46 results on '"Maria C. Mancebo"'
Search Results
2. Predictors of Long-Term Exercise Engagement in Patients With Obsessive-Compulsive Disorder: The Role of Physical Activity Enjoyment
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Kristin L. Szuhany, Margot H. Steinberg, Nicole C.R. McLaughlin, Maria C. Mancebo, Richard A. Brown, Benjamin D. Greenberg, Naomi M. Simon, and Ana M. Abrantes
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Clinical Psychology - Published
- 2023
3. Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center
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Agustin G. Yip, Christina L. Boisseau, Caron Zlotnick, Maria C. Mancebo, and Steven A. Rasmussen
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Obsessive-Compulsive Disorder ,050103 clinical psychology ,medicine.medical_specialty ,Community Mental Health Centers ,medicine.medical_treatment ,Behavioral therapy ,Pilot Projects ,behavioral disciplines and activities ,Coaching ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Behavior Therapy ,law ,Intervention (counseling) ,medicine ,Humans ,0501 psychology and cognitive sciences ,Depression (differential diagnoses) ,Cognitive Behavioral Therapy ,business.industry ,05 social sciences ,Mental health ,030227 psychiatry ,Cognitive behavioral therapy ,Exposure and response prevention ,Clinical Psychology ,Treatment Outcome ,Physical therapy ,business ,Psychology - Abstract
Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.
- Published
- 2021
4. Directionality of change in obsessive compulsive disorder (OCD) and suicidal ideation over six years in a naturalistic clinical sample✰
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Maria C. Mancebo, Emily Wakschal, Lily A. Brown, Jane L. Eisen, Steven A. Rasmussen, Christina L. Boisseau, and Stefanie Russman-Block
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Adult ,Male ,Obsessive-Compulsive Disorder ,Evidence-based practice ,Suicide, Attempted ,macromolecular substances ,behavioral disciplines and activities ,Article ,Suicidal Ideation ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Obsessive compulsive ,mental disorders ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Adverse effect ,Suicide Risk ,Suicidal ideation ,Obsessive-compulsive disorder (OCD) ,business.industry ,Symptom severity ,Middle Aged ,medicine.disease ,030227 psychiatry ,Diagnostic and Statistical Manual of Mental Disorders ,Psychiatry and Mental health ,Clinical Psychology ,Socioeconomic Factors ,Disease Progression ,Regression Analysis ,Anxiety ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Background Obsessive compulsive disorder (OCD) is associated with elevated suicide risk, but the directionality of the association between OCD severity and suicidal ideation has not been established, which was the goal of this study. Methods Participants (n = 325) were adults with either a current or past diagnosis of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) OCD who were assessed annually for suicidal ideation and OCD symptom severity for six years. Cross-lagged panel analyses statistically compared unidirectional and bidirectional models over time. Serious suicide-related adverse events were reported. Results The best-fitting and most parsimonious model included paths predicting suicidal ideation from OCD symptom severity, but not vice versa. These results were confirmed by comparing a model with cross-lagged paths constrained equal to a freely estimated model. Higher OCD symptom severity in a given year was associated with a higher suicidal ideation severity in the subsequent year. Five suicide-related adverse events were reported throughout the duration of the study, including two suicide deaths and three suicide attempts. Limitations The study relied on a single-item, annual measure of suicidal ideation in adults, with substantial variability in severity of suicide risk, and missing data increased with later observations in the study. Discussion OCD symptom severity predicted next year suicidal ideation severity. In contrast, suicidal ideation severity in a given year did not predict next-year OCD symptom severity in this OCD sample. Thus, rather than waiting for suicidal ideation to resolve, clinicians should consider providing empirically supported treatments for OCD.
- Published
- 2019
5. Impact of the peripartum period on the longitudinal course of obsessive-compulsive disorder
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Jody D. Ciolino, Jennifer Sprague, Maria C. Mancebo, Steven A. Rasmussen, Christina L. Boisseau, Katelyn Zumpf, Aparna Chatterjee, Jane L. Eisen, Katherine L. Wisner, and Crystal T. Clark
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Pediatrics ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Exacerbation ,behavioral disciplines and activities ,Severity of Illness Index ,Obsessive–compulsive disorder ,New onset ,Longitudinal Course ,03 medical and health sciences ,0302 clinical medicine ,Obsessive compulsive ,Pregnancy ,mental disorders ,medicine ,Peripartum Period ,Humans ,Prospective Studies ,Prospective study ,Prospective cohort study ,Reproductive cycle events ,reproductive and urinary physiology ,Retrospective Studies ,Psychiatric Status Rating Scales ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,female genital diseases and pregnancy complications ,humanities ,Peripartum ,030227 psychiatry ,Psychiatry and Mental health ,Observational study ,Female ,Original Article ,business ,030217 neurology & neurosurgery - Abstract
Some women are vulnerable to developing new onset obsessive–compulsive disorder (OCD) or having an exacerbation of pre-existing OCD during reproductive cycle events. Reports on the impact of the peripartum period on pre-existing OCD are inconsistent, with both worsening and improving symptom severity described. Studies have primarily been retrospective or have collected few data points, which limits the investigators’ ability to capture the range of OCD symptoms during this time period, systematically and prospectively. The objective of this investigation was to add to the existing literature on the impact of the peripartum period on the course of pre-existing OCD. We conducted a secondary analysis of a subset data from the Brown Longitudinal Obsessive Compulsive Study, a prospective, observational study of OCD course. Nineteen women who experienced a pregnancy during the course of the study (9.5% of overall sample of women) were followed on average for 486 ± 133 weeks. Weekly psychiatric status ratings (PSRs) of OCD severity were compared between peripartum and non-peripartum periods. We found that the peripartum period did not significantly impact the course of OCD severity in the majority of women (N = 13, 69%). Of the minority of women with measurable variability in OCD symptoms, no statistically significant difference in PSR scores was observed between peripartum and non-peripartum periods. In this novel yet small dataset, the severity of OCD does not appear to worsen for most women during the peripartum period.
