) is a common chronic psychiatric disorder that constitutes a leading cause of disability . Although Cognitive-Behaviour Therapy ( CBT ) has been shown to be an effective treatment for OCD , this specialised treatment is unavailable to many due to access issues and the social stigma associated with seeing a mental health specialist . Internet-based psychological treatments have shown to provide effective , accessible and affordable treatment for a range of anxiety disorders , and two R and omised Controlled Trials ( RCTs ) have demonstrated the efficacy and acceptability of internet-based CBT ( iCBT ) for OCD , as compared to waitlist or supportive therapy . Although these initial findings are promising , they do not isolate the specific effect of iCBT . This paper details the study protocol for the first r and omised control trial evaluating the efficacy of therapist-assisted iCBT for OCD , as compared to a matched control intervention ; internet-based therapist-assisted progressive relaxation training ( iPRT ) . It will aim to examine whether therapist-assisted iCBT is an acceptable and efficacious treatment , and to examine how effectiveness is influenced by patient characteristics . Method / design A r and omised controlled trial using repeated measures with two arms ( intervention and matched control ) will be used to evaluate the efficacy and acceptability of iCBT for OCD . The RCT will r and omise 212 Australian adults with a primary diagnosis of OCD into either the active intervention or control condition , for 12 weeks duration . Outcomes for participants in both study arms will be assessed at baseline and post-intervention . Participants in iCBT will be further assessed at six month follow-up , while participants in the control condition will be crossed over to receive the iCBT intervention and reassessed at post-intervention and six month follow-up . The primary outcome will be clinical ly significant change in obsessive-compulsive symptom scores . Discussion This will be the first known therapist assisted internet-based trial of a comprehensive CBT treatment for OCD as compared to a matched control intervention . Demonstrating the efficacy of an internet-based treatment for OCD will allow the development of models of care for broad-based access to an evidence -based but complex treatment This work aims is to evaluate the therapeutic efficacy of cognitive behavior therapy ( CBT ) in pediatric patients with obsessive-compulsive disorder ( OCD ) who had not previously been treated with either pharmacotherapy or psychotherapy and who remained medication-free during CBT . Sixteen OCD out patients , 8 - 17 years of age , were treated in a 12-week open trial with manualized CBT . Target symptoms were rated at two-week intervals with the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , the National Institute of Mental Health Global Obsessive-Compulsive Scale ( NIMH Global ) , the Clinical Global Impression Scale ( CGI ) , and the Hamilton Anxiety Rating Scale ( Ham-A ) . Statistical analyses showed a significant benefit for treatment . Ten patients experienced at least a 50 % reduction in symptoms on the CY-BOCS ; seven were asymptomatic on the NIMH Global . These results build on previous reports that CBT may be effective in the acute treatment of pediatric OCD . Further , the results of this study suggest that CBT can be efficacious in alleviating OCD symptoms in the absence of pharmacotherapy . These results must be considered preliminary , given the small sample size and open administration of treatment BACKGROUND Although a large body of evidence indicates the efficacy of pharmacotherapy in the treatment of obsessive-compulsive disorder ( OCD ) , a considerable percentage of these patients do not respond . Very few studies focus on factors related to treatment response of OCD . The purpose of this study was to investigate which clinical factors are related to drug treatment response in OCD . METHOD We examined 53 OCD patients treated with either clomipramine or fluoxetine for a period of 6 months , dividing the sample into " responders " and " nonresponders " to treatment . At admission , patients were evaluated using a semistructured clinical interview , the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) , the Hamilton Rating Scale for Depression , and the Hamilton Rating Scale for Anxiety . We then compared acute-phase patient characteristics and response to drug treatment . Response was defined as a decrease of at least 40 % in the Y-BOCS total score and a rating of " improved " or " very improved " on the Clinical Global Impressions scale within 