Current Psychiatry Reviews - Volume 10, Issue 4, 2014

In this article we define and describe the use of exposure-based therapy for OCD. This approach involves confrontation with feared stimulus with the aim of facilitating fear extinction. Exposure, however, is not applicable for a number of psychological conditions now listed as related to OCD in the DSM-5. We explain when it is appropriate to use exposure and when it is not, and raise cautions for clinicians to consider when working with patients with problems putatively related to OCD.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) includes a new category for Obsessive Compulsive Related Disorders (OCRDs). This category is based on the premise that the conditions in this class share a dysfunction in behavioral inhibition, and that treatment using similar methods have comparable efficacy. The available literature is examined to determine the degree that the conditions in this category are comparable for formal assessments of behavioral inhibition or for outcome on comparable interventions. The available evidence suggests that the conditions within the OCRD are more dissimilar on behavior inhibition and the efficacious outcome comes from a wider range of interventions that simply those applied for OCD per se. Suggestions for future approaches to conceptualization are offered.

Obsessive compulsive disorder is a severe disorder that is heterogeneous in nature and often challenging to treat. Exposure and response prevention is the leading treatment for OCD and has proven efficacious, with 75% long term improvement in symptoms. However, many patients do not respond optimally to treatment. In fact, many remain treatment resistant. The purpose of the current paper is to discuss factors contributing to treatment resistance as well as treatment planning strategies.

This paper reviews Acceptance and Commitment Therapy (ACT) for Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive (OC) spectrum disorders (e.g., trichotillomania and chronic skin picking). It reviews the philosophy of science that underlies ACT: functional contextualism; the basic research that informs it: learning theory, rule governed behavior and relational frame theory; ACT’s model: psychological flexibility; and the research to date that supports ACT for OCD and OC spectrum disorders. Limitations to this research and future directions are discussed.

Many children and adults with Obsessive-Compulsive Disorder experience incomplete symptom relief despite treatment with several evidence-based interventions for OCD. Converging lines of evidence from genetic, neuroimaging, biochemical and pharmacological studies implicate the importance of abnormalities in the glutamate symptoms in the pathogenesis of OCD. Strong evidence suggests that oxidative stress may be important in the progression of several psychiatric disorders, especially psychotic and affective disorders. N-acetylcysteine (NAC) is a cheap, relatively safe over-the-counter supplement that crosses the blood-brain barrier and acts potentially as a glutamate modulating agent and antioxidant. NAC has demonstrated efficacy in the treatment of a wide variety of psychiatric conditions in individual randomized, controlled trials including psychosis, autism, bipolar depression, trichotillomania. A recent double-blind placebo-controlled in adults with SRI-refractory OCD demonstrated the efficacy of NAC compared to placebo. In this review we summarize the preclinical and clinical data demonstrating NAC is a potentially promising new pharmacological agent in the treatment of OCD.

Variants of exposure therapy are effective for treating obsessive-compulsive and related disorders (OCRDs). However, significant numbers of patients do not respond adequately to exposure therapy resulting in continued distress and functional impairment. Therefore, novel approaches to augmenting exposure therapy are needed to adequately treat non- and partial-responders. Emerging research suggests that interventions that augment learning and memory processes associated with exposure therapy (i.e., extinction training) may display promise in enhancing treatment response in OCRDs. As the most studied example, d-cycloserine (DCS) is a relatively safe cognitive enhancer that appears to accelerate treatment gains associated with exposure therapy. This article reviews research on the use of DCS and other putative cognitive modifiers as they relate to the treatment (or prospective treatment) of obsessive-compulsive disorder and other OCRDs.

DSM-IV categorized obsessive-compulsive disorder (OCD) as an anxiety disorder, body dysmorphic disorder (BDD) as a somatoform disorder, and trichotillomania as an impulse control disorder not elsewhere classified. In DSM-5, these three disorders, together with hoarding disorder and excoriation (skin picking) disorder, which are new disorders in DSM-5, are classified together in a new chapter of obsessive-compulsive and related disorders. In this paper we consider some of the relevant considerations at play in making this change, some of the potential advantages and disadvantages of this new chapter, and a number of potential research and clinical misconceptions about the new chapter.

Introduction: Global Assessment of Functioning (GAF) is an assessment instrument that is known worldwide. It is widely used for rating the severity of illness. Results from evaluations in psychiatry should characterize the patients. Rating of GAF is based on collected information. The aim of the study is to identify the factors involved in collecting information that is relevant for rating GAF, and gaps in knowledge where it is likely that further development would play a role for improved scoring. Methods: A literature search was conducted with a combination of thorough hand search and search in the bibliographic databases PubMed, PsycINFO, Google Scholar, and Campbell Collaboration Library of Systematic Reviews. Results: Collection of information for rating GAF depends on two fundamental factors: the sources of information and the methods for information collection. Sources of information are patients, informants, health personnel, medical records, letters of referral and police records about violence and substance abuse. Methods for information collection include the many different types of interview – unstructured, semi-structured, structured, interviews for Axis I and II disorders, semistructured interviews for rating GAF, and interviews of informants – as well as instruments for rating symptoms and functioning, and observation. The different sources of information, and methods for collection, frequently result in inconsistencies in the information collected. The variation in collected information, and lack of a generally accepted algorithm for combining collected information, is likely to be important for rated GAF values, but there is a fundamental lack of knowledge about the degree of importance. Conclusions: Research to improve GAF has not reached a high level. Rated GAF values are likely to be influenced by both the sources of information used and the methods employed for information collection, but the lack of research-based information about these influences is fundamental. Further development of GAF is feasible and proposals for this are presented.