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.

"This is an extremely useful book for anyone who wishes to extend their knowledge and develop services for OCD.As well as presenting the science behind OCD, the outcomes of various therapeutic interventons are also examined.This is a useful additionl to the literature and would recommend it to all adult and child psychiatrists who may wonder how to treat these patients." (British Journal of Psychiatry, 2013)

• List of Contributors xii Introduction xviiSECTION 1 ASSESSMENT AND TREATMENT1 Assessment 3Jose M. MenchonIntroduction 3Detecting OCD 5Screening in clinical interview 7Structured interviews 8Clinical assessment of obsessive-compulsive symptoms 9Yale–brown obsessive-compulsive scale 10Dimensional yale–brown obsessive-compulsive scale (DY–BOCS) 11Leyton obsessional inventory (LOI) 12Maudsley obsessional-compulsive inventory (MOCI) 13Padua inventory (PI) 13Obsessive compulsive inventory (OCI) 14Insight 14Rating insight 15Assessment of the risk of suicide 17Differential diagnosis, comorbidities and related disorders 18Organic brain disorders 19Schizophrenia 20Depression 20Hypochondriasis 20Phobias 21Tourette disorder and tic disorders 21Obsessive-compulsive personality disorder (OCPD) 21Body dysmorphic disorder (BDD) 21Hoarding 22Other disorders 22Conclusions 22References 232 Pharmacotherapy of obsessive-compulsive disorder 31Eric H. Decloedt and Dan J. SteinIntroduction 31Placebo-controlled studies of clomipramine 32Placebo-controlled studies of fluvoxamine 32Placebo-controlled studies of fluoxetine 33Placebo-controlled studies of paroxetine 34Placebo-controlled studies of sertraline 34Placebo-controlled studies of citalopram/escitalopram 34Placebo-controlled studies of venlafaxine 35Improving early response in OCD 35Special populations: children 36Clomipramine 36Fluvoxamine 36Fluoxetine 36Paroxetine 37Sertraline 37Citalopram 38Meta-analyses 38Tolerability of clomipramine and serotonin reuptake inhibitors 40Optimal dose of treatment 41Duration of treatment 42Refractory OCD 43Increased dose of SSRI 43Augmentation of SSRI treatment with antipsychotics 44Other drugs 45Alternative modes of administration of SSRIs 46Combining SRIs 46Switching SSRIs 46Adding psychotherapy 47Future therapeutic options 47Conclusion 48References 483 Cognitive behavioural therapy in obsessive-compulsive disorder: state of the art 58Martin E. Franklin, Addie Goss and John S. MarchTheoretical models 58Treatment 60Exposure plus response prevention (ERP) 60Cognitive therapies 63ERP plus medication 63OCD protocols 64Assessment 64Adult ERP protocol 65Paediatric ERP protocol 67Dissemination 67Future research 69Summary 69References 704 Electroconvulsive therapy, transcranial magnetic stimulation and deep brain stimulation in OCD 75Rianne M. Blom, Martijn Figee, Nienke Vulink and Damiaan DenysIntroduction 75Electroconvulsive therapy 75Transcranial magnetic stimulation 76Mechanism of action 77Efficacy of rTMS in OCD 77Side effects and safety 84Conclusion and future directions 85Lesioning 85Deep brain stimulation 86Efficacy of DBS in OCD 86Mechanism of action of DBS in OCD 92Side effects of DBS in OCD 92Follow-up treatment 94Conclusions: DBS 94Conclusion 94Acknowledgements 95References 955 Approaches to treatment resistance 99Stefano Pallanti, Giacomo Grassi and Andrea CantisaniTerminological problems and operational definitions 100Pharmacological strategies in resistant OCD 103Switching 103Infusion therapy 104Cognitive behavioural therapy 105Serotoninergic agents 106Dopaminergic agents 108Glutamatergic agents 113Opioids 115Physical therapies 115Electroconvulsive therapy (ECT) 115Repetitive transcranial magnetic stimulation (rTMS) 116Deep brain stimulation (DBS) 116Family intervention 117Conclusions and future perspectives 117References 118SECTION 2 CLINICAL SPOTLIGHTS6 Subtypes and spectrum issues 135Eric Hollander, Steven Poskar and Adriel GerardThe obsessive-compulsive spectrum 135Introduction 135Cluster approach 135Compulsivity and impulsivity 137Repetitive