Obsessive-Compulsive Disorder

Joseph Zohar is Department Chair of the Division of Psychiatry at Chaim Sheba Medical Center, Tel Hashomer, Israel. He is also Professor of Psychiatry at the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. He is President of the European College of Neuropharmacology, Associate editor of the World Journal of Biological Psychiatry and International editor of CNS.
 
Dr. Zohar has received numerous awards, including: Fogarty International Research Fellowship Award, in 1984; A.E. Bennet Award for Clinical Research in 1986; European College of Neuropsychopharmacology - Lilly Neuroscience Award for Clinical Research in 1998; and World Federation Society of Biological Psychiatry on excellency in education in 2001.

Obsessive compulsive disorder (OCD) remains one of the most challenging disorders of the brain.
 
Contemporary conceptualization and therapeutic strategies are undergoing a revolution as a result of new insights derived from modern technological advances. This book was conceived in order to present this revolution to the reader. It covers current theories regarding the etiology of OCD, what is known about the genetics of this disorder, evidence from neuroimaging and a discussion of potential endophenotypes. There is an evaluation of current treatment approaches for the disorder, encompassing psychological, psychopharmacological and physical interventions, as well as a discussion of treatment resistance. The book considers methodological issues, plus reviews of OCD in pediatric populations. A summary chapter highlights some potential research avenues, in a discussion of the future directions in OCD.
 
Rather than provide comprehensive coverage, repeating material from standard psychiatry textbooks, this book focuses on recent information and its application, distinguishing it from other titles.
* If you work in children with OCD,
* If you are interested in genetics, neurocognition or brain imaging,
* If you work with patients and would like to improve your assessment in OCD and OCD Spectrum disorders, to update your therapeutic strategies and to get a handle on cutting edge developments in this intriguing field,
* If you are planning a research project in OCD and would like to get some hints from people who are research leaders in this field and also learn about methodological issues specific to OCD research,
 
then this book will be a valuable resource.
* A concise overview of the current state of the art in OCD assessment and treatment, including physical interventions and treatment resistance
* Focuses on scientific advances (including specific methodological issues) and how they can inform and benefit clinical practice
* Looks critically and broadly at the diagnostic classification, including the ongoing revision of the two major international systems
* Written by an A-list team of experts in the field who have a track record of being engaging authors

List of Contributors xii
 
Introduction xvii
 
SECTION 1 ASSESSMENT AND TREATMENT
 
1 Assessment 3
Jose M. Menchon
 
Introduction 3
 
Detecting OCD 5
 
Screening in clinical interview 7
 
Structured interviews 8
 
Clinical assessment of obsessive-compulsive symptoms 9
 
Yale-brown obsessive-compulsive scale 10
 
Dimensional yale-brown obsessive-compulsive scale (DY-BOCS) 11
 
Leyton obsessional inventory (LOI) 12
 
Maudsley obsessional-compulsive inventory (MOCI) 13
 
Padua inventory (PI) 13
 
Obsessive compulsive inventory (OCI) 14
 
Insight 14
 
Rating insight 15
 
Assessment of the risk of suicide 17
 
Differential diagnosis, comorbidities and related disorders 18
 
Organic brain disorders 19
 
Schizophrenia 20
 
Depression 20
 
Hypochondriasis 20
 
Phobias 21
 
Tourette disorder and tic disorders 21
 
Obsessive-compulsive personality disorder (OCPD) 21
 
Body dysmorphic disorder (BDD) 21
 
Hoarding 22
 
Other disorders 22
 
Conclusions 22
 
References 23
 
2 Pharmacotherapy of obsessive-compulsive disorder 31
Eric H. Decloedt and Dan J. Stein
 
Introduction 31
 
Placebo-controlled studies of clomipramine 32
 
Placebo-controlled studies of fluvoxamine 32
 
Placebo-controlled studies of fluoxetine 33
 
Placebo-controlled studies of paroxetine 34
 
Placebo-controlled studies of sertraline 34
 
Placebo-controlled studies of citalopram/escitalopram 34
 
Placebo-controlled studies of venlafaxine 35
 
Improving early response in OCD 35
 
Special populations: children 36
 
Clomipramine 36
 
Fluvoxamine 36
 
Fluoxetine 36
 
Paroxetine 37
 
Sertraline 37
 
Citalopram 38
 
Meta-analyses 38
 
Tolerability of clomipramine and serotonin reuptake inhibitors 40
 
Optimal dose of treatment 41
 
Duration of treatment 42
 
Refractory OCD 43
 
Increased dose of SSRI 43
 
Augmentation of SSRI treatment with antipsychotics 44
 
Other drugs 45
 
Alternative modes of administration of SSRIs 46
 
Combining SRIs 46
 
Switching SSRIs 46
 
Adding psychotherapy 47
 
Future therapeutic options 47
 
Conclusion 48
 
References 48
 
3 Cognitive behavioural therapy in obsessive-compulsive disorder: state of the art 58
Martin E. Franklin, Addie Goss and John S. March
 
Theoretical models 58
 
Treatment 60
 
Exposure plus response prevention (ERP) 60
 
Cognitive therapies 63
 
ERP plus medication 63
 
OCD protocols 64
 
Assessment 64
 
Adult ERP protocol 65
 
Paediatric ERP protocol 67
 
Dissemination 67
 
Future research 69
 
Summary 69
 
References 70
 
4 Electroconvulsive therapy, transcranial magnetic stimulation and deep brain stimulation in OCD 75
Rianne M. Blom, Martijn Figee, Nienke Vulink and Damiaan Denys
 
Introduction 75
 
Electroconvulsive therapy 75
 
Transcranial magnetic stimulation 76
 
Mechanism of action 77
 
Efficacy of rTMS in OCD 77
 
Side effects and safety 84
 
Conclusion and future directions 85
 
Lesioning 85
 
Deep brain stimulation 86
 
Efficacy of DBS in OCD 86
 
Mechanism of action of DBS in OCD 92
 
Side effects of DBS in OCD 92
 
Follow-up trea