- Published
- 2020
6. The Brown Incompleteness Scale (BINCS): Measure development and initial evaluation
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Nicholas J. Sibrava, Jane L. Eisen, Steven A. Rasmussen, Maria C. Mancebo, Sarah L. Garnaat, and Christina L. Boisseau
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050103 clinical psychology ,Measure (data warehouse) ,Conceptualization ,Scale (ratio) ,05 social sciences ,Degree (music) ,Article ,Exploratory factor analysis ,03 medical and health sciences ,Psychiatry and Mental health ,Clinical Psychology ,0302 clinical medicine ,Convergent and divergent production ,Internal consistency ,0501 psychology and cognitive sciences ,Psychology ,030217 neurology & neurosurgery ,Reliability (statistics) ,Cognitive psychology - Abstract
Background In recent years, incompleteness has received increased clinical attention as a core motivation underlying obsessive-compulsive spectrum disorders. Yet, assessment of incompleteness has relied almost exclusively on self-report and has assumed a unitary conceptualization of this phenomenon. Therefore, we sought to develop and validate a new multi-faceted clinician-administered measure of incompleteness. The Brown Incompleteness Scale (BINCS) consists of 21 items; each rated on a 5-point scale, with higher scores indicating a greater degree of incompleteness. The current study describes the measure's development and preliminary validation. Methods The scale was administered to 100 consecutive participants who were part of a longitudinal follow-up study of OCD. The reliability, validity, and factor analytic structure of the scale were evaluated. Results Exploratory factor analysis supported a two-factor solution, which can best be described as representing both behavioral and sensory manifestations of incompleteness. Conclusions The BINCS demonstrated strong internal consistency as well as convergent and divergent validity. This clinician-administered scale will provide a more comprehensive clinical assessment of patients with incompleteness.
- Published
- 2018
7. The impact of lifetime PTSD on the seven-year course and clinical characteristics of OCD
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Madhavi K. Reddy, Christina L. Boisseau, Jane L. Eisen, Steven A. Rasmussen, Maria C. Mancebo, and Rachel Ojserkis
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Adult ,Male ,Longitudinal sample ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Time Factors ,Substance-Related Disorders ,Comorbidity ,behavioral disciplines and activities ,Article ,Stress Disorders, Post-Traumatic ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,mental disorders ,medicine ,Humans ,Longitudinal Studies ,Psychiatry ,Biological Psychiatry ,Mood Disorders ,Small sample ,humanities ,030227 psychiatry ,Psychiatry and Mental health ,Mood ,Quality of Life ,Female ,Substance use ,Psychology ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Research has suggested that the co-occurrence of PTSD in individuals with OCD is associated with more severe symptoms and less responsivity to empirically supported treatment as compared to individuals with OCD and no history of PTSD. However, much of this work has been limited by non-empirical case report design, cross-sectional and retrospective analyses, or small sample sizes. The current study extended this research by comparing the clinical characteristics of individuals with OCD with and without a lifetime PTSD diagnosis in a large, naturalistic, longitudinal sample over the course of seven years. At baseline, individuals with comorbid lifetime PTSD reported significantly more severe symptoms of OCD (including symptom levels and insight), lower quality of life, and higher rates of comorbid lifetime mood and substance use disorders than participants without lifetime PTSD. Further, individuals with comorbid OCD and lifetime PTSD reported significantly more severe OCD symptoms over the course of seven years than those without lifetime PTSD. These results are largely consistent with the existing literature and support the need to consider PTSD symptoms in the assessment and treatment of OCD.
- Published
- 2017
8. App-guided exposure and response prevention for obsessive compulsive disorder: an open pilot trial
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Christina L. Boisseau, Carly M. Schwartzman, Jessica Lawton, and Maria C. Mancebo
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Adult ,Male ,Obsessive-Compulsive Disorder ,050103 clinical psychology ,medicine.medical_specialty ,Evidence-based practice ,medicine.medical_treatment ,Implosive Therapy ,Pilot Projects ,Anxiety ,behavioral disciplines and activities ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Obsessive compulsive ,Intervention (counseling) ,mental disorders ,medicine ,Humans ,0501 psychology and cognitive sciences ,Psychiatry ,Depression (differential diagnoses) ,Depression ,05 social sciences ,Pilot trial ,Middle Aged ,Mobile Applications ,Telemedicine ,030227 psychiatry ,Exposure and response prevention ,Clinical Psychology ,Treatment Outcome ,Patient Satisfaction ,Quality of Life ,Female ,Self Report ,medicine.symptom ,Psychology ,Clinical psychology - Abstract
Although effective treatments for obsessive-compulsive disorder (OCD) exist, there are significant barriers to receiving evidence-based care. Mobile health applications (Apps) offer a promising way of overcoming these barriers by increasing access to treatment. The current study investigated the feasibility, acceptability, and preliminary efficacy of LiveOCDFree, an App designed to help OCD patients conduct exposure and response prevention (ERP). Twenty-one participants with mild to moderate symptoms of OCD were enrolled in a 12-week open trial of App-guided self-help ERP. Self-report assessments of OCD, depression, anxiety, and quality of life were completed at baseline, mid-treatment, and post-treatment. App-guided ERP was a feasible and acceptable self-help intervention for individuals with OCD, with high rates of retention and satisfaction. Participants reported significant improvement in OCD and anxiety symptoms pre- to post-treatment. Findings suggest that LiveOCDFree is a feasible and acceptable self-help intervention for OCD. Preliminary efficacy results are encouraging and point to the potential utility of mobile Apps in expanding the reach of existing empirically supported treatments.
- Published
- 2017
9. Behavioral therapy teams for adults with OCD in a community mental health center: An open trial
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Maria C. Mancebo, Jordana Muroff, Gail Steketee, Steven A. Rasmussen, and Caron Zlotnick
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genetic structures ,business.industry ,medicine.medical_treatment ,media_common.quotation_subject ,Behavioral therapy ,Fidelity ,behavioral disciplines and activities ,Mental health ,Coaching ,030227 psychiatry ,Exposure and response prevention ,Cognitive behavioral therapy ,03 medical and health sciences ,Psychiatry and Mental health ,Clinical Psychology ,0302 clinical medicine ,Intervention (counseling) ,medicine ,Open label ,business ,Psychology ,030217 neurology & neurosurgery ,Clinical psychology ,media_common - Abstract
Objective This study assessed the acceptability and feasibility of a team-based approach to deliver Exposure and Ritual Prevention (ERP) for Obsessive Compulsive Disorder (OCD) in a community mental health center (CMHC). Method Group ERP was adapted to meet the needs of adults with OCD receiving treatment in a CMHC and to be delivered by behavioral therapy teams (BTT). A training program, treatment manual, and fidelity ratings were developed to train CMHC therapists and case managers. Participants received 12 group ERP sessions and 10 individual home-based coaching sessions over 12 weeks. Results Eight participants entered group ERP. Feasibility and acceptability of the BTT intervention were good with six clients completing treatment, 89% of scheduled sessions attended, and high treatment satisfaction ratings. Fidelity ratings indicated staff adhered well to an ERP protocol. Half of treatment completers experienced clinically significant reductions in symptoms on the Yale-Brown Obsessive Compulsive Scale by post-treatment or at the 3-month follow-up. Conclusions BTT appear to be a feasible and acceptable way to deliver ERP for OCD in CMHCs. Modifications to ERP for CMCH populations may be needed to increase the reach of the intervention.
