Obsessive-Compulsive Disorder (OCD) Research Annotated

Obsessive-Compulsive Disorder (OCD) Research

Annotated Bibliography

About OCD." 2006 Obsessive Compulsive Foundation. 20 October, 2008 at http://www.ocfoundation.org

Although I will not be using this site specifically for information in my report, it was helpful in providing information on what was presently taking place in the OCD field. A yearly conference focusing on OCD will be the first thing you will see upon entering this site. There are intensive treatment programs and hoarding information for both adolescent and young adults with OCD. There are also medications that are described for those being treated and research participation with a focus on special interest groups. By examining what OCD really is, this website allows its audience to recognize the difference between obsessions and compulsions. In offering external links it allows those that seek more information or treatment for OCD. This site is for anyone seeking general knowledge, ways to find treatment and for people dealing with the disorder. I found that it will help me with my research paper in creating a thesis, because of the information shared by medical professionals and sufferers alike.

Abramowitz, Jonathan S. Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review.); Journal of Consulting and Clinical Psychology 65.1(1997): 44-52.

Although relatively dated -- a great deal can occur in mental health research in a decade -- this quantitative review by Abramowitz was very helpful. It provided a thorough overview of studies conducted on the two main therapeutic approaches to OCD, as well as the pharmaceutical results to date. It also showed that there is a crossover between cognitive approaches and exposure procedures and both were equally effective in treatment.. Serotonergic medication, especially clomipramine, also significantly reduced OCD symptoms. However, most importantly, this quantitative review showed how few studies have been conducted in this area and the need for more research to determine the best approaches for OCD treatment. Abramowitz, in addition to his present professorship, was the director of OCD/anxiety attacks at Mayo Clinic in Minnesota. His information, therefore, is not only informative but highly credible.

Hackman, A., and C. McLean. A comparison of flooding and thought stopping in the treatment of obsessional neurosis. Behavior Research and Therapy. 13(1975): 263-269.

This study is of interest from an historical standpoint, since it was an early investigation of comparing flooding in vivo and thought stopping in patients with OCD. Although the authors hypothesized that the two techniques would have different effects on symptoms, they found no significant differences between them. One of the problems with this study, however, is that there were only 11 participants, because it was a pilot. When trying to find more information on Hackman and McLean, I was unsuccessful. Because APA style only uses the first initials, I did not have enough information to find bios on these individuals. However, I did see that their 1975 study was used in numerous research reports as primary sources.

Glannon, Walter. Altering the brain and mind. American Journal of Psychiatry. 161.6 (2004): 1038-1048

Glannon's article was very thought-provoking, because it not only showed how therapies can be of help, but also may present a sizeable risk of side effects. The patient needs to weigh the pros and cons of the benefits vs. The possible negative impacts. In this case, Glannon was looking at electrical deep-brain stimulation, which has been used for Parkinson's. A very telling fact: Two patients receiving DBS for severe OCD stated if this treatment were not available, they would have committed suicide because their illness was so severe. After the DBS they could live their lives with enjoyment as once before. However, there have been rare occurrences of side effects, such as the Parkinson's patient who became manic from the treatment.

Lambert, Mara APA releases guidelines on treating obsessive-compulsive disorder. American Family Physician 78.1(2008): 131.

This report, naturally, is very interesting because it is the most recent of all my sources. Since this was an overview of the 2007 American Psychiatric Association (APA) published treatment recommendations for obsessive-compulsive disorder (OCD), it was very comprehensive and covered information on all areas of mental care of patients with OCD. For those who do not have much of an understanding of the different types of therapy and pharmaceuticals for this illness and the advantages and disadvantages of each, this is an excellent source.

However, because it is from a conservative source, it will not be including alternative approaches in his overview. That information has to come from other research.

One of the interesting facts included is that OCD patients have symptoms that "wax and wane" over time, and treatment has to be considered that is in line with these changing symptoms.

Saxena, Sanjava, Arthur L. Brody, Karron M. Maidment, Erlyn C. Smith, Narineh Zohrabi, Elyse Katz, Stephanie K. Baker, and Lewis R. Baxter Jr. Cerebral glucose metabolism in obsessive-compulsive hoarding. Arch Gen Psychiatry. 59.12 (2002):1162-1172

Lewis Baxter, one of the authors in this study, has done several earlier studies that have deal with more general aspects of OCD, but still looking at the neurological changes that occur in the brain during these periods of obsessive behavior. I believe the more that is known about the brain, the better will be the treatment for OCD. Therapy and pharmaceuticals have been found to be very helpful, but they are secondary treatments. When researchers can narrow down the primary sources for OCD in the brain, they will be able to eventually provide treatment at the primary source. I am very hopeful that with more studies, further treatments can come that are maximum in curative ability.

