How resistant is 'treatment-resistant' obsessive-compulsive disorder in youth?
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|
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|
|Journal||British Journal of Clinical Psychology|
|Journal citation||54 (1), pp. 63 - 75|
|Publisher||John Wiley and Sons Ltd|
|Digital Object Identifier (DOI)||https://doi.org/10.1111/bjc.12061|
|Page range||63 - 75|
|Research Group||School of Philosophy|
File Access Level
|Place of publication||United Kingdom|
0views this month
0downloads this month