- Published
- 2017
10. Symptom subtype and quality of life in obsessive-compulsive disorder
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Christina L. Boisseau, Nicholas J. Sibrava, Maria C. Mancebo, Steven A. Rasmussen, Jane L. Eisen, and Carly M. Schwartzman
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Adult ,Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Family functioning ,media_common.quotation_subject ,Hoarding ,Article ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Obsessive compulsive ,medicine ,Humans ,Longitudinal Studies ,Psychiatry ,Biological Psychiatry ,media_common ,Psychiatric Status Rating Scales ,Taboo ,Physical health ,Middle Aged ,humanities ,030227 psychiatry ,Psychiatry and Mental health ,Harm ,Quality of Life ,Social relationship ,Female ,Psychology ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Quality of life (QoL) is significantly impaired in OCD across several facets of life, such as social, occupational, and family functioning, subjective sense of well-being, and enjoyment of leisure activities. The present study examined the relationship between 5 symptom subtypes of OCD (contamination, symmetry, hoarding, overresponsibility for harm, and taboo) and QoL. Participants were 325 adults with OCD enrolled in the Brown Longitudinal Obsessive Compulsive Study. Hierarchical linear regression analyses indicated hoarding, contamination, symmetry, and overresponsibility for harm were associated with impairment in household functioning, enjoyment of leisure activities, social relationships, and physical health. The implications of these findings are discussed.
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- 2017
11. Changes in social anxiety symptoms and loneliness after increased isolation during the COVID-19 pandemic
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Claire Thompson, Ethan Moitra, and Maria C. Mancebo
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Isolation (health care) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Social anxiety ,Loneliness ,Psychiatry and Mental health ,Pandemic ,medicine ,medicine.symptom ,Social isolation ,Psychiatry ,Psychology ,Biological Psychiatry - Published
- 2021
12. An empirical investigation of incompleteness in a large clinical sample of obsessive compulsive disorder
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Nicholas J. Sibrava, Christina L. Boisseau, Jane L. Eisen, Maria C. Mancebo, and Steven A. Rasmussen
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Adult ,Male ,Obsessive-Compulsive Disorder ,050103 clinical psychology ,medicine.medical_specialty ,Severity of Illness Index ,behavioral disciplines and activities ,Article ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Obsessive compulsive ,Surveys and Questionnaires ,mental disorders ,medicine ,Humans ,0501 psychology and cognitive sciences ,Psychiatry ,05 social sciences ,Middle Aged ,medicine.disease ,Comorbidity ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Compulsive Behavior ,Quality of Life ,Harm avoidance ,Female ,Obsessive Behavior ,Symptom Assessment ,Psychology ,Clinical psychology - Abstract
Obsessive Compulsive Disorder (OCD) is a disorder with heterogeneous clinical presentations. To advance our understanding of this heterogeneity we investigated the prevalence and clinical features associated with incompleteness (INC), a putative underlying core feature of OCD. We predicted INC would be prominent in individuals with OCD and associated with greater severity and impairment. We examined the impact of INC in 307 adults with primary OCD. Participants with clinically significant INC (22.8% of the sample) had significantly greater OCD severity, greater rates of comorbidity, poorer ratings of functioning, lower quality of life, and higher rates of unemployment and disability. Participants with clinically significant INC were also more likely to be diagnosed with OCPD and to endorse symmetry/exactness obsessions and ordering/arranging compulsions than those who reported low INC. Our findings provide evidence that INC is associated with greater severity, comorbidity, and impairment, highlighting the need for improved assessment and treatment of INC in OCD.
- Published
- 2016
13. Parental Accommodation Predicts Symptom Severity at Long-Term Follow-Up in Children with Obsessive–Compulsive Disorder: A Preliminary Investigation
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Maria C. Mancebo, Christina L. Boisseau, Nicholas J. Sibrava, Christopher A. Flessner, Jane L. Eisen, Sarah Francazio, and Steven A. Rasmussen
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Chronic condition ,Longitudinal study ,medicine.medical_specialty ,business.industry ,05 social sciences ,Symptom severity ,behavioral disciplines and activities ,030227 psychiatry ,03 medical and health sciences ,Distress ,0302 clinical medicine ,Obsessive compulsive ,mental disorders ,Developmental and Educational Psychology ,medicine ,Anxiety ,0501 psychology and cognitive sciences ,medicine.symptom ,Life-span and Life-course Studies ,Psychology ,business ,Psychiatry ,Accommodation ,Depression (differential diagnoses) ,050104 developmental & child psychology - Abstract
Pediatric obsessive–compulsive disorder (OCD) is a chronic condition affecting millions of children. Though well intentioned, accommodation (i.e., a parent’s attempt to assuage their child’s distress and anxiety) is thought to increase OCD symptom severity and may cause greater OCD-related impairment. The present study sought to examine the relative contribution of parental accommodation in predicting OCD symptom severity. Children between the ages of 6 and 18 (and their parents) participated in a prospective, longitudinal study investigating the course of pediatric OCD utilizing a longitudinal design. Data was collected at intake (n = 30) and two-years (n = 22) post-intake controlling for age, anxiety and depression. Parental accommodation (measured at intake) significantly predicted OCD symptom severity and was the strongest predictor at both intake and two-year follow-up. These preliminary findings highlight the importance of further research seeking to delineate factors relevant to the development and maintenance of accommodation as well as parent-level variables that might mediate the relationship between accommodation and OCD symptom severity.