Obsessive-compulsive disorder (OCD) is a potentially disabling syndrome that can last throughout an individual's lifetime. Those suffering from OCD become enmeshed in a pattern of repetitive thoughts and behaviors that are senseless and distressing, but extremely difficult to overcome. Disagreement exists about the number of people afflicted with OCD. In the recent past, mental health professionals considered it a rare disease, because only a small minority of their patients had the condition. That was because many people with the illness did not seek treatment. However, a survey conducted in the early 1980s by the National Institute of Mental Health (NIMH) showed that OCD affects more than 2% of the population, or more common than such severe mental illnesses as schizophrenia, bipolar disorder, or panic disorder. The social and economic costs of OCD were estimated to be $8.4 billion in 1990.

Because it is only within the past few decades that the true number of OCD victims has been recognized, studies have not been conducted for many years and there are not relatively a lot of studies overall. This report will review some of the research that has thus been done and the overall results and recommendations of these studies. It will also draw some conclusions based on the research thus far conducted. There are three questions that will be asked when reviewing these materials: 1) What is the therapy or pharmaceutical approach that this study focuses on; 2) was the approach found to be helpful in the treatment of OCD, why/why not; and 3) what recommendations does the author make in terms of his or her study results.

The thesis statement is: "Although a number of studies have been conducted regarding OCD treatment and conclusions are being drawn based on these results, more research needs to be conducted to better refine the data and to consider alternative approaches that are either in process now or may be in the future

LITERATURE REVIEW

Obsessive compulsive disorder (OCD) consists of invasive and undesired thoughts or images -- or what are termed obsessions -- which result in increased anxiety along with a repetition of deliberate rituals acted upon to neutralize this anxiety -- or otherwise known as compulsions. Not even a decade ago, this disorder was considered to be atypical. In recent years, however, the Epidemiological Catchment Area survey reported that in the United States the prevalence rate during a lifetime could reach 2.5%.

Further, once believed that control of the illness was not possible, OCD is now seen to respond to specific psychological and pharmacological interventions. However, debate continues on which of the approaches will help the person best gain control of the disorder, since a complete curative is not possible.

OCD psychological interventions include exposure-based procedures (ERP, Steketee) through rational emotive behavior therapy (Ellis), cognitive behavioral treatment founded on Beck's use of this therapy for purposes of depression, and thought stopping (Hackman & McLean). Many believe that ERP is the main choice of treatment (Abromowitz), based on a number of studies. However, a number of these have been single-case anecdotal reports and uncontrolled trials, instead of comparisons between random patients and control groups. The former may not take into consideration the fact that individuals with OCD have periods that are better/worse than others and may only seek therapeutic help when their symptoms have worsened. Plus, there have only been a small number of studies conducted in this area (Abromowitz).

Most recent ERP treatments consist of both daily purposeful exposure to those circumstances that cause anxiety until the compulsiveness no longer occurs and total restraint of ritual performance. These studies show the importance of confronting feared stimuli for extinguishing anxiety. However, at the same time, other research has found that the cognitive methodology has had equal results to the ERP in OCD treatment. Hackman and McLean report that they have as positive results with thought-stopping as those found with ERP. Once again, however, the number of studies has been very small (Abromowitz).

It has only been in the past decade that advances have been made in another possible treatment for the future. In the early 1990s, Baxter began looking at changes in cerebral metabolic patterns that occur with obsessive compulsiveness. He was able to specific changes in the cerebral patterns when ODC activity was occurring. These studies are continuing and becoming more refined. Most recently, Baxter joined others in a study that looked at the affect of hording. Compulsive hoarding and saving are common in individuals with OCD, as a part of the symptoms such as inability to make decisions, need for perfectionism, lack of organization, procrastinating and avoidance. Saxena and colleagues, including Baxter, attempted to identify cerebral metabolic patterns that were especially associated with this compulsive hoarding by using the positron emission tomography (PET). They took PET scans from 45 adults with DSM-IV criteria for OMD, 12 of whom had The authors compared the regional cerebral glucose metabolism between the groups and found that the individuals with compulsive hoarding syndrome had considerably reduce glucose metabolism in the posterior cingulate gyrus and cuneus when compared relative to the comparison subjects.