16 weeks of treatment and maintained over three consecutive evaluations . RESULTS By the sixth month of treatment , 31 patients ( 58.5 % ) responded to either clomipramine or fluoxetine . Nonresponders had lower age at onset and longer duration of the disorder ; in addition , they showed higher frequency of compulsions , washing rituals , chronic course , concomitant schizotypal personality disorder , and previous hospitalizations . A worse response to drug treatment was predicted in a stepwise multiple regression by ( 1 ) concomitant schizotypal personality disorder , ( 2 ) presence of compulsions , and ( 3 ) longer illness length . CONCLUSION Our findings suggest that there are distinct types of OCD with respect to drug treatment response . They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities , which may be of value in the selection of patients for alternative treatments Rigorously design ed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder ( OCD ) but not in patients below 18 years old . This report describes a r and omized , double-blind , placebo-controlled , fixed-dose ( 20 mg qd ) trial of fluoxetine in 14 children and adolescents with OCD , ages 8 to 15 years old ; the study was 20 weeks long with crossover at 8 weeks . Obsessive-compulsive symptom severity was measured on the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Clinician 's Global Impression-Obsessive Compulsive Disorder scale ( CGI-OCD ) . The CY-BOCS total score decreased 44 % ( N = 7 , p = .003 ) after the initial 8 weeks of fluoxetine treatment , compared with a 27 % decrease ( N = 6 , p = .13 ) after placebo . During the initial 8 weeks , the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD ( p = .01 ) but not by the CY-BOCS ( p = .17 ) . The most common drug side effects were generally well tolerated . The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD BACKGROUND To examine the efficacy of sequential sertraline and cognitive-behavioral therapy ( CBT ) treatment relative to CBT with pill placebo over 18 weeks in children and adolescents with obsessive-compulsive disorder ( OCD ) . METHODS Forty-seven children and adolescents with OCD ( Range = 7 - 17 years ) were r and omized to 18-weeks of treatment in one of three arms : 1 ) sertraline at st and ard dosing + CBT ( RegSert + CBT ) ; 2 ) sertraline titrated slowly but achieving at least 8 weeks on the maximally tolerated daily dose + CBT ( SloSert + CBT ) ; or 3 ) pill placebo + CBT ( PBO + CBT ) . Assessment s were conducted at screening , baseline , weeks 1 - 9 , 13 , and 17 , and post-treatment . Raters and clinicians were blinded to sertraline ( but not CBT ) r and omization status . Primary outcomes included the Children 's Yale-Brown Obsessive-Compulsive Scale , and response and remission status . Secondary outcomes included the Child Obsessive Compulsive Impact Scale-Parent/Child , Children 's Depression Rating Scale-Revised , Multidimensional Anxiety Scale for Children , and Clinical -Global Impressions-Severity . RESULTS All groups exhibited large within-group effects across outcomes . There was no group by time interaction across all outcomes suggesting that group changes over time were comparable . CONCLUSIONS Among youth with OCD , there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with CBT . CLINICAL TRIALSGOV IDENTIFIER NCT00382291 The augmentation of serotonin reuptake inhibitors ( SRIs ) with atypical antipsychotics for the management of  treatment-resistant obsessive-compulsive disorder ( OCD ) is gaining increasing acceptance . Quetiapine is a novel antipsychotic which is well tolerated , and which may therefore be particularly useful in this context . Charts of all patients treated in our OCD clinic with the combination of an SRI and quetiapine  were review ed . Demographic details and clinical symptoms on the Yale-Brown Obsessive-Compulsive Scale and the Clinical Global Impressions Scale ( CGI ) were tabulated before and after augmentation . Eight OCD patients who had proven resistance to treatment with SRIs  had received quetiapine augmentation . Four of these eight patients were responders ( CGI of 1 or 2 ) within 4 weeks . In the treatment-responders , the medication was well tolerated . Although limited by the retrospective design and lack of controls , these data are consistent with the growing literature suggesting that approximately one-half of OCD patients resistant to treatment with SRIs  may respond to augmentation with an atypical antipsychotic . Quetiapine , a relatively well tolerated agent , deserves further controlled study in this context The effects of clomipramine hydrochloride ( CMI ) versus placebo upon DSM-III-defined obsessive-compulsive disorder ( OCD ) were assessed in a 10-week double-blind multicenter trial and in a corresponding 1-year double-blind extension study . The NIMH global O-C scale , a 15-point ordinal severity scale , incorporating categorical features specific to OCD , was used to evaluate the severity of obsessive compulsive symptoms over the course of treatment , and a physician 's rating of global therapeutic effect was used to assess overall change from baseline . In the core study , patients receiving placebo demonstrated minor and non systematic changes , whereas patients who received CMI had clinical ly and statistically significant reductions in the global severity of their disorder . Findings from the extension study were consistent with continuing efficacy for CMI , whereas corresponding data for patients receiving long-term placebo were difficult to interpret . Based upon shifts in categorical severity , symptoms for over half those patients who received CMI were rendered sub clinical or within a range of normal functioning . In contast , less than 5 % of patients receiving placebo had their symptoms reduced to a sub clinical level . Generally , both treatments were well tolerated . Previous studies have indicated therapeutic potential for CMI  in obsessive compulsive disorder . These findings confirm and extend previous observations BACKGROUND Current pharmacological treatments for Tourette Syndrome ( TS ) , such as antipsychotic agents and α-2 agonists , are moderately effective in the treatment of tics , but have substantial side effects that limit their use . N-acetylcysteine ( NAC ) modulates glutamatergic systems , and has been used safely as an antioxidant agent with minimal side effects for decades . NAC has been increasingly studied for the treatment of other obsessive-compulsive spectrum disorders . We aim to examine the efficacy of NAC for the treatment of pediatric TS in a double-blind , placebo-controlled , add-on study . METHODS Thirty-one children and adolescents 8 - 17 years of age with TS were r and omly assigned to receive NAC or matching placebo for 12 weeks . Our primary outcome was change in severity of tics as measured by the Yale Global Tic Severity Scale ( YGTSS ) , Total tic score . Secondary measures assessed comorbid obsessive-compulsive disorder ( OCD ) , depression , anxiety , and attention-deficit/hyperactivity disorder ( ADHD ) . Linear mixed models in SAS were used to examine differences between NAC and placebo . RESULTS Of 31 r and omized subjects , 14 were assigned to placebo ( two females ; 11.5 + 2.8 years ) and 17 to active NAC ( five females ; 12.4 + 1.4 years ) treatment . No significant difference between NAC and placebo was found in reducing tic severity or any secondary outcomes . CONCLUSIONS We found no evidence for efficacy of NAC in treating tic symptoms . Our findings st and in contrast to studies suggesting benefits of NAC in the treatment of other obsessive-compulsive spectrum disorders in adults , including OCD and trichotillomania , but are similar to a recent placebo-controlled trial of pediatric trichotillomania that found no benefit of NAC Objective : To examine the relationship between remission of psychiatric disorders  and age . Methods : We interviewed 3258 r and omly selected adult residents of Edmonton using the Diagnostic Interview Schedule ( DIS ) , which yielded DIS/DSM-III diagnoses . Remission was defined as being free of symptoms of the index lifetime disorder in the year preceding the interview , this being the difference between the lifetime and one-year prevalence . For each age group , the proportion of cases with and without symptoms in the preceding year was calculated . Numbers and proportions of cases were estimated after adjusting to the census population and weighting for household size . Only the more common disorders were examined ; any comorbidities were ignored . Results : Drug abuse or dependence , antisocial personality disorder ( in both sexes ) , and alcohol abuse or dependence ( in men ) all showed remission rates that increased with age . Panic disorder and obsessive – compulsive disorder ( OCD ) showed a decreased likelihood of remission with increasing age . Major depression and phobias showed little tendency to remission with age . Considering all disorders together , the one-year remission rate for all ages combined was only 33.2 % , with a tendency for lower remission rates to be found in those aged 55 to 64 . Conclusions : As may be expected , antisocial personality , drug abuse or dependence , and alcohol abuse or