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- 2016
14. Predicting Course of Illness in Patients With Severe Obsessive-Compulsive Disorder
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Nicholas J. Sibrava, Agustin G. Yip, Nicole C.R. McLaughlin, Steven A. Rasmussen, Sarah L. Garnaat, Christina L. Boisseau, Jane L. Eisen, Maria C. Mancebo, and Benjamin D. Greenberg
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Adult ,Male ,Obsessive-Compulsive Disorder ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Psychological intervention ,macromolecular substances ,Severity of Illness Index ,behavioral disciplines and activities ,Article ,Obsessive compulsive ,Drop out ,mental disorders ,Humans ,Medicine ,General pattern ,In patient ,Longitudinal Studies ,Psychiatry ,Proportional Hazards Models ,business.industry ,musculoskeletal, neural, and ocular physiology ,Course of illness ,Prognosis ,Psychiatry and Mental health ,nervous system ,Chronic Disease ,Female ,Patient report ,business ,Severe course - Abstract
OBJECTIVE Few data are available to inform clinical expectations about course and prognosis of severe obsessive-compulsive disorder (OCD). Such information is necessary to guide clinicians and to inform criteria for invasive interventions for severe and intractable OCD. This study sought to examine course and prospective predictors of a chronic course in patients with severe OCD over 5 years. METHOD A selected subset of adults in the Brown Longitudinal Obsessive-Compulsive Study (BLOCS) was included. Adult BLOCS participants were enrolled between 2001 and 2006. All participants in the current study (N = 113) had DSM-IV OCD diagnosis, severe OCD symptoms at baseline, and at least 1 year of follow-up data. RESULTS Cox proportional hazard models were used to examine the general pattern of course in the severe OCD sample based on Longitudinal Interval Follow-Up Evaluation (LIFE) psychiatric status ratings, as well as test predictors of chronically severe course. Results indicated that approximately half of patients with severe OCD at baseline had illness drop to a moderate or lower range of severity during 5 years of follow-up (50.4%) and that marked improvement was rare after 3 years of severe illness. The only unique predictor of a more chronically severe course was patient report of ever having been housebound for a week or more due to OCD symptoms (P < .05). CONCLUSIONS Findings of this study were 3-fold: (1) half of participants with severe OCD have symptom improvement over 5 years of follow-up, (2) the majority of participants that drop out of the severe range of symptom severity do so within the first 3 years of follow-up, and (3) patient-reported history of being housebound for 1 week or more due to OCD is a significant predictor of OCD's remaining severe over the 5-year follow-up.
- Published
- 2015
15. Prediction of remission in obsessive compulsive disorder using a novel machine learning strategy
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Sarah L. Garnaat, Benjamin D. Greenberg, David R. Strong, Nicholas J. Sibrava, Kathleen D. Askland, Jane L. Eisen, Maria C. Mancebo, Christina L. Boisseau, and S. A. Rasmussen
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medicine.medical_specialty ,Social adjustment ,business.industry ,Word error rate ,Variance (accounting) ,Machine learning ,computer.software_genre ,Ensemble learning ,Checklist ,Random forest ,Psychiatry and Mental health ,Obsessive compulsive ,medicine ,Artificial intelligence ,Bootstrap confidence interval ,Psychiatry ,business ,Psychology ,computer - Abstract
The study objective was to apply machine learning methodologies to identify predictors of remission in a longitudinal sample of 296 adults with a primary diagnosis of obsessive compulsive disorder (OCD). Random Forests is an ensemble machine learning algorithm that has been successfully applied to large-scale data analysis across vast biomedical disciplines, though rarely in psychiatric research or for application to longitudinal data. When provided with 795 raw and composite scores primarily from baseline measures, Random Forest regression prediction explained 50.8% (5000-run average, 95% bootstrap confidence interval [CI]: 50.3–51.3%) of the variance in proportion of time spent remitted. Machine performance improved when only the most predictive 24 items were used in a reduced analysis. Consistently high-ranked predictors of longitudinal remission included Yale–Brown Obsessive Compulsive Scale (Y-BOCS) items, NEO items and subscale scores, Y-BOCS symptom checklist cleaning/washing compulsion score, and several self-report items from social adjustment scales. Random Forest classification was able to distinguish participants according to binary remission outcomes with an error rate of 24.6% (95% bootstrap CI: 22.9–26.2%). Our results suggest that clinically-useful prediction of remission may not require an extensive battery of measures. Rather, a small set of assessment items may efficiently distinguish high- and lower-risk patients and inform clinical decision-making. Copyright © 2015 John Wiley & Sons, Ltd.
- Published
- 2015
16. A pilot randomized controlled trial of aerobic exercise as an adjunct to OCD treatment
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Deborah Riebe, Julie Desaulniers, Nicole C.R. McLaughlin, Benjamin D. Greenberg, Steven A. Rasmussen, David R. Strong, Maria C. Mancebo, Richard A. Brown, Agustin G. Yip, Ana M. Abrantes, and Sarah L. Garnaat
- Subjects
Adult ,Male ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Pilot Projects ,Anxiety ,behavioral disciplines and activities ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Patient Education as Topic ,law ,mental disorders ,Outcome Assessment, Health Care ,medicine ,Aerobic exercise ,Humans ,Exercise ,Health Education ,Depression (differential diagnoses) ,Depression ,Cardiorespiratory fitness ,Middle Aged ,Mental health ,Combined Modality Therapy ,humanities ,Adjunct ,030227 psychiatry ,Exercise Therapy ,Psychiatry and Mental health ,Physical therapy ,Health education ,Female ,medicine.symptom ,Psychology ,030217 neurology & neurosurgery - Abstract
The purpose of the current study was to conduct a randomized controlled trial testing the efficacy of aerobic exercise for decreasing OCD symptom severity, other mental health outcomes, and increasing exercise behaviors and cardiorespiratory fitness among individuals with OCD.Fifty-six patients (64% female; mean age=38.8years) with OCD and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 16 or greater despite engaging in OCD treatment were randomized to 12-weeks of supervised plus home-based moderate-intensity aerobic exercise (AE; n=28) or to 12-weeks of health education sessions (HE; n=28).Random intercepts mixed models examined differences between conditions at post-treatment. Though no difference between conditions on outcomes was observed, both AE and HE showed significant reduction in OCD symptom severity, depression and anxiety at post-treatment. Relative to HE, significant increases were noted in amount of exercise and cardiorespiratory fitness for those in the AE condition. At post-treatment, 30.4% of the AE condition (7 of 23) were treatment-responders (using the commonly accepted measure of 35% symptom reduction from baseline). In the HE condition, 7.7% of the sample (2 of 26) met this criterion at post-treatment.The results of this preliminary study suggest that exercise and health-focused interventions may be beneficial adjuncts to existing OCD treatment. Future studies with larger samples are needed to more definitively answer questions the efficacy of AE for reducing OCD symptoms and improving related clinical outcomes.
