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How resistant is 'treatment-resistant' obsessive-compulsive disorder in youth?

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Title: How resistant is 'treatment-resistant' obsessive-compulsive disorder in youth?
Authors: Krebs, Georgina, Isomura, Kayoko, Lang, Katie, Jassi, Amita, Heyman, Isobel, Diamond, Holly, Advani, Jana, Turner, Cynthia, Mataix‐Cols, David
Source: British Journal of Clinical Psychology. Mar2015, Vol. 54 Issue 1, p63-75. 13p. 2 Charts, 1 Graph.
Subjects: Mental health services, Cognitive therapy, Confidence intervals, Drug resistance, Interviewing, Longitudinal method, Medical care, Obsessive-compulsive disorder, Psychological tests, Questionnaires, Statistical sampling, Logistic regression analysis, Multiple regression analysis, Treatment effectiveness, Pre-tests & post-tests, Retrospective studies, Data analysis software, Descriptive statistics, Evaluation, Adolescence
Geographic Terms: United Kingdom
Abstract: Objectives Obsessive-compulsive disorder ( OCD) is often perceived as being difficult to treat. This study aimed to test the hypothesis that treatment non-response in routine clinical practice is often due to failures in the delivery of treatment, and that most patients who are apparently treatment-resistant will respond to treatment if adequately delivered. Design Retrospective cohort data analysis. Methods Forty-three young people with severe, treatment-resistant OCD (defined as Children's Yale-Brown Obsessive-Compulsive Scale [ CY- BOCS] scores ≥30 and non-response to previous cognitive behaviour therapy [ CBT] and selective serotonin reuptake inhibitors) were referred to a specialist clinic and completed a course of manualized CBT, with ( N = 21) or without ( N = 22) optimization of medication. A sub-sample ( N = 15) completed a semi-structured interview to determine characteristics of their previous CBT; quality was assessed according to pre-determined criteria. Results Specialist treatment was associated with significant reductions in OCD symptoms at post-treatment with gains maintained at 3-month follow-up. At the 3-month follow-up, 58% of patients showed a meaningful clinical response (≥35% drop on the CY- BOCS) and 22% were in remission (≤12 on the CY- BOCS). Patients whose medication was optimized tended (non-significantly) to have better responses. The quality of previous CBT was assessed in a sub-group of participants and rated as inadequate in 95.5% of cases. The most common inadequacy was insufficient focus on exposure techniques. Conclusions These findings provide support for the notion that treatment non-response in routine practice may be due to technical treatment failures and highlight the need to disseminate good quality evidence-based treatment among this population. Research is also needed to understand factors that impede outcome to further improve response and remission rates. Practitioner points Among young people with OCD, failure to respond to treatment in routine clinical practice may often reflect the nature of the treatment received., Exposure techniques may often be overlooked in CBT for OCD, potentially resulting in poor therapeutic response., Most young people with severe and apparent treatment-resistant OCD respond to outpatient CBT incorporating E/ RP., Further research is needed to establish effective methods for disseminating good quality CBT for OCD. [ABSTRACT FROM AUTHOR]
Copyright of British Journal of Clinical Psychology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: How resistant is 'treatment-resistant' obsessive-compulsive disorder in youth?
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  Data: <searchLink fieldCode="AR" term="%22Krebs%2C+Georgina%22">Krebs, Georgina</searchLink><br /><searchLink fieldCode="AR" term="%22Isomura%2C+Kayoko%22">Isomura, Kayoko</searchLink><br /><searchLink fieldCode="AR" term="%22Lang%2C+Katie%22">Lang, Katie</searchLink><br /><searchLink fieldCode="AR" term="%22Jassi%2C+Amita%22">Jassi, Amita</searchLink><br /><searchLink fieldCode="AR" term="%22Heyman%2C+Isobel%22">Heyman, Isobel</searchLink><br /><searchLink fieldCode="AR" term="%22Diamond%2C+Holly%22">Diamond, Holly</searchLink><br /><searchLink fieldCode="AR" term="%22Advani%2C+Jana%22">Advani, Jana</searchLink><br /><searchLink fieldCode="AR" term="%22Turner%2C+Cynthia%22">Turner, Cynthia</searchLink><br /><searchLink fieldCode="AR" term="%22Mataix‐Cols%2C+David%22">Mataix‐Cols, David</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22British+Journal+of+Clinical+Psychology%22">British Journal of Clinical Psychology</searchLink>. Mar2015, Vol. 54 Issue 1, p63-75. 13p. 2 Charts, 1 Graph.
