Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: A practical clinical trial

Belotto-Silva, Cristina; Diniz, Juliana Belo; Malavazzi, Dante Marino; Valério, Carolina; Fossaluza, Victor; Borcato, Sonia; Seixas, André Augusto Anderson; Morelli, Dawn; Miguel, Eurí­pedes Constantino; Shavitt, Roseli Gedanke

doi:10.1016/j.janxdis.2011.08.008

Cited by 64 publications

(52 citation statements)

References 31 publications

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“…This investigation is an arm of a research protocol that involved administering several neurobiological measures to treatment-naive OCD patients who participated in a larger clinical trial intended to investigate the effectiveness of fluoxetine and group CBT in a setting more similar to clinical practice (clinical registration information: http:// clinicaltrials.govFNCT00680602) (Belotto-Silva et al, 2011). This project was conducted in our outpatient OCD clinics at the University of São Paulo Medical School, Brazil (protocol, training, and reliability of instruments can be found elsewhere) (Hoexter et al, 2009;Miguel et al, 2008).…”

Section: Subjectsmentioning

confidence: 99%

Gray Matter Volumes in Obsessive-Compulsive Disorder Before and After Fluoxetine or Cognitive-Behavior Therapy: A Randomized Clinical Trial

Hoexter

Duran

D’Alcante

et al. 2011

Neuropsychopharmacol

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110

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Serotonin reuptake inhibitors and cognitive-behavior therapy (CBT) are considered first-line treatments for obsessive-compulsive disorder (OCD). However, little is known about their modulatory effects on regional brain morphology in OCD patients. We sought to document structural brain abnormalities in treatment-naive OCD patients and to determine the effects of pharmacological and cognitive-behavioral treatments on regional brain volumes. Treatment-naive patients with OCD (n=38) underwent structural magnetic resonance imaging scan before and after a 12-week randomized clinical trial with either fluoxetine or group CBT. Matched-healthy controls (n=36) were also scanned at baseline. Voxel-based morphometry was used to compare regional gray matter (GM) volumes of regions of interest (ROIs) placed in the orbitofrontal, anterior cingulate and temporolimbic cortices, striatum, and thalamus. Treatment-naive OCD patients presented smaller GM volume in the left putamen, bilateral medial orbitofrontal, and left anterior cingulate cortices than did controls (p<0.05, corrected for multiple comparisons). After treatment with either fluoxetine or CBT (n=26), GM volume abnormalities in the left putamen were no longer detectable relative to controls. ROI-based within-group comparisons revealed that GM volume in the left putamen significantly increased (p<0.012) in fluoxetine-treated patients (n=13), whereas no significant GM volume changes were observed in CBT-treated patients (n=13). This study supports the involvement of orbitofronto/cingulo-striatal loops in the pathophysiology of OCD and suggests that fluoxetine and CBT may have distinct neurobiological mechanisms of action.

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Section: Subjectsmentioning

confidence: 99%

Gray Matter Volumes in Obsessive-Compulsive Disorder Before and After Fluoxetine or Cognitive-Behavior Therapy: A Randomized Clinical Trial

Hoexter

Duran

D’Alcante

et al. 2011

Neuropsychopharmacol

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110

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“…Clinical trials have established the use of selective serotonin reuptake inhibitors and/or cognitive behavioral therapy as first-line treatment options (Belotto-Silva et al, 2012). Unfortunately, up to 10% of patients remain refractory to all conventional treatments, including augmentation strategies (Bloch et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Visuospatial Memory Improvement after Gamma Ventral Capsulotomy in Treatment Refractory Obsessive–Compulsive Disorder Patients

