DBS and the Treatment of Obsessive Compulsive Disorder (original) (raw)
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A Synergistic Treatment Strategy for Severe Obsessive Compulsive Disorder
Neuromodulation: Technology at the Neural Interface, 2016
Deep brain stimulation (DBS) revolutionized the treatment of movement disorders such as Parkinson's disease and is emerging into a promising tool as therapy for psychiatric disorders. Although DBS has been approved by the Food and Drug Administration (FDA) and the European authorities for treatment-resistant obsessive-compulsive disorder (OCD) for more than 4 years, its application still is controversial (1) and regarded with suspicion. National as well as international guidelines for OCD are rather reluctant to implement DBS, which is, if at all, recommended in the context of controlled clinical trials only (2). Indeed, scientific studies, including larger sample sizes, are definitely needed to tackle the still unsolved questions of response prediction or to determine the mechanisms of action underlying the therapeutic effects of DBS. Yet, large effect sizes (3) and meta-analytical results (4,5) underline that DBS constitutes a valid option for a subgroup of severely affected and treatment-resistant OCDpatients. Therefore, we advocate the extended integration of DBS into the overall therapeutic concept and propose a sequential approach based on the neurobiological underpinnings of OCD. OCD is amongst the most common and disabling mental disorders worldwide (6). It is characterized by recurrent and intrusive thoughts and/or repetitive behaviors that are time consuming, cause remarkable distress and often are perceived as inappropriate by the patient who, most often unsuccessfully tries to resist (7). International guidelines agree on cognitive behavioral therapy (CBT) being the first line treatment for OCD (2), thereby focusing on the exposure to anxiety-inducing situations while at the same time preventing the engagement in fear relieving compulsions (8). In more severe cases, or for patients suffering predominantly from obsessions or comorbid depressive symptoms, CBT should be combined with pharmacological interventions. The efficacy of serotonin reuptake inhibitors (SSRI) and clomipramine is well established in the treatment of OCD. SSRIs usually show a higher tolerability and are therefore given priority. If treatment response is unsatisfactory an augmentation with atypical antipsychotics or dual medications as venlafaxine should be considered (9). These therapeutic strategies are based on different concepts of the pathogenesis of OCD. Even though studies have shown, that CBT also influences the neurobiological substrate of OCD (10,11), it primarily addresses the psychological aspects via behavioral alterations and deconditioning, whereas pharmacotherapy aims to modulate neurobiological or neurochemical aspects of OCD in the first place. These different approaches are not contradictory but complementary. Typically OCD manifests in the second or third decade of life and often takes a chronic persistent course. Particularly early
Review Article: An Overview of Symptoms and Treatments of Obsessivecompulsive Disorder (OCD
2024
Context: The investigation of obsessive-compulsive disorder (OCD) is paramount in comprehending the fundamental causes, symptoms, and potential therapeutic approaches for this incapacitating psychological condition. OCD is characterized by intrusive thoughts or obsessions, as well as repetitive behaviors or compulsions, which hinder daily functioning and may impact sleep patterns. Understanding the underlying mechanisms of OCD can aid healthcare professionals in devising more efficacious treatment modalities and interventions for individuals afflicted by this disorder. Research on this mental illness can also help diminish the stigma surrounding mental health disorders and promote awareness regarding the importance of seeking assistance for those grappling with OCD. Additionally, research on OCD is imperative for advancing our understanding of the brain and mental health in a broader sense. Such investigations could yield groundbreaking discoveries that might ultimately enhance the overall quality of life for individuals suffering from OCD and other related mental health issues. Evidence Acquisition: Treatment with Selective Serotonin Reuptake Inhibitors (SSRIs) or cognitive-behavioral therapy (CBT), alone or in a combined approach, are considered to be the most effective methods for treating OCD. In addition, Neurofeedback has also represented promise as a treatment for OCD. The difficulties that people with OCD encounter on a daily basis, including the effects on their relationships, career, and emotional well-being, will be covered in this article. Results: Therefore, in this review, we intend to discuss most popular and efficient OCD treatments, including CBT, SSRIs, and neurofeedback. The pros and cons of these treatments will be covered. Conclusion: Despite extensive studies, the use of neuroimaging and electroencephalogram (EEG) comparisons in understanding and treating OCD is not well investigated. EEG studies have yielded promising results in identifying neural patterns associated with OCD and determining the efficacy of different treatment approaches.