- Published
- 2017
17. Long-term course of pediatric obsessive–compulsive disorder: 3years of prospective follow-up
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Sarah L. Garnaat, Jane L. Eisen, Nicholas J. Sibrava, Benjamin D. Greenberg, Steven A. Rasmussen, Robert L. Stout, Christina L. Boisseau, and Maria C. Mancebo
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Adult ,Male ,Obsessive-Compulsive Disorder ,Pediatrics ,medicine.medical_specialty ,Adolescent ,lcsh:RC435-571 ,medicine.medical_treatment ,Personality Assessment ,behavioral disciplines and activities ,Article ,Young Adult ,Recurrence ,Obsessive compulsive ,lcsh:Psychiatry ,mental disorders ,Humans ,Medicine ,Longitudinal Studies ,Prospective Studies ,Age of Onset ,Young adult ,Child ,Prospective cohort study ,Cognitive Behavioral Therapy ,business.industry ,Rhode Island ,Prognosis ,humanities ,Psychiatry and Mental health ,Clinical Psychology ,Massachusetts ,Cognitive therapy ,Female ,Age of onset ,Personality Assessment Inventory ,business - Abstract
Objective: This study assesses the long-term course of treatment-seeking youth with a primary diagnosis of DSM-IV OCD. Method: Sixty youth and their parents completed intake interviews and annual follow-up interviews for 3 years using the youth version of the Longitudinal Interval Follow-up Evaluation (Y-LIFE) and Children's Yale–Brown Obsessive Compulsive Scale (CY-BOCS). Remission was defined as no longer meeting DSM-IV criteria for OCD for 8 weeks or more, and recurrence was defined as meeting full criteria for OCD for 4 consecutive weeks after having achieved symptom remission. Remission rates for youth were compared to rates of adults participating in the same study. Results: The probability of achieving partial remission of OCD was 0.53 and the probability of achieving full remission was 0.27. Among the 24 youth participants who achieved remission, 79% stayed in remission throughout the study (mean of 88 weeks of follow-up) and 21% experienced a recurrence of symptoms. Better functioning at intake and a shorter latency to initial OCD treatment were associated with faster onset of remission (P
- Published
- 2014
18. A cross-cultural clinical comparison between subjects with obsessive-compulsive disorder from the United States and Brazil
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Albina Rodrigues Torres, Christina L. Boisseau, Jon E. Grant, Eric W. Leppink, Jane L. Eisen, Maria Conceição do Rosário, Ygor Arzeno Ferrão, Maria C. Mancebo, Leonardo F. Fontenelle, Gustavo C. Medeiros, Steven A. Rasmussen, University of Chicago, Universidade Estadual Paulista (Unesp), Alpert Medical School of Brown University, Mount Sinai St. Lukes/Mount Sinai West, Universidade Federal do Rio de Janeiro (UFRJ), Universidade de São Paulo (USP), and Rio Grande do Sul
- Subjects
Adult ,Cross-Cultural Comparison ,Male ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Generalized anxiety disorder ,media_common.quotation_subject ,Developing country ,Global problem ,Comorbidity ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Obsessive compulsive ,mental disorders ,Obsessive-compulsive disorder ,medicine ,Cross-cultural ,Humans ,Longitudinal Studies ,Psychiatry ,Biological Psychiatry ,media_common ,Transcultural psychiatry ,Clinical aspects ,Addiction ,Middle Aged ,medicine.disease ,United States ,030227 psychiatry ,Psychiatry and Mental health ,Cross-Sectional Studies ,Cross-cultural psychiatry ,Transcultural Psychiatry ,Female ,Psychology ,030217 neurology & neurosurgery ,Brazil ,Clinical psychology - Abstract
Made available in DSpace on 2018-12-11T17:23:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-08-01 Although OCD is a global problem, the literature comparing, in a direct and standardized way, the manifestations across countries is scarce. Therefore, questions remain as to whether some important clinical findings are replicable worldwide, especially in the developing world. The objective of this study was to perform a clinical comparison of OCD patients recruited in the United States (U.S.) and Brazil. Our sample consisted of 1187 adult, treatment-seeking OCD outpatients from the U.S. (n=236) and Brazil (n=951). With regards to the demographics, U.S. participants with OCD were older, more likely to identify as Caucasian, had achieved a higher educational level, and were less likely to be partnered when compared to Brazilians. Concerning the clinical variables, after controlling for demographics the two samples presented largely similar profiles. Brazilian participants with OCD, however, endorsed significantly greater rates of generalized anxiety disorder and post-traumatic stress disorder, whereas U.S. subjects were significantly more likely to endorse a lifetime history of addiction (alcohol-use and substance-use disorders). This is the largest direct cross-cultural comparison to date in the OCD field. Our results provide much needed insight regarding the development of culture-sensitive treatments. Department of Psychiatry & Behavioral Neuroscience University of Chicago Botucatu Medical School-São Paulo State University (UNESP) Alpert Medical School of Brown University Department of Psychiatry Mount Sinai St. Lukes/Mount Sinai West Institute of Psychiatry Universidade Federal do Rio de Janeiro (UFRJ) Department of Psychiatry and Psychology Federal University of São Paulo Porto Alegre Health Sciences Federal University Rio Grande do Sul Botucatu Medical School-São Paulo State University (UNESP)
- Published
- 2016
19. Prevalence and clinical characteristics of mental rituals in a longitudinal clinical sample of obsessive-compulsive disorder
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Steven A. Rasmussen, Jane L. Eisen, Nicholas J. Sibrava, Christina L. Boisseau, and Maria C. Mancebo
- Subjects
Adult ,Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Affect (psychology) ,Article ,Young Adult ,Quality of life (healthcare) ,Obsessive compulsive ,Prevalence ,medicine ,Humans ,Longitudinal Studies ,Age of Onset ,Young adult ,Psychiatry ,Ceremonial Behavior ,Aged ,Middle Aged ,medicine.disease ,Psychiatry and Mental health ,Clinical Psychology ,Compulsive behavior ,Chronic Disease ,Compulsive Behavior ,Anxiety ,Female ,Age of onset ,medicine.symptom ,Psychology ,Anxiety disorder - Abstract
Obsessive-compulsive disorder (OCD) is a chronic and debilitating anxiety disorder associated with significant impairment in quality of life and functioning. Research examining the differences in clinical correlates and treatment response associated with different obsessions in OCD has yielded important findings underscoring the heterogeneous nature of this disorder. To date, most of this research has focused on differences associated with primary obsessions, and little attention has been paid to the clinical utility of studying how compulsive symptoms affect clinical course. Virtually no systematic research has explored the clinical characteristics of one understudied symptom presentation, mental rituals, and what impact this primary symptom has on severity and course of illness. Mental rituals, or compulsions without overt signs, represent unique clinical challenges but often go understudied for numerous methodological and clinical reasons.In this study, we explored the impact of primary mental rituals on clinical severity and chronicity in a large, longitudinal sample of OCD patients (N = 225) over 4 years.Mental rituals were a primary presenting symptom for a sizable percentage of the sample (12.9%). Primary mental rituals were associated with greater clinical severity and lower functioning at intake, as well as a more chronic course of illness, as participants with primary mental rituals spent nearly 1 year longer in full DSM-IV criteria episodes over the 4-year follow-up interval than OCD patients without mental rituals.These results suggest that mental rituals are uniquely impairing and highlight the need for further empirical exploration and consideration in treatment.