dependence tend to show increased remission rates with increasing age . In OCD and panic disorder , the low rates of remission found in all age groups indicate that these disorders produce significant long-term morbidity . For depression , which had an overall remission rate of less than 50 % , the stable low rate of remission probably indicates not only the difficulties of treatment but also the low rates at which cases get treated Abstract Objective . Anxiety disorders are frequently under-diagnosed conditions in primary care , although they can be managed effectively by general practitioners . Methods . This paper is a short and practical summary of the World Federation of Biological Psychiatry ( WFSBP ) guidelines for the pharmacological treatment of anxiety disorders , obsessive – compulsive disorder ( OCD ) and posttraumatic stress disorder ( PTSD ) for the treatment in primary care . The recommendations were developed by a task force of 30 international experts in the field and are based on r and omized controlled studies . Results . First-line pharmacological treatments for these disorders are  selective serotonin reuptake inhibitors  ( for all disorders ) ,  serotonin-norepinephrine reuptake inhibitors  ( for some ) and  pregabalin  ( for generalized anxiety disorder only ) . A combination of  medication and cognitive behavior/exposure therapy  was shown to be a clinical ly desired treatment strategy . Conclusions . This short version of an evidence -based guideline may improve treatment of anxiety disorders , OCD , and PTSD in primary care OBJECTIVE To examine whether  adverse perinatal experiences of  children  are associated with obsessive compulsive disorder ( OCD ) in youth . METHODS Subjects were 130 children and adolescents with OCD recruited from a family genetic study of pediatric OCD and 49 matched controls from a contemporaneous family case-control study of attention-deficit/hyperactivity disorder ( ADHD ) . Subjects were comprehensively assessed in multiple domains of function . A systematic history of pregnancy , delivery , and infancy complications was obtained . RESULTS Compared to normal controls , children with OCD had mothers with significantly higher rates of illness during pregnancy requiring medical care ( chi(2 ) + /- 8.61 , p + /- 0.003 ) and more birth difficulties ( induced labor , forceps delivery , nuchal cord , or prolonged labor ) ( chi(2 ) + /- 7.51 , p + /- 0.006 ) . Among the OCD-affected children , we found several significant associations between adverse perinatal experiences and earlier age at onset , increased OCD severity , and increased risk for comorbid ADHD , chronic tic disorder , anxiety disorder , and major depressive disorder . CONCLUSION Although exploratory , our analyses found that children with OCD had higher rates of several adverse perinatal experiences compared with controls . Among OCD-affected children , comorbid psychopathology was predicted by specific perinatal risk factors . Prospect i ve studies of perinatal adverse events that minimize potential recall bias and type I errors are needed OBJECTIVE To evaluate the relative efficacy of ( 1 ) individual cognitive-behavioral family-based therapy ( CBFT ) ; ( 2 ) group CBFT ; and ( 3 ) a waitlist control group in the treatment of childhood obsessive-compulsive disorder ( OCD ) . METHOD This study , conducted at a university clinic in Brisbane , Australia , involved 77 children and adolescents with OCD who were r and omized to individual CBFT , group CBFT , or a 4- to 6-week waitlist control condition .  Children were assessed before and after treatment and at 3 months and 6 months following the completion of treatment using diagnostic interviews , symptom severity interviews , and self-report measures . Parental distress , family functioning , sibling distress , and levels of accommodation to OCD dem and s were also assessed . Active treatment involved a manualized 14-week cognitive-behavioral protocol , with parental and sibling components . RESULTS By an evaluable patient analysis , statistically and clinical ly significant pretreatment-to-posttreatment change occurred in OCD diagnostic status and severity across both individual and group CBFT , with no significant differences in improvement ratings between these conditions . There were no significant changes across measures for the waitlist condition . Treatment gains were maintained up to 6 months of follow-up . CONCLUSIONS Contrary to previous findings and expectations , group CBFT is as effective in reducing OCD symptoms for children and adolescents as individual treatment . Findings support the efficacy and