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  Data: <searchLink fieldCode="DE" term="%22United+Kingdom%22">United Kingdom</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Objectives Obsessive-compulsive disorder ( OCD) is often perceived as being difficult to treat. This study aimed to test the hypothesis that treatment non-response in routine clinical practice is often due to failures in the delivery of treatment, and that most patients who are apparently treatment-resistant will respond to treatment if adequately delivered. Design Retrospective cohort data analysis. Methods Forty-three young people with severe, treatment-resistant OCD (defined as Children's Yale-Brown Obsessive-Compulsive Scale [ CY- BOCS] scores ≥30 and non-response to previous cognitive behaviour therapy [ CBT] and selective serotonin reuptake inhibitors) were referred to a specialist clinic and completed a course of manualized CBT, with ( N = 21) or without ( N = 22) optimization of medication. A sub-sample ( N = 15) completed a semi-structured interview to determine characteristics of their previous CBT; quality was assessed according to pre-determined criteria. Results Specialist treatment was associated with significant reductions in OCD symptoms at post-treatment with gains maintained at 3-month follow-up. At the 3-month follow-up, 58% of patients showed a meaningful clinical response (≥35% drop on the CY- BOCS) and 22% were in remission (≤12 on the CY- BOCS). Patients whose medication was optimized tended (non-significantly) to have better responses. The quality of previous CBT was assessed in a sub-group of participants and rated as inadequate in 95.5% of cases. The most common inadequacy was insufficient focus on exposure techniques. Conclusions These findings provide support for the notion that treatment non-response in routine practice may be due to technical treatment failures and highlight the need to disseminate good quality evidence-based treatment among this population. Research is also needed to understand factors that impede outcome to further improve response and remission rates. Practitioner points Among young people with OCD, failure to respond to treatment in routine clinical practice may often reflect the nature of the treatment received., Exposure techniques may often be overlooked in CBT for OCD, potentially resulting in poor therapeutic response., Most young people with severe and apparent treatment-resistant OCD respond to outpatient CBT incorporating E/ RP., Further research is needed to establish effective methods for disseminating good quality CBT for OCD. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of British Journal of Clinical Psychology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/bjc.12061
    Languages:
      – Code: eng
        Text: English
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        PageCount: 13
        StartPage: 63
    Subjects:
      – SubjectFull: Mental health services
        Type: general
      – SubjectFull: Cognitive therapy
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Drug resistance
        Type: general
      – SubjectFull: Interviewing
        Type: general
      – SubjectFull: Longitudinal method
        Type: general
      – SubjectFull: Medical care
        Type: general
      – SubjectFull: Obsessive-compulsive disorder
        Type: general
      – SubjectFull: Psychological tests
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Statistical sampling
        Type: general
      – SubjectFull: Logistic regression analysis
        Type: general
      – SubjectFull: Multiple regression analysis
        Type: general
      – SubjectFull: Treatment effectiveness
        Type: general
      – SubjectFull: Pre-tests & post-tests
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      – SubjectFull: Retrospective studies
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      – SubjectFull: Adolescence
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      – SubjectFull: United Kingdom
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      – TitleFull: How resistant is 'treatment-resistant' obsessive-compulsive disorder in youth?
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              M: 03
              Text: Mar2015
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