- Published
- 2011
20. OCD with comorbid OCPD: A subtype of OCD?
- Author
-
Jane L. Eisen, Maria C. Mancebo, Anthony Pinto, Meredith E. Coles, and Steven A. Rasmussen
- Subjects
Adult ,Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Longitudinal study ,media_common.quotation_subject ,Sadistic personality disorder ,Comorbidity ,Avoidant personality disorder ,Personality Disorders ,Severity of Illness Index ,behavioral disciplines and activities ,mental disorders ,Severity of illness ,Prevalence ,Humans ,Medicine ,Personality ,First-degree relatives ,Psychiatry ,Biological Psychiatry ,media_common ,Cognitive Behavioral Therapy ,business.industry ,medicine.disease ,humanities ,Obsessive–compulsive personality disorder ,Diagnostic and Statistical Manual of Mental Disorders ,Psychiatry and Mental health ,Female ,business ,Clinical psychology - Abstract
Objective The current study examined the validity of using comorbid obsessive–compulsive personality disorder (OCPD) to identify a subtype of individuals with obsessive–compulsive disorder (OCD). Method Data for the current study were drawn from an ongoing, longitudinal study of the course of OCD and include intake assessments for 238 subjects with primary and current DSM-IV OCD who were treatment seeking. Results More than one fourth of the subjects ( N = 65, 27%) met criteria for comorbid OCPD. As compared to OCD − OCPD subjects, the OCD + OCPD subjects had a significantly younger age at onset of first OC symptoms ( p = 0.013), and a higher rate of symmetry and hoarding obsessions, and cleaning, ordering, repeating, and hoarding compulsions (all p ’s p = 0.007) and avoidant personality disorder ( p = 0.006). The OCD + OCPD subjects also had significantly lower ratings of global functioning ( p = 0.001) and more impaired social functioning ( p = 0.004), despite a lack of significant differences on overall severity of OCD symptoms. Conclusions Our findings indicate that individuals with both OCD and OCPD have distinct clinical characteristics in terms of age at onset of initial OC symptoms, the types of obsessions and compulsions they experience, and psychiatric comorbidity. Our findings, coupled with data from family studies showing a higher than expected frequency of OCPD in first degree relatives of OCD probands, suggest that OCD associated with OCPD may represent a specific subtype of OCD. Additional research is warranted to further establish the validity of this subtype.
- Published
- 2008
21. Development of the Treatment Adherence Survey—patient version (TAS-P) for OCD
- Author
-
Steven A. Rasmussen, Maria C. Mancebo, Anthony Pinto, and Jane L. Eisen
- Subjects
Adult ,Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Psychometrics ,medicine.medical_treatment ,Concurrent validity ,behavioral disciplines and activities ,Article ,Pharmacotherapy ,mental disorders ,medicine ,Humans ,Psychological testing ,Psychiatry ,Psychological Tests ,Cognitive Behavioral Therapy ,Reproducibility of Results ,Combined Modality Therapy ,Cognitive behavioral therapy ,Intake interview ,Psychiatry and Mental health ,Clinical Psychology ,Cognitive therapy ,Patient Compliance ,Female ,Observational study ,Psychology ,Clinical psychology - Abstract
This paper reports on the development and initial psychometric evaluation of the Treatment Adherence Survey-patient version (TAS-P), a brief instrument designed to assess patient adherence to Cognitive-Behavioral Therapy (CBT) and pharmacotherapy recommendations for OCD. Eighty individuals with Obsessive Compulsive Disorder (OCD) were administered the TAS-P as part of the intake interview of a prospective, observational study of the course of OCD. Results demonstrated excellent test-retest reliability. Responses on the TAS-P were also significantly correlated with scores on a self-report measure of general treatment adherence and with data collected from a chart-review, demonstrating concurrent validity. Treatment adherence was not explained by demographic variables. However, participants who reported nonadherence to CBT recommendations had more severe OCD symptoms at the time of intake than those who did not endorse CBT nonadherence (mean Y-BOCS = 23.27 +/- 7.5 versus 18.20 +/- 8.0, respectively). Results suggest that the TAS-P is a promising instrument for assessing reasons for nonadherence to recommendations for CBT and pharmacotherapy interventions.
- Published
- 2008
22. Late-onset obsessive compulsive disorder: Clinical characteristics and psychiatric comorbidity
- Author
-
Steven A. Rasmussen, Jon E. Grant, Kyle A. Williams, Maria C. Mancebo, Jane L. Eisen, and Anthony Pinto
- Subjects
Adult ,Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,medicine.medical_treatment ,Culture ,Late onset ,Comorbidity ,Personality Assessment ,Personality Disorders ,behavioral disciplines and activities ,Quality of life ,mental disorders ,Epidemiology ,medicine ,Humans ,Psychiatry ,Biological Psychiatry ,Aged ,Depressive Disorder ,Cognitive Behavioral Therapy ,Mental Disorders ,Age Factors ,Awareness ,Middle Aged ,Prognosis ,medicine.disease ,Anxiety Disorders ,humanities ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Treatment Outcome ,Quality of Life ,Female ,Age of onset ,Personality Assessment Inventory ,Psychology ,Anxiety disorder ,Clinical psychology - Abstract
There has been little research examining clinical correlates of late-onset OCD in a large sample of individuals with a primary diagnosis of OCD. Using a sample of 293 consecutive subjects with lifetime DSM-IV OCD, we compared subjects with late-onset (after age 30 years) OCD to those with earlier onset on a variety of clinical measures. Symptom severity was examined using the Yale-Brown Obsessive Compulsive Scale. Thirty-three (11.3%) of the 293 subjects with OCD reported onset of OCD on or after age 30 years (mean age of OCD onset of 38.8+/-9.7 years). Subjects with late-onset had significantly shorter durations of illness prior to receiving treatment, less severe obsessinality, and a trend demonstrating a greater likelihood of responding to cognitive behavioral therapy (CBT). Late-onset OCD subjects were also significantly less likely to report contamination, religious, or somatic obsessions. Comorbidity, insight, depressive symptoms, quality of life, and social functioning did not differ between groups. These preliminary results suggest that although onset on or after age 30 years is fairly uncommon among people with OCD, individuals developing OCD later in life have similar clinical characteristics as those with earlier onset and may respond better to CBT.
