Obsessive Compulsive Disorder Current Science and Clinical Practice

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ISBN: 9780470711255 | 0470711256
Cover: Hardcover
Copyright: 8/13/2012

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A clear summary of what is known about a highly prevalent and debilitating disorder that affects nearly as many people as does asthma. Expert authors review the biological basis for the disorder and describe both pharmacological and psychological approaches to treatment.

List of Contributors	p. xii
Introduction	p. xvii
Assessment and Treatment
Assessment	p. 3
Introduction	p. 3
Detecting OCD	p. 5
Screening in clinical interview	p. 7
Structured interviews	p. 8
Clinical assessment of obsessive-compulsive symptoms	p. 9
Yale-brown obsessive-compulsive scale	p. 10
Dimensional yale-brown obsessive-compulsive scale (DY-BOCS)	p. 11
Leyton obsessional inventory (LOI)	p. 12
Maudsley obsessional-compulsive inventory (MOCI)	p. 13
Padua inventory (PI)	p. 13
Obsessive compulsive inventory (OCI)	p. 14
Insight	p. 14
Rating insight	p. 15
Assessment of the risk of suicide	p. 17
Differential diagnosis, comorbidities and related disorders	p. 18
Organic brain disorders	p. 19
Schizophrenia	p. 20
Depression	p. 20
Hypochondriasis	p. 20
Phobias	p. 21
Tourette disorder and tic disorders	p. 21
Obsessive-compulsive personality disorder (OCPD)	p. 21
Body dysmorphic disorder (BDD)	p. 21
Hoarding	p. 22
Other disorders	p. 22
Conclusions	p. 22
References	p. 23
Pharmacotherapy of obsessive-compulsive disorder	p. 31
Introduction	p. 31
Placebo-controlled studies of clomipramine	p. 32
Placebo-controlled studies of fluvoxarnine	p. 32
Placebo-controlled studies of fluoxetine	p. 33
Placebo-controlled studies of paroxetine	p. 34
Placebo-controlled studies of sertraline	p. 34
Placebo-controlled studies of citalopram/escitalopram	p. 34
Placebo-controlled studies of venlafaxine	p. 35
Improving early response in OCD	p. 35
Special populations: children	p. 36
Clomipramine	p. 36
Fluvoxamine	p. 36
Fluoxetine	p. 36
Paroxetine	p. 37
Sertraline	p. 37
Citalopram	p. 38
Meta-analyses	p. 38
Tolerability of clomipramine and serotonin reuptake inhibitors	p. 40
Optimal dose of treatment	p. 41
Duration of treatment	p. 42
Refractory OCD	p. 43
Increased dose of SSRI	p. 43
Augmentation of SSRI treatment with antipsychotics	p. 44
Other drugs	p. 45
Alternative modes of administration of SSRIs	p. 46
Combining SRIs	p. 46
Switching SSRIs	p. 46
Adding psychotherapy	p. 47
Future therapeutic options	p. 47
Conclusion	p. 48
References	p. 48
Cognitive behavioural therapy in obsessive-compulsive disorder: state of the art	p. 58
Theoretical models	p. 58
Treatment	p. 60
Exposure plus response prevention (ERP)	p. 60
Cognitive therapies	p. 63
ERP plus medication	p. 63
OCD protocols	p. 64
Assessment	p. 64
Adult ERP protocol	p. 65
Paediatric ERP protocol	p. 67
Dissemination	p. 67
Future research	p. 69
Summary	p. 69
References	p. 70
Electroconvulsive therapy, transcranial magnetic stimulation and deep brain stimulation in OCD	p. 75
Introduction	p. 75
Electroconvulsive therapy	p. 75
Transcranial magnetic stimulation	p. 76
Mechanism of action	p. 77
Efficacy of rTMS in OCD	p. 77
Side effects and safety	p. 84
Conclusion and future directions	p. 85
Lesioning	p. 85
Deep brain stimulation	p. 86-
Efficacy of DBS in OCD	p. 86
Mechanism of action of DBS in OCD	p. 92
Side effects of DBS in OCD	p. 92
Follow-up treatment	p. 94
Conclusions: DBS	p. 94
Conclusion	p. 94
Acknowledgements	p. 95
References	p. 95
Approaches to treatment resistance	p. 99
Terminological problems and operational definitions	p. 100
Pharmacological strategies in resistant OCD	p. 103
Switching	p. 103
Infusion therapy	p. 104
Cognitive behavioural therapy	p. 105
Serotoninergic agents	p. 106
Dopaminergic agents	p. 108
Glutamatergic agents	p. 113
Opioids	p. 115
Physical therapies	p. 115
Electroconvulsive therapy (ECT)	p. 115
Repetitive transcranial magnetic stimulation (rTMS)	p. 116
Deep brain stimulation (DBS)	p. 116
Family intervention	p. 117
Conclusions and future perspectives	p. 117
References	p. 118
Clinical Spotlights
Subtypes and spectrum issues	p. 135
The obsessive-compulsive spectrum	p. 135
Introduction	p. 135
Cluster approach	p. 135
Compulsivity and impulsivity	p. 137