durability of CBFT in treating childhood OCD The aim of the current study was to test the effectiveness of ERP-based 12 weeks group therapy for OCD patients in a community-based , general Norwegian outpatient clinic . The sample consisted of 54 patients diagnosed with OCD . The Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) , the Beck Depression Inventory ( BDI ) and the Spielberger State Anxiety Inventory ( STAI-S ) were administered before treatment , after treatment and at 3- and 12-month follow-ups . Analyses with mixed models for repeated measurements showed that group behavioural therapy offered to OCD patients significantly improved ratings of obsessive-compulsive symptoms , depression and anxiety . These improvements were maintained at 3- and 12-month follow-ups and an additional reduction in obsessive-compulsive symptoms was observed from post-treatment to 3-month follow-up . However , the delayed effect of therapy was no longer present at 12-month follow-up . The results also revealed that the patients had a lower chance for an increased outcome category ( e.g. from unchanged to improved or recovered ) with high scores on STAI-S at the given observation times ( post-treatment , 3- and 12-months follow-ups ) . Depressive symptoms ( BDI ) at post-treatment and follow-ups had no significant influences on the three categories of outcome for OCD . In conclusion , the results indicate that behavioural group therapy can successfully be delivered to patients with considerable comorbidity in a real world setting conducted by therapists with limited training in the CBT The purpose of this study was to evaluate the comparative efficacy and tolerability of sertraline and fluoxetine in the treatment of obsessivecompulsive disorder ( OCD ) . Out patients meeting DSM-IV criteria for OCD , with a Yale-Brown Obsessive-Compulsive ( Y-BOCS ) total score ≥ 17 , an NIMH Global Obsessive-Compulsive ( NIMH-OC ) scale score ≥ 7 , and a CGI-Severity score ≥ 4 were r and omized to 24 weeks of double-blind treatment with sertraline ( N = 77 ) or fluoxetine ( N = 73 ) . Primary efficacy measures consisted of the Y-BOCS , the NIMH-OC scale , and the CGI-Severity ( CGI-S ) and Improvement ( CGI-I ) scales . Equivalent and significant ( p < 0.001 ) improvement was found at week 24 in Y-BOCS and NIMH-OC scale scores  for sertraline and fluoxetine . After 12 weeks , 49.2 % of patients on sertraline were rated on the CGI-S scale as being mildly ill or not ill compared to 24.6 % on fluoxetine ( p < 0.01 ) . A Cox analysis found patients on sertraline to have a statistically nonsignificant 42 % greater likelihood of achieving a response by week 12 ( CGI-I , much or very much improved ; 95 % CI , 0.85 , 2.38;p = 0.18 ) . Sertraline treatment also result ed in a higher proportion of remissions  than fluoxetine ( defined as a CGI-I ≤ 2 and a Y-BOCS score ≤ 11 ) , both at week 12 ( 20 % vs. 8 % ; χ2 , 3.95;df 1;p = 0.047 ) and week 24 ( 36 % vs. 22 % ; χ2 , 3.18;df , 1;p = 0.075 ) . Both medications were welltolerated and demonstrated significant efficacy in the treatment of out patients with moderate to severe OCD with the subjects treated with sertraline showing a greater likelihood of remission as well as an earlier improvement on some but not all efficacy OBJECTIVE This pilot study explored the efficacy and tolerability of paliperidone augmentation of serotonin reuptake inhibitors ( SRIs ) in adults with treatment-resistant obsessive-compulsive disorder ( OCD ) . METHOD Thirty-four patients aged 24 - 67 years ( mean = 43.7 years , SD = 11.4 ) who met DSM-IV criteria for OCD and remained symptomatic following 2 or more past adequate SRI trials ( including their current medication ) were enrolled from May 2008 to March 2012 . Participants were treated for 8 weeks in a double-blind study with either paliperidone ( up to 9 mg/d ) or matching placebo in addition to their SRI . Blinded raters conducted outcome assessment s. The primary outcome , obsessive-compulsive symptom severity , was assessed using the Yale-Brown Obsessive Compulsive Scale ( YBOCS ) . Secondary outcomes included the Clinical Global Impressions-Severity of Illness and -Improvement scales . RESULTS Paliperidone administration result ed in significant baseline-to-posttreatment reductions in obsessive-compulsive symptoms as measured by the YBOCS ( P < .01 , d = 0.66 ) , although placebo administration also result ed in medium-sized , trend-level significant YBOCS changes ( P = .05 , d = 0.53 ) . In exploratory analyses examining between-group differences , tests for paliperidone superiority relative to placebo were not significant ( P = .14 , d = 0.34 ) ; however , a numerical trend toward significant between-group differences was found , with a reduction of 7.98 points on the YBOCS for the paliperidone group compared to a reduction of 4.02 points for the placebo group . Paliperidone was generally well tolerated and not associated with significant weight gain ( mean [ SD ] weight : paliperidone , pretreatment 84.70 [ 27.08 ] kg , posttreatment 84.84 [ 18.99 ] kg ; vs placebo , pretreatment 77.50 [ 25.33 ] kg , posttreatment 77.43 [ 19.90 ] kg ; P = .21 ) . CONCLUSIONS These results suggest that paliperidone augmentation is well tolerated and has potential efficacy in the short-term treatment of some patients with SRI-resistant OCD . Well-powered , r and omized , controlled studies are necessary to more definitively address the efficacy of this treatment strategy . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00632229 Anorexia nervosa ( AN ) and obsessive-compulsive disorder ( OCD ) are highly comorbid , and appear to share a common neurophysiological dysfunction that contributes to the obsessional thoughts and compulsive behaviours seen in both disorders . Obsessive-compulsive personality ( OCP ) traits are also important risk factors for AN . Since excessive exercise has also been associated with greater obsessionality , we hypothesised that AN patients with a hyperactive behavioural profile represent a phenotype more closely linked to OCD than their non-exercising counterparts . We examined prospect ively 50 female AN-Restrictor patients whom we classified as " excessive " or " non-excessive " based on their exercise status i ) at admission and ii ) over the lifetime of their illness . Vali date d measures of OCD symptoms and OCP traits were obtained at admission and after refeeding at discharge . On both classification methods , excessive exercisers had greater OCD symptoms and OCP traits than the non-excessive group , but did not differ on body mass index . OCD symptoms , but not OCP traits , decreased between admission and discharge . Findings support our prediction that AN patients with excessive physical activity constitute a subtype of the disorder with strong links to OCD . Indeed , this phenotype may be a culture-bound variant of OCD In this report , which is an up date of a guideline published in 2002 ( B and elow et al. 2002 , World J Biol Psychiatry 3:171 ) , recommendations for the pharmacological treatment of anxiety disorder , obsessive-compulsive disorder ( OCD ) and post-traumatic stress disorder ( PTSD ) are presented . Since the publication of the first version of this guideline , a substantial number of new r and omized controlled studies of anxiolytics have been published . In particular , more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs . The recommendations , developed by the World Federation of Societies of Biological Psychiatry ( WFSBP ) Task Force for the Pharmacological Treatment of Anxiety , Obsessive-Compulsive and Post-traumatic Stress Disorders , a consensus panel of 30 international experts , are now based on 510 published r and omized , placebo- or comparator-controlled clinical studies ( RCTs ) and 130 open studies and case reports . First-line treatments for these disorders are selective serotonin reuptake inhibitors ( SSRIs ) , serotonin-noradrenaline reuptake inhibitors ( SNRIs ) and the calcium channel modulator pregabalin . Tricyclic antidepressants ( TCAs ) are equally effective for some disorders , but many are less well tolerated than the SSRIs/SNRIs . In treatment-resistant cases , benzodiazepines may be used when the patient does not have a history of substance abuse disorders . Potential treatment options for patients unresponsive to st and ard treatments are described in this overview . Although these guidelines focus on medications , non-pharmacological were also considered . Cognitive behavioural therapy ( CBT ) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders , OCD , and PTSD to support them being recommended either alone or in combination with the above medicines
CONCLUSIONS The effects of treatment with clomipramine and selective serotonin reuptake inhibitors ( SSRIs : fluvoxamine , sertraline , fluoxetine , citalopram , and escitalopram ) proved to be similar , except for the lower adherence rate in case of clomipramine because of its side effects .
PURPOSE This systematic review examines the efficacy of pharmacological therapy for obsessive-compulsive disorder ( OCD ) , addressing two major issues : which treatment is most effective in treating the patient 's symptoms and which is beneficial for maintaining remission .