Obsessive–compulsive disorder (OCD): Practical strategies for pharmacological and somatic treatment in adults

Fineberg, Naomi; Reghunandanan, Samar; Simpson, Helen Blair; Phillips, Katharine A.; Richter, Margaret A.; Matthews, Keith; Stein, Dan J.; Sareen, Jitender; Brown, Angus; Sookman, Debbie

doi:10.1016/j.psychres.2014.12.003

Cited by 108 publications

(56 citation statements)

References 137 publications

(147 reference statements)

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“…Although augmentation strategies with other psychotropic substances (e.g., second generation antipsychotics) may help to improve otherwise treatment-resistant cases, there is still a large number of patients suffering from persistent obsessive-compulsive (OC) symptoms (Fineberg et al, 2015;Foa, Liebowitz, & Kozak, 2005;Simpson, Huppert, Petkova, Foa, & Liebowitz, 2006). Therefore, new therapeutic approaches are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Prefrontal tDCS and sertraline in obsessive compulsive disorder: a case report and review of the literature

et al. 2017

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Obsessive-compulsive (OC) disorder is a disabling disorder resulting in tremendous individual and social burden. It has a large overlap with depression and anxiety disorders and shows treatment resistance in a relevant proportion of patients. Since a couple of years, different noninvasive brain stimulation methods have been investigated to improve OC symptoms. The application of transcranial direct current stimulation (tDCS) has shown inconsistent results which can probably be attributed to a lack in randomized controlled trials with adequate sample size. Anodal stimulation of pre-supplementary motor areas has shown promising results, and there is also sparse data on orbitofrontal and prefrontal stimulation. Here, we provide the first report on a patient with treatment-refractory OC disorder treated with sertraline and an enhanced prefrontal tDCS protocol (twice per day, 10 days) with a classic left-anodal/right cathodal montage, experiencing a 22% reduction of OC symptoms as well as reduction in depression (-10%) and anxiety symptoms (-21%). Due to multifactorial origin of OC disorder and the variety of brain circuits involved, there are probably multiple approaches for brain stimulation regarding site, polarity, and frequency to be assessed in future studies.

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Section: Introductionmentioning

confidence: 99%

Prefrontal tDCS and sertraline in obsessive compulsive disorder: a case report and review of the literature

et al. 2017

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“…Overall, the evidence is not strong enough to support the superior efficacy or tolerability of any one SSRI in OCD [4]. In the face of equivalent efficacy of the SSRIs and clomipramine, as determined by large-scale head-to-head studies [reviewed in 1, 35,38], deciding between SSRIs or clomipramine currently depends largely on secondary factors, including treatment tolerability and safety as well as the existence of comorbid illness and the potential for drug interactions.…”

Section: Which Compound?mentioning

confidence: 99%

“…There have been no dose-finding studies of clomipramine. Daily doses ranging from 75 mg clomipramine [41] to 300 mg [42] have been found to be effective, though doses exceeding 250 mg should only be used with caution [1,4].…”

Section: Which Dose?mentioning

confidence: 99%

“…Glutamatergic drugs, such as memantine and riluzole, anti-epileptic mood stabilisers such as lamotrigine, topiramate and pregabalin, serotonin receptor antagonists such as ondansetron, agomelatine and mirtazapine, stimulants such as D-amphetamine, and benzodiazepines such as clonazepam may all have a role, though the evidence from randomised controlled trials is not yet strong enough to unequivocally support their use [1,4,35]. Hypotheses deriving from pre-clinical studies that the identification of specific endophenotypic markers measurable on laboratory tests may predict a positive response to some of these compounds, e.g.…”

Section: Novel Compounds?mentioning

confidence: 99%

“…In SSRI non-responders, approximately one third of patients experience clinical improvement with further treatment with adjunctive dopamine antagonists [1]. For the more highly treatment-refractory patient, a range of potentially effective experimental treatments are available, including the use of novel pharmacological agents, intensive inpatient CBT [3] and somatic treatments such as ablative neurosurgery and deep brain stimulation [4].…”

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confidence: 99%

See 2 more Smart Citations

Evidence-Based Treatment Pathways for Translational Studies in Obsessive-Compulsive Disorders

Fineberg

Pallanti²,

Reghunandanan³

2013

Modern Trends in Psychiatry

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Obsessive-compulsive disorder (OCD) and related disorders are costly and burdensome long-term illnesses. Whilst evidence-based pharmacological and psychological treatments are available for OCD, a significant proportion of OCD patients fail to respond and for many of the OCD-related disorders no validated treatments are as yet recognised. In addition, predictors of treatment response/non-response to guide clinicians in the management of individual patients are lacking. The introduction of personalised medicine to psychiatry is expected to offer the novel prospect of identifying the most effective treatment for a patient in a timely and cost-effective way. Translational research that investigates endophenotype predictors of treatment response in OCD and related disorders may pave the way toward personalised medicine. Such research is likely to require multidisciplinary collaboration between neuroscientists and clinicians, so that the right clinical questions are addressed, and large datasets, entailing multinational, multicentre sampling. In order to facilitate the translational investigation of the key aspects of the treatment response, these studies would require access to standardised treatment paradigms that are internationally recognised. In this chapter, we introduce some of the most important outstanding questions for personalised medicine that translational research could be expected to address within the next 10 years. We review the available tools and techniques for standardised clinical assessment and the criteria that are used to define the degree of therapeutic response (response, remission, relapse, resistance) that would naturally dictate the direction of treatment. We also present a series of consecutive stepped treatment algorithms based on evidence-based practice and modelled on naturalistic care that we believe could be adapted to multicentre settings as a template for the translational researcher to aid in the design of pragmatic treatment trials that are capable of identifying biomarkers of treatment response or non-response at each key stage of the evidence-based canon.

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Neural Network Models as Explanatory Frameworks of Psychopathology and Its Treatment

Tryon¹,

Hoffman²,

McKay³

2017

Treatments for Psychological Problems and Syndromes

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Obsessive–compulsive disorder (OCD): Practical strategies for pharmacological and somatic treatment in adults

Cited by 108 publications

References 137 publications

Prefrontal tDCS and sertraline in obsessive compulsive disorder: a case report and review of the literature

Prefrontal tDCS and sertraline in obsessive compulsive disorder: a case report and review of the literature

Evidence-Based Treatment Pathways for Translational Studies in Obsessive-Compulsive Disorders

Neural Network Models as Explanatory Frameworks of Psychopathology and Its Treatment

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