Brain SPECT imaging in children and adolescents with obsessive-compulsive disorder.

OBJECTIVE: To evaluate the patterns of regional cerebral blood flow (rCBF) in cortical and subcortical regions by Brain SPECT imaging, in children and adolescents with obsessive-compulsive disorder (OCD) before and after treatment. METHOD: Fourteen OCD patients (6 to 17 years old) underwent brain SPECT; ten of those subjects were reexamined after successful treatment. rCBF ratios were correlated with clinical parameters on the 14 patients in symptomatic state, and we compared rCBF ratios of the ten patients before and after treatment. RESULTS: There was no statistically significant difference in average ratios of rCBF before and after treatment. There were significant clinical correlations between current age and age of onset of OCD and rCBF in the bilateral superior frontal, and bilateral parietal cortical regions. CONCLUSIONS: Further investigations on abnormal neurodevelopment of cortical-subcortical circuits possibly involved in symptomatology of paediatric OCD are warranted.

Self-exposure therapy for panic disorder with agoraphobia: randomised controlled study of external v. interoceptive self-exposure.

BACKGROUND: Exposure to external phobic cues is an effective therapy for panic/agoraphobia but the value of exposure to interoceptive cues is unclear. AIMS: Randomised controlled comparison in panic/agoraphobia of the effects of (a) external, (b) interceptive or (c) combined external and interoceptive self-exposure to (d) control subjects. METHOD: Eighty out-patients were randomised to a control group or to one of three forms of self-exposure treatment (external, interoceptive, or combined). Each treatment included seven sessions over 10 weeks and daily self-exposure homework. Assessments were at pre- and post-treatment and up to 1 year post-entry. Assessors remained blind during treatment. RESULTS: The three self-exposure groups improved significantly and similarly at post-treatment and up to 1-year followup, and significantly more than did the control subjects. Rates of improvement on main outcome measures averaged 60% at post-treatment and 77% at follow-up. CONCLUSIONS: The three methods of self-exposure were equally effective in reducing panic and agoraphobic symptoms in the short- and long-term.

Early compliance and other factors predicting outcome of exposure for obsessive-compulsive disorder.

BACKGROUND: Identifying predictors of treatment outcome can suggest ways to improve treatment delivery and understanding of its mechanism of action. METHOD: Predictors of treatment outcome were sought among 46 out-patients with obsessive-compulsive disorder who completed a nine-week randomised controlled trial of two forms of exposure therapy with ritual prevention. RESULTS: In both exposure conditions the best predictor of good outcome at the end of treatment (week 9) and of follow-up (week 32) was early compliance in doing exposure homework within a week of starting treatment. A weaker predictor of good outcome at follow-up was within-session reduction in anxiety from weeks 0 to 4. CONCLUSION: The strongest and most consistent predictor of better outcome to weeks 9 and 32 was compliance with exposure and ritual prevention in the first week of treatment.

Comparisons among the Yale-Brown Obsessive-Compulsive Scale, compulsion checklist, and other measures of obsessive-compulsive disorder.

BACKGROUND: The Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Compulsion Checklist (CC) were compared with one another and with five other measures to assess their place in measuring the outcome of obsessive-compulsive disorder (OCD). METHOD: Data came from a randomised trial of 46 patients with OCD who completed eight Weeks of treatment by exposure and response prevention. Using a structured modelling analysis, the YBOCS and the CC were compared with a latent factor derived from five other variables (Target Rituals, Target Obsession, Clinical Global Impression, Avoidance, Disability) of baseline severity and change after treatment, and also directly with those variables. RESULTS: Both the YBOCS and the CC were accurate and sensitive measures of OCD. The YBOCS related slightly more than did the CC to the latent factor and to Disability directly. The YBOCS related slightly more to Disability than it did to other measures. Inter-assessor and self kappa assessor reliability was high. CONCLUSIONS: The 10-Item YBOCS plus the 4-item Disability scale are a simple and efficient way to measure important aspects of OCD in clinical practice.

Does imagined exposure to the consequences of not ritualising enhance live exposure for OCD? A controlled study. I. Main outcome.

BACKGROUND: This randomised controlled study tested whether adding imagined to live exposure plus ritual prevention would enhance gains in obsessive-compulsive disorder (OCD). METHOD: Out-patients with OCD were randomly allocated to either have nine sessions of daily live self-exposure and ritual prevention to external cues alone (Ex) (n = 23) or to have, in addition to Ex, daily self-exposure to the imagined internal cues of the consequences of not ritualising (group Exi) (n = 23). All patients had the same sessional exposure time of 1 h 30 min (Exi 1 h live, 30 min imagined; Ex 1 h 30 min live), and had to practise either Exi or Ex daily for the same duration and to keep diaries of that self-exposure homework throughout treatment. Patients were followed up to week 32. Outcome measures were YBOCS for rituals and obsessions, compulsion checklist, target rituals and obsession, general anxiety, depression (Beck, Hamilton), work and social disability, clinical global impression (CGI). RESULTS: At weeks 4, 9, 20 and 32 the two groups improved similarly with no significant difference between them, neither for washers nor for checkers. Imagined exposure was more difficult to do than live exposure and there were more drop-outs. CONCLUSIONS: Daily imaged exposure to internal cues did not enhance exposure to external cues. Perhaps longer imagined exposure would have been more enhancing.

Does imagined exposure to the consequences of not ritualising enhance live exposure for OCD? A controlled study. II. Effect on behavioural v. subjective concordance of improvement.

BACKGROUND: This study tested whether adding imagined exposure to live exposure would increase the concordance between behavioural and subjective improvement in obsessive-compulsive disorder (OCD). METHOD: 46 OCD out-patients were randomly allocated to 9 weekly sessions of either combined live+imagined exposure/ritual prevention (Exi, n = 23), or only live exposure/ritual prevention (Ex, n = 23). Patients were asked to do 90 min of daily self-exposure at home (corresponding to Exi or Ex). Measures were: (A) behavioural; (B) subjective; (C) clinical global impression (CGI). RESULTS: After 9 weeks of treatment, improvement was greater on behavioural than subjective measures (similar for the Exi and Ex groups). At 20 weeks (3-month follow-up) each group had improved slightly more on subjective measures and slightly less on behavioural ones. Two subjective measures improved less during Exi than Ex, but this difference disappeared at follow-up. The greater difference between behavioural and subjective improvement scores in Exi than in Ex did not relate to clinical outcome at the end of treatment or follow-up. CONCLUSIONS: Compared to live exposure alone, combined imagined plus live exposure did not enhance behavioural/subjective concordance.