- Published
- 2007
23. A Pilot Study of Moderate-Intensity Aerobic Exercise for Obsessive Compulsive Disorder
- Author
-
Steven A. Rasmussen, Richard A. Brown, Benjamin D. Greenberg, David R. Strong, Julie Menard, Ana M. Abrantes, and Maria C. Mancebo
- Subjects
Adult ,Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Health Status ,medicine.medical_treatment ,Physical fitness ,Pilot Projects ,Physical exercise ,Severity of Illness Index ,behavioral disciplines and activities ,law.invention ,Randomized controlled trial ,law ,Intervention (counseling) ,mental disorders ,Severity of illness ,medicine ,Humans ,Aerobic exercise ,Exercise ,Psychiatric Status Rating Scales ,Cognitive Behavioral Therapy ,business.industry ,medicine.disease ,Combined Modality Therapy ,humanities ,Exercise Therapy ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Treatment Outcome ,Physical Fitness ,Body Composition ,Quality of Life ,Physical therapy ,Female ,Psychology ,business ,Anxiety disorder ,Follow-Up Studies - Abstract
This preliminary study examined the impact of aerobic exercise as an adjunctive intervention to regular care in reducing obsessive compulsive disorder (OCD) symptoms in a clinical sample. Fifteen patients (53% male; mean age = 44.4 years) receiving behavioral therapy and/or pharmacotherapy for OCD and who still demonstrated clinically significant OCD symptoms (i.e., Yale-Brown obsessive compulsive scale, Y-BOCS scores above 16) were enrolled in a 12-week moderate-intensity exercise intervention. Measures of OCD symptom severity were obtained at baseline, end of treatment, and at 3- and 6-week, and 6-month follow-up. Study findings at the end of this 12-week aerobic exercise intervention point to a beneficial effect (Cohen's d = 1.69) on reduction in OCD symptom severity. Further, reductions in OCD symptom severity appear to persist 6 months later. Lastly, improvement in overall sense of well-being was observed after the 12-week intervention. Results of this study suggest that a randomized clinical trial evaluating the efficacy of this 12-week aerobic exercise intervention is warranted.
- Published
- 2007
24. Obsessive–compulsive disorder versus body dysmorphic disorder: a comparison study of two possibly related disorders
- Author
-
Steven A. Rasmussen, Katharine A. Phillips, B A William Menard, Anthony Pinto, Jane L. Eisen, and Maria C. Mancebo
- Subjects
Adult ,Male ,Suicide Prevention ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Substance-Related Disorders ,Poison control ,Comorbidity ,Personality Assessment ,Personality Disorders ,behavioral disciplines and activities ,Article ,Delusions ,mental disorders ,Body Image ,medicine ,Humans ,Longitudinal Studies ,Somatoform Disorders ,Psychiatry ,Suicidal ideation ,Depressive Disorder, Major ,Awareness ,Middle Aged ,medicine.disease ,Anxiety Disorders ,Personality disorders ,humanities ,Substance abuse ,Suicide ,Psychiatry and Mental health ,Clinical Psychology ,Body dysmorphic disorder ,Major depressive disorder ,Female ,medicine.symptom ,Personality Assessment Inventory ,Psychology ,Clinical psychology - Abstract
The relationship between obsessive–compulsive disorder (OCD) and body dysmorphic disorder (BDD) is unclear. BDD has been proposed to be an OCD-spectrum disorder or even a type of OCD. However, few studies have directly compared these disorders’ clinical features. We compared characteristics of subjects with OCD (n = 210), BDD (n = 45), and comorbid BDD/OCD (n = 40). OCD and BDD did not significantly differ in terms of demographic features, age of OCD or BDD onset, illness duration, and many other variables. However, subjects with BDD had significantly poorer insight than those with OCD and were more likely to be delusional. Subjects with BDD were also significantly more likely than those with OCD to have lifetime suicidal ideation, as well as lifetime major depressive disorder and a lifetime substance use disorder. The comorbid BDD/OCD group evidenced greater morbidity than subjects with OCD or BDD in a number of domains, but differences between the comorbid BDD/OCD group and the BDD group were no longer significant after controlling for BDD severity. However, differences between the comorbid BDD/OCD group and the OCD group remained significant after controlling for OCD severity. In summary, OCD and BDD did not significantly differ on many variables but did have some clinically important differences. These findings have implications for clinicians and for the classification of these disorders.
- Published
- 2007
25. Longitudinal course of body-focused repetitive behaviors in obsessive-compulsive disorder
- Author
-
Jon E, Grant, Maria C, Mancebo, Marc E, Mooney, Jane L, Eisen, and Steven A, Rasmussen
- Subjects
Adult ,Male ,Psychiatric Status Rating Scales ,Obsessive-Compulsive Disorder ,Remission Induction ,Anxiety ,Middle Aged ,Prognosis ,United States ,Socioeconomic Factors ,Prevalence ,Humans ,Female ,Longitudinal Studies ,Age of Onset ,Self-Injurious Behavior - Abstract
The course of body-focused repetitive behaviors (BFRBs) (eg, trichotillomania, skin picking, and nail biting) has received scant research attention. We sought to understand the longitudinal course of BFRBs over an 8-year period and whether the co-occurrence of a BFRB with obsessive-compulsive disorder (OCD) affects the course of OCD.Three hundred ninety-five participants with OCD completed annual interviews using the Longitudinal Interval Follow-up Evaluation to estimate BFRB and OCD symptom severity during each week of follow-up.Of the 395 participants, 83 (21%) had a co-occurring BFRB. In almost one-half of the participants, BFRB onset occurred before OCD. Participants with OCD and BFRB spent the majority of the rating period experiencing full BFRB symptoms. Having a BFRB was associated with spending less time in remission from OCD.Although BFRBs have long been known to be common in individuals with OCD, these data demonstrate that most individuals who have a co-occurring BFRB with OCD do not experience BFRB remission and that having a BFRB predicts a worse course for OCD.
