ABSTRACT
OBJECTIVE: The Korean College of Neuropsychopharmacology developed a Korean treatment algorithm for obsessive-compulsive disorder (OCD) to aid clinical decisions. The goal of this preliminary study was to encourage clinical practitioners to treat patients using cognitive-behavioral therapy. METHODS: We sent a questionnaire to 34 leading experts on OCD to investigate their opinions about treating patients with OCD using cognitive-behavioral therapy. RESULTS: Of the 34 experts, 12 responded to the survey. The responses indicated that most patients with obsessive-compulsive disorder should be offered cognitive-behavioral therapy, incorporating intensive and sufficient cognitive therapy with response prevention. CONCLUSION: These results may provide information about the application of cognitive-behavioral therapy to treat obsessive-compulsive disorder.
Subject(s)
Humans , Cognitive Behavioral Therapy , Obsessive-Compulsive Disorder , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The Korean College of Neuropsychopharmacology developed a Korean treatment algorithm for obsessive-compulsive disorder (OCD) to aid clinical decisions. The goal of this preliminary study was to encourage clinical practitioners to treat patients using cognitive-behavioral therapy. METHODS: We sent a questionnaire to 34 leading experts on OCD to investigate their opinions about treating patients with OCD using cognitive-behavioral therapy. RESULTS: Of the 34 experts, 12 responded to the survey. The responses indicated that most patients with obsessive-compulsive disorder should be offered cognitive-behavioral therapy, incorporating intensive and sufficient cognitive therapy with response prevention. CONCLUSION: These results may provide information about the application of cognitive-behavioral therapy to treat obsessive-compulsive disorder.
Subject(s)
Humans , Cognitive Behavioral Therapy , Obsessive-Compulsive Disorder , Surveys and QuestionnairesABSTRACT
OBJECTIVES: Patients with obsessive-compulsive disorder (OCD) frequently exhibit complex clinical features, including comorbidity with other psychiatric disorders, which challenge diagnostic and therapeutic practice. This study presents a number of Korean experts' ratings of the appropriateness of treatments for patients with comorbid OCD and other psychiatric disorders. METHODS: The Korean Treatment Algorithm Project for Obsessive-Compulsive Disorder (KTAP-OCD 2007) developed a questionnaire that included questions about seven psychiatric comorbid conditions: major depressive disorder, bipolar disorder, panic or social anxiety disorder, schizophrenia, attention deficit hyperactive disorder (ADHD), oppositional/conduct/antisocial disorder, and Tourette disorder. Answers from 24 respondents were analyzed to assess first-line and second-line treatments for each comorbid condition. RESULTS: Experts selected cognitive behavior therapy (CBT) in conjunction with medication as the treatment for comorbidity with major depressive disorder, anxiety disorders, ADHD, or Tourette disorder. They selected a selective serotonin reuptake inhibitor (SSRI) combined with atypical antipsychotics as the treatment of choice for patients with comorbid OCD and schizophrenia. When patients had comorbid OCD and bipolar disorder, experts preferred adjunctive serotonin reuptake inhibitors to CBT. In all cases, experts were less likely to select clomipramine for second-line treatment. CONCLUSION: The findings from the KTAP-OCD 2007 survey on psychiatric comorbid conditions were generally consistent with foreign guidelines. However, more guidelines might be required for comorbidity with bipolar disorder and the use of clomipramine.
Subject(s)
Humans , Antipsychotic Agents , Anxiety Disorders , Bipolar Disorder , Clomipramine , Cognitive Behavioral Therapy , Comorbidity , Surveys and Questionnaires , Depressive Disorder, Major , Obsessive-Compulsive Disorder , Panic , Schizophrenia , Serotonin , Selective Serotonin Reuptake Inhibitors , Tourette SyndromeABSTRACT
OBJECTIVES: Patients with obsessive-compulsive disorder (OCD) frequently exhibit complex clinical features, including comorbidity with other psychiatric disorders, which challenge diagnostic and therapeutic practice. This study presents a number of Korean experts' ratings of the appropriateness of treatments for patients with comorbid OCD and other psychiatric disorders. METHODS: The Korean Treatment Algorithm Project for Obsessive-Compulsive Disorder (KTAP-OCD 2007) developed a questionnaire that included questions about seven psychiatric comorbid conditions: major depressive disorder, bipolar disorder, panic or social anxiety disorder, schizophrenia, attention deficit hyperactive disorder (ADHD), oppositional/conduct/antisocial disorder, and Tourette disorder. Answers from 24 respondents were analyzed to assess first-line and second-line treatments for each comorbid condition. RESULTS: Experts selected cognitive behavior therapy (CBT) in conjunction with medication as the treatment for comorbidity with major depressive disorder, anxiety disorders, ADHD, or Tourette disorder. They selected a selective serotonin reuptake inhibitor (SSRI) combined with atypical antipsychotics as the treatment of choice for patients with comorbid OCD and schizophrenia. When patients had comorbid OCD and bipolar disorder, experts preferred adjunctive serotonin reuptake inhibitors to CBT. In all cases, experts were less likely to select clomipramine for second-line treatment. CONCLUSION: The findings from the KTAP-OCD 2007 survey on psychiatric comorbid conditions were generally consistent with foreign guidelines. However, more guidelines might be required for comorbidity with bipolar disorder and the use of clomipramine.
