How resistant is 'treatment-resistant' obsessive-compulsive disorder in youth?
Journal article
Krebs, Georgina, Isomura, Kayoko, Lang, Katie, Jassi, Amita, Heyman, Isobel, Diamond, Holly, Advani, Jana, Turner, Cynthia Michelle and Mataix-Cols, David. (2015). How resistant is 'treatment-resistant' obsessive-compulsive disorder in youth? British Journal of Clinical Psychology. 54(1), pp. 63 - 75. https://doi.org/10.1111/bjc.12061
Authors | Krebs, Georgina, Isomura, Kayoko, Lang, Katie, Jassi, Amita, Heyman, Isobel, Diamond, Holly, Advani, Jana, Turner, Cynthia Michelle and Mataix-Cols, David |
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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. |
Keywords | obsessive-compulsive disorder; cognitive behaviour therapy; paediatric; treatment-resistant |
Year | 2015 |
Journal | British Journal of Clinical Psychology |
Journal citation | 54 (1), pp. 63 - 75 |
Publisher | John Wiley & Sons Ltd |
ISSN | 0144-6657 |
Digital Object Identifier (DOI) | https://doi.org/10.1111/bjc.12061 |
Scopus EID | 2-s2.0-84921555696 |
Page range | 63 - 75 |
Publisher's version | File Access Level Controlled |
Place of publication | United Kingdom |
Editors | J. Henry |
https://acuresearchbank.acu.edu.au/item/88q66/how-resistant-is-treatment-resistant-obsessive-compulsive-disorder-in-youth
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