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
AuthorsKrebs, Georgina, Isomura, Kayoko, Lang, Katie, Jassi, Amita, Heyman, Isobel, Diamond, Holly, Advani, Jana, Turner, Cynthia Michelle and Mataix-Cols, David
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.

Keywordsobsessive-compulsive disorder; cognitive behaviour therapy; paediatric; treatment-resistant
Year2015
JournalBritish Journal of Clinical Psychology
Journal citation54 (1), pp. 63 - 75
PublisherJohn Wiley and Sons Ltd
ISSN0144-6657
Digital Object Identifier (DOI)https://doi.org/10.1111/bjc.12061
Scopus EID2-s2.0-84921555696
Page range63 - 75
Research GroupSchool of Philosophy
Publisher's version
File Access Level
Controlled
Place of publicationUnited Kingdom
EditorsJ. Henry
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