On the other hand, Saxena et al. found that the nonhoarding OCD individuals had much higher glucose metabolism in bilateral thalamus and caudate. When compared to nonhoarding OCD patients, compulsive hoarders had much lower metabolism in the dorsal anterior cingulate gyrus. Among all of the OCD patients, high levels of hoarding were negatively correlated with glucose metabolism in the dorsal anterior cingulate gyrus. It was the authors' conclusion that patients with the compulsive hoarding syndrome have a different pattern of cerebral glucose metabolism than nonhoarding OCD patients and comparison subjects. Therefore, obsessive-compulsive hoarding may be a neurobiologically distinct subgroup or variant of OCD with symptoms and poor response to anti-obsessional treatment are mediated by lower activity in the cingulate cortex. The positive aspect of such studies is that the researchers are getting closer to narrowing down the impact of the OCD. In the future, these technologies may guide clinical diagnosis of psychiatric conditions and the choice of appropriate treatment.

Neurology, in fact, is showing promise of taking control of even the most difficult brain disorders. Electrical deep-brain stimulation (DBS) is now being used to treat OCD. Psychopharmacology can treat cognitive and affective disorders as well as greatly improve normal cognitive capacities. The other side of the coin, however, is whether such treatment as deep-brain stimulation should be done on a regular basis given the possible risk and also the patient's personal analysis of his or her quality of life. Two patients who received DBS for severe OCD explained if this treatment had not been available, they would have committed suicide (Glannon). After the DBS they could live their lives with enjoyment as once before. They saw no ethical consideration, since their symptoms were so bad that they were willing to accept the risk of other side effects. Yet sometimes one has to be more alert to minor changes in personality than anything radical. Most people are more concerned about the major risks, which rarely occur, such as the Parkinson's patient who becomes manic when the DBS stimulator is on. Last year, the American Psychiatric Association published recommendations regarding treatment for OCD. Because the symptoms of OCD increase or decrease over time, it is necessary to seek are as soon the symptoms interfere with functioning or cause considerable stress. The APA also recognizes that there are a number of different therapeutic approaches to being able to manage one's OCD, based on the needs, abilities and interests of each individual. It is also suggested that an individual coordinate his or her care with both physicians and social services. In order to choose a plan of treatment, the physician and the patient must work together to determine the personal ability to comply with pharmacotherapy and/or psychotherapy. The two also need to discuss whether medicine and therapy will be used, based on the degree of symptoms, symptoms, medicines already taking, the severity of the illness, and treatment up until this time. A combined plan of treatment is recommended for those patients who have not responded to only one form of therapy, have other psychiatric conditions that respond to medication or who want to limit the duration of the pharmaceutical treatment.

DISCUSSION

As can be seen in these studies regarding OCD and its treatment, significant amounts of research has only been conducted over the past couple of decades on this condition. Because of this, results to date give physicians, psychologists and other therapists general directions to take to help their patients. However, these healthcare providers may have to try a couple of different approaches before finding the one that best meets their patient's specific needs. The side effects and amount of therapy or pharmaceuticals needed for each patient will differ considerably depending on such factors as the severity of OCD symptoms, other illness/conditions that the patient may have in tandem with OCD, the patient's motivation, the patient's susceptibility to medicine, and the relationship between the therapist and the patient. It is highly recommended that more therapists write up the results they have with their particular patients in regard to treatment. The more information available, the better the chances will be for improved lives for those suffering from OCD.

Continual research also has to be conducted regarding the work that is being done with the brain scan studies. Over time, as brain neurology is known better, it may be that neurological changes rather than other forms of therapy will be most productive. Or, perhaps a combination of these different approaches will be best. As is noted, the side effects for some of the current neurological therapies are still in the experimental stages, and individuals request such help only as a last resort instead of such drastic measures as committing suicide.

As noted in the literature review, there are three main areas of treatment for OCD.

The aims of behavior therapy are desensitization and relearning. This form of therapy is based on exposure and response prevention. It exposes the patients to the objects or situations that act as trigger points for obsessions, fears, and anxieties, but then keeps them from engaging in the usual compulsive response. The psychologist works with the individuals to define their unreasonable obsessions and assist them to recognize that the responses to their thoughts are not calamitous. The goal is to help people learn how to take control of their anxieties without turning to ritualized behavior. As a result, the patients will often feel at first a great deal of anxiety, which they eventually learn to manage until they subside. For instance, a person who has a great deal of anxiety over germs will be prohibited to wash his or her hands immediately after shaking another person's hands or touching items in public areas In addition, this person recognizes that these obsessions if responded to will eventually disappear along with the anxiety. The degree of success depends on a range of factors, such as motivation and time. It normally takes at least 10 to 20 hours of therapist-controlled practice before any results are seen.

There have, as noted above, been a number of different studies that have found positive results from exposure and response prevention therapy. It is believed to be effective in over 80% of people. Recently, in fact, therapists have found that this form of treatment does not have to be done in person, but can rather be handled over the phone if necessary. This is very helpful for individuals who are too anxious to leave their homes to get assistance.