Batistuzzo

Hoexter

Taub

et al. 2015

Neuropsychopharmacol

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Gamma ventral capsulotomy (GVC) radiosurgery is intended to minimize side effects while maintaining the efficacy of traditional thermocoagulation techniques for the treatment of refractory obsessive-compulsive disorder (OCD). Neuropsychological outcomes are not clear based on previous studies and, therefore, we investigated the effects of GVC on cognitive and motor performance. A doubleblind, randomized controlled trial (RCT) was conducted with 16 refractory OCD patients allocated to active treatment (n = 8) and sham (n = 8) groups. A comprehensive neuropsychological evaluation including intellectual functioning, attention, verbal and visuospatial learning and memory, visuospatial perception, inhibitory control, cognitive flexibility, and motor functioning was applied at baseline and one year after the procedure. Secondary analysis included all operated patients: eight from the active group, four from the sham group who were submitted to surgery after blind was broken, and five patients from a previous open pilot study (n = 5), totaling 17 patients. In the RCT, visuospatial memory (VSM) performance significantly improved in the active group after GVC (p = 0.008), and remained stable in the sham group. Considering all patients operated, there was no decline in cognitive or motor functioning after one year of follow-up. Our initial results after 1 year of follow-up suggests that GVC not only is a safe procedure in terms of neuropsychological functioning but in fact may actually improve certain neuropsychological domains, particularly VSM performance, in treatment refractory OCD patients.

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“…Most of these characteristics were associated with worse prognosis, in previous studies (Belotto-Silva et al, 2012;Catapano et al, 2010;Erzegovesi et al, 2001;Mataix-Cols et al, 1999;Kishore et al, 2004;Shetti et al, 2005); nevertheless, in the only study that systematically investigated the impact of BDD on OCD treatment response, there were similar response patterns observed in OCD patients with and without comorbid BDD (Stewart et al, 2008). In that particular study, the sample comprised 275 patients with severe and treatment-refractory OCD (42 with comorbid BDD) and the treatment response was obtained for 403 individuals whom had participated in a previous clinical trial (Stewart et al, 2005) that evaluated the efficacy of intensive residential treatment for OCD.…”

Section: Introductionmentioning

confidence: 71%

“…Although beyond the scope of this paper, comparison of these four groups was included to assess whether there was interference of SAD in the BDD-OCD comorbidity, since SAD is highly associated with both OCD and BDD (Gunstad and Phillips, 2003), and is also associated with a worse prognosis in OCD (Belotto-Silva et al, 2012).…”

Section: Statistical Analysesmentioning

confidence: 99%

The impact of comorbid body dysmorphic disorder on the response to sequential pharmacological trials for obsessive-compulsive disorder

et al. 2013

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Our aim was to investigate the impact of comorbid body dysmorphic disorder (BDD) on the response to sequential pharmacological trials in adult obsessive-compulsive disorder (OCD) patients. The sequential trial initially involved fluoxetine monotherapy followed by one of three randomized, add-on strategies: placebo, clomipramine or quetiapine. We included 138 patients in the initial phase of fluoxetine, up to 80 mg or the maximum tolerated dosage, for 12 weeks. We invited 70 non-responders to participate in the add-on trial; as 54 accepted, we allocated 18 to each treatment group and followed them for an additional 12 weeks. To evaluate the combined effects of sex, age, age at onset, initial severity, type of augmentation and BDD on the response to sequential treatments, we constructed a model using generalized estimating equations (GEE). Of the 39 patients who completed the study (OCD-BDD, n = 13; OCD-non-BDD, n = 26), the OCD-BDD patients were less likely to be classified as responders than the OCD-non-BDD patients (Pearson Chi-Square = 4.4; p = 0.036). In the GEE model, BDD was not significantly associated with a worse response to sequential treatments (z-robust = 1.77; p = 0.07). The predictive potential of BDD regarding sequential treatment strategies for OCD did not survive when the analyses were controlled for other clinical characteristics.

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Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: A practical clinical trial

Cited by 64 publications

References 31 publications

Gray Matter Volumes in Obsessive-Compulsive Disorder Before and After Fluoxetine or Cognitive-Behavior Therapy: A Randomized Clinical Trial

Gray Matter Volumes in Obsessive-Compulsive Disorder Before and After Fluoxetine or Cognitive-Behavior Therapy: A Randomized Clinical Trial

Visuospatial Memory Improvement after Gamma Ventral Capsulotomy in Treatment Refractory Obsessive–Compulsive Disorder Patients

The impact of comorbid body dysmorphic disorder on the response to sequential pharmacological trials for obsessive-compulsive disorder

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