behaviour domain 138Determining placement of proposed OCSDs using cross-cutting domains 139Obsessive-compulsive spectrum nosology 144OCD subtypes: understanding the heterogeneity of OCD 148Dimensional approach 148Associated symptom domains 150Compulsive hoarding: OCPD, OCD subtype, dimension, OCSD or something else? 151Conclusion 154References 1547 Paediatric OCD: developmental aspects and treatment considerations 160Daniel A. Geller, Alyssa L. Faro, Ashley R. Brown and Hannah C. LevyIntroduction 160Epidemiology 160Aetiological considerations 161Genetic factors 161Non-genetic factors 164Aetiology: summary 167Clinical features 167Gender and age at onset 168Elaboration of phenotypic dimensions 168Comorbid conditions 169Neuropsychological endophenotypes 170Clinical features: summary 170Clinical assessment 171Differential diagnosis 172Normal development 172Other psychiatric disorders 172Treatment 173Pharmacotherapy 174Moderating effect of comorbid conditions 175Multimodal treatment 176Medication augmentation strategies in treatment resistance 177Safety and tolerability 178Treatment: summary 178Course and prognosis 179Conclusions and future research 179Acknowledgements 180References 180SECTION 3 RESEARCH SPOTLIGHTS8 Methodological issues for clinical treatment trials in obsessive-compulsive disorder 193Samar Reghunandanan and Naomi A. FinebergIntroduction 193Randomized controlled trials 194The rationale of placebo 196Recruitment criteria 199Diagnosis 199OCD dimensions and subtypes 200The problem of comorbidity 201Rating scales for OCD trials 203Evaluating anxiety and depression in OCD 204Measuring response and remission 205Relapse prevention 207Treatment-resistant OCD 208Psychological treatment trials 209Integrated pharmacological and psychological treatments in OCD 210Health-related quality of life 211Summary 211References 2129 Serotonin and beyond: a neurotransmitter perspective of OCD 220Anat Abudy, Alzbeta Juven-Wetzler, Rachel Sonnino and Joseph ZoharSerotonin 221Serotonin and metabolite concentrations in OCD – 30 years later 222Pharmacological challenge tests 224Pharmacotherapy 225Animal models and the role of serotonin 226Dopamine 227Dopamine and metabolite concentrations in humans 227Pharmacological challenge tests 228Pharmacotherapy 229Animal models and the role of dopamine 231Glutamate 232The glutamatergic influence 232Glutamate and metabolite concentrations in humans 232Animal models and the role of glutamate 233Serotonin: is it the one to blame? 233The puzzle of antipsychotics and OCD: Is dopamine the answer? 234So, is it a question of location? (Or . . . location, location, location?) 234References 23510 Brain imaging 244David R. Rosenberg, Phillip C. Easter and Georgia MichalopoulouNeuroimaging modalities 244Structural assessment 244Functional neurochemical assessment 245Structural assessment of OCD 246Total brain volume/ventricles 246Basal ganglia 246Prefrontal cortex 248Medial temporal-limbic cortex 252Pituitary 253Supramarginal gyrus 253White matter 254Functional neuroimaging studies of OCD 255Neurochemistry 258Serotonin 258N-acetyl-aspartate 258Choline 259Creatine/phosphocreatine 262Glutamate 262Conclusion 266Acknowledgements 267References 26811 The genetics of obsessive-compulsive disorder: current status 277David L. PaulsIntroduction 277Twin studies 277Family studies 279Family history studies 280Family interview studies 280Segregation analyses 284Candidate gene studies 285Genetic linkage studies 290Future work 291Acknowledgements 292References 29212 Neurocognitive angle: the search for endophenotypes 300Samuel R. Chamberlain and Lara MenziesIntroduction 300Heritability of OCD 301The concept of an endophenotype 302Applying the endophenotype construct to OCD 305Domains of interest in hierarchical modelling of OCD 307Cognition 307Neuroimaging 308Searching for endophenotypes of OCD 311Cognition 311Neuroimaging 313Other potential endophenotypes 316Summary 317Acknowledgements and disclosures 319References 32013 Conclusion and future directions 327Joseph ZoharReferences 329Index 331