Psychopharmacological treatment of Obsessive-Compulsive Disorder (OCD)
Current neuropharmacology, 2018
Obsessive-compulsive disorder (OCD) is associated with affective and cognitive symptoms causing personal distress and reduced global functioning. These have considerable societal costs due to healthcare service utilization. Our aim was to assess the efficacy of pharmacological interventions in OCD and clinical guidelines, providing a comprehensive overview of this field. We searched the PubMed database for papers dealing with drug treatment of OCD, with a specific focus on clinical guidelines, treatments with antidepressants, antipsychotics, mood stabilizers, off-label medications, and pharmacogenomics. Prolonged administration of selective serotonin reuptake inhibitors (SSRIs) is most effective. Better results can be obtained with a SSRI combined with cognitive behavioral therapy (CBT) or the similarly oriented exposure and response prevention (ERP). Refractory OCD could be treated with different strategies, including a switch to another SSRI or clomipramine, or augmentation with a...
Treatment for Obsessive Compulsive Disorder
Current Psychiatry Reviews, 2010
Obsessive-compulsive disorder (OCD), a common complex psychiatric illness with a 2% lifetime prevalence rate is highlighted by World Health Organization (WHO) as one of the top 5 disabling illnesses in the world. Its treatment was the focus of formal guidance from National Institute for Clinical Excellence (NICE) in 2005. Despite the increased focus on treatment of OCD, it is an area that is often misunderstood and undertreated. It is particularly tragic as OCD is surprisingly easy to treat and amenable to both psychological and psychopharmacological treatment. This review examines the important changes that have taken place in the psychological and psychopharmacological treatments for OCD in recent years. How these treatments may be delivered using the framework of NICE guidance will also be discussed. Finally the review will examine current experimental treatments and possible future developments in the management of patients.
Journal of psychopharmacology (Oxford, England), 2014
It is unknown what next-step strategies are being used in clinical practice for patients with obsessive-compulsive disorder (OCD) who do not respond to first-line treatment. As part of a cross-sectional study of OCD, treatment and symptom information was collected. Method: Consecutive OCD out-patients in nine international centers were evaluated by self-report measures and clinical/structured interviews. OCD symptom severity was evaluated by the Yale Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impression-Severity Scale (CGI-S). Clinical response to current treatment was evaluated by the CGI-Improvement Scale (CGI-I ≤ 2). Results: In total, 361 participants reported taking medication; 77.6% were taking a selective serotonin reuptake inhibitor; 50% reported use of at least one augmentation strategy. Antipsychotics were most often prescribed as augmenters (30.3%), followed by benzodiazepines (24.9%) and antidepressants (21.9%). No differences in OCD symptom severity were found between patients taking different classes of augmentation agents. Conclusions: Results from this international cross-sectional study indicate that current OCD treatment is in line with evidence-based treatment guidelines. Although augmentation strategies are widely used, no significant differences in OCD symptom severity were found between monotherapy and augmentation or between different therapeutic agents.
Cureus
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder widely recognized for its recurrent obsessions and compulsions, which may cause severe impairment worldwide. This review explores the difficulties in diagnosing OCD, its comorbidities, and its treatment approaches. Psychiatry and neuroscience face noteworthy obstacles in treating OCD, which is frequently misdiagnosed and inadequately addressed. This illness, which causes upsetting symptoms that interfere with day-today living, affects not only adults but also children and adolescents to a great extent. Despite the availability of multiple therapy methods, such as pharmacological and psychological approaches, many patients exhibit resistance, emphasizing the necessity for alternative therapies. OCD and other psychiatric conditions like bipolar disorder, schizophrenia, and attention deficit hyperactivity disorder substantially overlap, highlighting the complexity of mental health diagnoses. Furthermore, its comorbidity with these diseases further highlights OCD's intricacy. Several therapy considerations have been mentioned, such as using larger dosages of medications and combining different therapeutic approaches. Their association suggests possible common pathogenic pathways between OCD and other psychiatric illnesses. The review concludes that, given the significant number of people who still struggle with chronic symptoms, new treatment techniques and ongoing research are necessary, even in the face of improvements in the understanding and treatment of OCD.
Management of obsessive-compulsive disorder
F1000prime reports, 2014
Obsessive-compulsive disorder (OCD) is a common, often debilitating disorder characterized by the presence of obsessions and compulsions. Obsessions are repetitive thoughts or images which are experienced as intrusive and unwanted; they cause marked anxiety and distress. Compulsions (also known as rituals) are repetitive behaviors or mental acts that individuals with OCD perform in an attempt to decrease their anxiety. Patients tend to hide their symptoms due to shame; the amount of time between onset of symptoms and appropriate treatment is often many years. The disorder likely results from several etiological variables; functional imaging studies have consistently shown hyperactivity in the orbitofrontal cortex, anterior cingulate, thalamus, and striatum. The mainstays of treatment include cognitive-behavioral therapy in the form of exposure and response prevention (ERP) and serotonin reuptake inhibiting medications. Several pharmacological augmentation strategies exist for treatm...