Repetitive behaviour domain	p. 138
Determining placement of proposed OCSDs using cross-cutting domains	p. 139
Obsessive-compulsive spectrum nosology	p. 144
OCD subtypes: understanding the heterogeneity of OCD	p. 148
Dimensional approach	p. 148
Associated symptom domains	p. 150
Compulsive hoarding: OCPD, OCD subtype, dimension, OCSD or something else?	p. 151
Conclusion	p. 154
References	p. 154
Paediatric OCD: developmental aspects and treatment considerations	p. 160
Introduction	p. 160
Epidemiology	p. 160
Aetiological considerations	p. 161
Genetic factors	p. 161
Non-genetic factors	p. 164
Aetiology: summary	p. 167
Clinical features	p. 167
Gender and age at onset	p. 168
Elaboration of phenotypic dimensions	p. 168
Comorbid conditions	p. 169
Neuropsychological endophenotypes	p. 170
Clinical features: summary	p. 170
Clinical assessment	p. 171
Differential diagnosis	p. 172
Normal development	p. 172
Other psychiatric disorders	p. 172
Treatment	p. 173
Pharmacotherapy	p. 174
Moderating effect of comorbid conditions	p. 175
Multimodal treatment	p. 176
Medication augmentation strategies in treatment resistance	p. 177
Safety and tolerability	p. 178
Treatment: summary	p. 178
Course and prognosis	p. 179
Conclusions and future research	p. 179
Acknowledgements	p. 180
References	p. 180
Research Spotlights
Methodological issues for clinical treatment trials in obsessive-compulsive disorder	p. 193
Introduction	p. 193
Randomized controlled trials	p. 194
The rationale of placebo	p. 196
Recruitment criteria	p. 199
Diagnosis	p. 199
OCD dimensions and subtypes	p. 200
The problem of comorbidity	p. 201
Rating scales for OCD trials	p. 203
Evaluating anxiety and depression in OCD	p. 204
Measuring response and remission	p. 205
Relapse prevention	p. 207
Treatment-resistant OCD	p. 208
Psychological treatment trials	p. 209
Integrated pharmacological and psychological treatments in OCD	p. 210
Health-related quality of life	p. 211
Summary	p. 211
References	p. 212
Serotonin and beyond: a neurotransmitter perspective of OCD	p. 220
Serotonin	p. 221
Serotonin and metabolite concentrations in OCD - 30 years later	p. 222
Pharmacological challenge tests	p. 224
Pharmacotherapy	p. 225
Animal models and the role of serotonin	p. 226
Dopamine	p. 227
Dopamine and metabolite concentrations in humans	p. 227
Pharmacological challenge tests	p. 228
Pharmacotherapy	p. 229
Animal models and the role of doparnine	p. 231
Glutamate	p. 232
The glutamatergic influence	p. 232
Glutamate and metabolite concentrations in humans	p. 232
Animal models and the role of glutamate	p. 233
Serotonin: is it the one to blame?	p. 233
The puzzle of antipsychotics and OCD: Is dopamine the answer?	p. 234
So, is it a question of location? (Or… location, location, location?)	p. 234
References	p. 235
Brain imaging	p. 244
Neuroimaging modalities	p. 244
Structural assessment	p. 244
Functional neurochemical assessment	p. 245
Structural assessment of OCD	p. 246
Total brain volume/ventricles	p. 246
Basal ganglia	p. 246
Prefrontal cortex	p. 248
Medial temporal-limbic cortex	p. 252
Pituitary	p. 253
Supramarginal gyrus	p. 253
White matter	p. 254
Functional neuroimaging studies of OCD	p. 255
Neurochemistry	p. 258
Serotonin	p. 258
N-acetyl-aspartate	p. 258
Choline	p. 259
Creatine/phosphocreatine	p. 262
Glutamate	p. 262
Conclusion	p. 266
Acknowledgements	p. 267
References	p. 268
The genetics of obsessive-compulsive disorder: current status	p. 277
Introduction	p. 277
Twin studies	p. 277
Family studies	p. 279
Family history studies	p. 280
Family interview studies	p. 280
Segregation analyses	p. 284
Candidate gene studies	p. 285
Genetic linkage studies	p. 290
Future work	p. 291
Acknowledgements	p. 292
References	p. 292
Neurocognitive angle: the search for endophenotypes	p. 300
Introduction	p. 300
Heritability of OCD	p. 301
The concept of an endophenotype	p. 302
Applying the endophenotype construct to OCD	p. 305
Domains of interest in hierarchical modelling of OCD	p. 307
Cognition	p. 307
Neuroimaging	p. 308
Searching for endophenotypes of OCD	p. 311
Cognition	p. 311
Neuroimaging	p. 313
Other potential endophenotypes	p. 316
Summary	p. 317
Acknowledgements and disclosures	p. 319
References	p. 320
Conclusion and future directions	p. 327
References	p. 329
Index	p. 331
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