Subject(s)
Humans , Antipsychotic Agents , Anxiety Disorders , Bipolar Disorder , Clomipramine , Cognitive Behavioral Therapy , Comorbidity , Surveys and Questionnaires , Depressive Disorder, Major , Obsessive-Compulsive Disorder , Panic , Schizophrenia , Serotonin , Selective Serotonin Reuptake Inhibitors , Tourette SyndromeABSTRACT
OBJECTIVE: Obsessive-compulsive disorder (OCD) is one of the more common serious mental illnesses. Effective psychological and drug treatments are available for the distressing, time-consuming, repetitive thoughts and rituals and the associated functional impairment. The decision of a treatment, however, is not easy because of the various clinical features and many treatment options. Therefore, practice guidelines and algorithms have been developed in some countries to provide the proper information to clinicians. We sought to develop the Korean Treatment Algorithm Project for OCD 2007 (KTAP-OCD 2007). METHODS: The survey questionnaire based on the Expert Consensus Guideline Series-Obsessive Compulsive disorder (1997) and was developed through modification and review by a study group for the KTAP-OCD 2007. Twenty-four (70.6%) of the 34 members of the review committee completed the survey. RESULTS: For the initial treatment of OCD, all of the selective serotonin reuptake inhibitor (SSRI)monotherapies, cognitive-behavioral therapy (CBT), and SSRI+CBT were included in the first treatment options. Fluoxetine, sertraline, paroxetine, citalopram, and fluvoxamine were included among the available SSRIs. The treatment for resistant OCD, maintenance treatment, treatment for comorbidities, and CBT for various clinical symptoms were also evaluated by the questionnaire. DISCUSSION: Most experts presented a consensus opinion as to the initial treatment of OCD, some nonconsensual opinions were expressed and gaps occurred between research data and clinical usage in some steps. And there are some differences were seen between Western countries and Korea. The KTAP-OCD 2007 is the first algorithm developed for OCD treatment in Korea, and our hope is that the KTAP-OCD will assist clinicians and researchers.
Subject(s)
Advisory Committees , Ceremonial Behavior , Citalopram , Comorbidity , Consensus , Fluoxetine , Fluvoxamine , Hope , Korea , Obsessive-Compulsive Disorder , Paroxetine , Surveys and Questionnaires , Serotonin , SertralineABSTRACT
OBJECTIVE: Treating obsessive-compulsive disorder (OCD) has always been a challenge requiring a mix of science and art. Although selective serotonin reuptake inhibitors (SSRIs) provide clinically significant relief to a large group of patients, a large number of patients do not respond to adequate trials of SSRIs. For these treatment-resistant patients, other treatment options such as augmentation, switching, combination strategies, and neurosurgical or device-based approaches have been suggested. Because several sequential treatment steps are often needed to achieve an adequate treatment benefit, we have developed a Korean treatment algorithm for OCD. METHOD: A questionnaire to survey the expert opinion of medications for OCD was completed by the review committee, which consisted of 24 experienced Korean psychiatrists. The questionnaire was composed of 47 questions, and each question included various subitems. We classified the expert opinions into three categories (1st line, 2nd line, and 3rd line). RESULTS: For initial treatment of OCD, SSRIs (fluoxetine, sertraline, paroxetine, citalopram) were recommended as 1st line therapy. If treatment by a SSRI fails, changing to another SSRI is preferred over augmentation strategy. When the response is not sufficient after changing SSRIs, augmentation strategies including atypical antipsychotics or changing to clomipramine are recommended. Among atypical antipsychotics, risperidone is the drug of choice for augmentation. Neuromodulation such as deep brain stimulation, neurosurgery, ECT, or repetitive transcranial magnetic stimulation are recommended after four or five failures of SSRIs including clomipramine. CONCLUSION: These results, which reflect recent studies and clinical experiences, suggest that the treatment strategies for OCD are changing. The development of a more comprehensive treatment algorithm for OCD, that includes cognitive-behavioral therapy, is needed.
Subject(s)
Humans , Advisory Committees , Antipsychotic Agents , Clomipramine , Deep Brain Stimulation , Drug Therapy , Expert Testimony , Neurosurgery , Obsessive-Compulsive Disorder , Paroxetine , Psychiatry , Surveys and Questionnaires , Risperidone , Selective Serotonin Reuptake Inhibitors , Sertraline , Transcranial Magnetic StimulationABSTRACT
OBJECTS: This open study was designed to investigate the efficacy and safety of risperidone in the treatment-resistant patients with chronic schizophrenia. 24 patients were entered on the 8-week open trial. A total of 3 patients discontinued risperidone treatment before the end of the study. METHODS: We investigated risperidone's efficacy and its side effects in 21 patients with treatment-resistant chronic schizophrenia, who had previously been treated with different kinds of classical antipsychotic drugs but with insufficient clinical effect or distressing extrapyramidal side effects, over a 8-week period. After 3- 7 days of placebo wash-out period, patients were assigned to receive risperidone. The overall clinical efficacy was assessed at the 1st, 2nd, 4th, and 8th week of the treatment using the PANSS and the CGI. Safety and tolerability were assessed by the ESRS, the UKU side effect rating scale, the vital signs, and the laboratory tests including CBC, urinalysis, liver function test, and ECG. RESULTS: Clinically PANSS total score and CGI severity score on the end study point showed a significant improvement compared with baseline state. Significant improvements in both PANSS positive and negative subscale scores was as early as week 1 through week 8. Nine(43%) among of the 21 patients showed at least a 20% decrease in total PANSS scores. The tolerability of risperidone was geneally found to be good. Insomnia(52%), fatigue(52%), and sedation(52%) were the most common side effects. CONCLUSION: These results suggest that risperidone may be a effective antipsychotic agent in the treatment of refractory schizophrenia. However, double-blind comparative trial between risperidone and clozapine should be performed to further clarify the efficacy of risperidone in treatment-resistant patients with chronic schizophrenia.