- Published
- 2015
26. The Brown Longitudinal Obsessive Compulsive Study
- Author
-
Jane L. Eisen, Anthony Pinto, Ingrid R. Dyck, Steven A. Rasmussen, Maria C. Mancebo, and Benjamin D. Greenberg
- Subjects
Adult ,Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Severity of Illness Index ,Patient satisfaction ,Pharmacotherapy ,Naturalistic observation ,Obsessive compulsive ,Severity of illness ,medicine ,Humans ,Longitudinal Studies ,Psychiatry ,Prospective cohort study ,Aged ,Psychotropic Drugs ,Middle Aged ,Serotonin reuptake ,medicine.disease ,Psychiatry and Mental health ,Treatment Outcome ,Patient Satisfaction ,Physical therapy ,Drug Therapy, Combination ,Female ,Psychology ,Selective Serotonin Reuptake Inhibitors ,Anxiety disorder ,Antipsychotic Agents - Abstract
Objective The primary aim of this study was to assess the extent to which individuals with obsessive-compulsive disorder (OCD) received recommended doses of treatment and perceived a response to these treatments. Method Participants were 293 adults with primary OCD (DSM-IV) who were enrolled in the Brown Longitudinal Obsessive Compulsive Study, a naturalistic, prospective study of course in OCD. Data were collected at intake interviews between June 2001 and October 2004. Patient impressions of response to treatments received were assessed using the Clinical Global Impressions-Improvement Scale-patient version. Results Of the 182 participants taking recommended doses of serotonin reuptake inhibitors (SRIs) at intake, 112 (62%) rated themselves as being very much or much improved. The remaining participants rated themselves as minimally improved, unchanged, or worse while taking recommended doses of SRIs. These participants (N = 70) reported receiving their current SRI for a mean (SD) of 2.7 (3.2) years. Twelve (29%) of the 42 participants receiving neuroleptic augmentation of SRIs reported a response. Thirty-eight percent of the sample received the recommended number of 13 sessions of cognitive-behavioral therapy (CBT) lifetime. Only 24% reported completing a continuous course of 13 weekly sessions. Eighteen (67%) of the 27 participants who received a course of CBT in the past year rated themselves as very much or much improved. Conclusions In this large, naturalistic study of OCD, over one third of participants receiving recommended doses of SRIs did not perceive substantial long-term benefit from pharmaco-therapy. Relatively few participants received recommended doses of CBT. Clinical implications and future directions are discussed.
- Published
- 2006
27. Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder
- Author
-
Steven A. Rasmussen, Matthew Gunnip, Jon E. Grant, Maria C. Mancebo, Jane L. Eisen, and Anthony Pinto
- Subjects
Adult ,Male ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,lcsh:RC435-571 ,Sexual Behavior ,Poison control ,Human sexuality ,behavioral disciplines and activities ,lcsh:Psychiatry ,mental disorders ,Sexual obsessions ,medicine ,Humans ,Age of Onset ,Psychiatry ,Depression (differential diagnoses) ,Aged ,Psychiatric Status Rating Scales ,Middle Aged ,medicine.disease ,Comorbidity ,Intrusive thought ,Aggression ,Religion ,Psychiatry and Mental health ,Clinical Psychology ,Female ,medicine.symptom ,Age of onset ,Obsessive Behavior ,Psychology ,Anxiety disorder ,Clinical psychology - Abstract
Because little is known about sexual obsessions in individuals with obsessive-compulsive disorder (OCD), we examined rates and clinical correlates of sexual obsessions in 293 consecutive subjects with primary lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, OCD (54.6% females; mean age, 40.5 F 12.9 years). Symptom severity was examined using the Yale-Brown Obsessive Compulsive Scale. Comorbidity, treatment response, insight, depression symptoms, quality of life, and social functioning were also assessed. All variables were compared in subjects who have OCD with and without sexual obsessions. Of the 293 subjects with primary OCD, 73 (24.9%) reported a history of sexual obsessions, and 39 (13.3%) of the subjects with OCD reported current sexual obsessions. Women were as likely as men to report sexual obsessions. As compared to those without these symptoms, subjects with current sexual obsessions were significantly more likely to report current aggressive (P b .001) and religious (P = .001) obsessions. Subjects with sexual obsessions also reported an earlier age of onset of OCD than subjects without these symptoms. Severity of OCD, comorbidity, treatment response, insight, depressive symptoms, quality of life, and social functioning did not differ between those with and without sexual obsessions. These preliminary results suggest that sexual obsessions are fairly common among individuals with OCD and may be associated with important clinical characteristics.
- Published
- 2006
28. The Brown Longitudinal Obsessive Compulsive Study
- Author
-
Anthony Pinto, Maria C. Mancebo, Jane L. Eisen, S. A. Rasmussen, and Maria E. Pagano
- Subjects
Adult ,Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Personality Inventory ,Cross-sectional study ,Sample (statistics) ,Comorbidity ,Severity of Illness Index ,Article ,Age Distribution ,Severity of illness ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Age of Onset ,Psychiatry ,Prospective cohort study ,Psychiatric Status Rating Scales ,Mental Disorders ,Patient Acceptance of Health Care ,medicine.disease ,Diagnostic and Statistical Manual of Mental Disorders ,Psychiatry and Mental health ,Cross-Sectional Studies ,Female ,Age of onset ,Personality Assessment Inventory ,Psychology ,Anxiety disorder ,Follow-Up Studies ,Clinical psychology - Abstract
This article describes the method and intake findings of the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the naturalistic course of obsessive-compulsive disorder (OCD) in a large clinical sample using longitudinal research methodology.Intake data, collected between June 2001 and October 2004, are presented for 293 adult participants in a prospective, naturalistic study of OCD. Participants had a primary diagnosis of DSM-IV OCD and had sought treatment for the disorder.Our findings indicate that OCD typically has a gradual onset and a continuous course regardless of age at onset. There is a substantial lag between the onset of the disorder and initiation of treatment. OCD, which almost always coexists with other psychiatric symptoms, leads to serious social and occupational impairment. Compared with participants with late-onset OCD, early-onset participants had higher rates of lifetime panic disorder, eating disorders, and obsessive-compulsive personality disorder. The groups also differed on the types of obsessive-compulsive symptoms that were first noticed, as well as on rates of current obsessions and compulsions.The demographics, clinical characteristics, comorbidity rates, and symptom presentation of the sample are consistent with those reported for cross-sectional studies of OCD, including the DSM-IV Field Trial. The current sample has a number of advantages over previously collected prospective samples of OCD in that it is large, diagnostically well characterized, recruited from multiple settings, and treatment seeking. This unique data set will contribute to the identification of meaningful phenotypes in OCD based on stability of symptom dimensions, prospective course patterns, and treatment response.
- Published
- 2006
29. Obsessive Compulsive Personality Disorder and Obsessive Compulsive Disorder: Clinical Characteristics, Diagnostic Difficulties, and Treatment
- Author
-
Maria C. Mancebo, Jon E. Grant, Jane L. Eisen, and Steven A. Rasmussen
- Subjects
Obsessive-Compulsive Disorder ,medicine.medical_specialty ,media_common.quotation_subject ,General Medicine ,medicine.disease ,Obsessive–compulsive personality disorder ,Psychiatry and Mental health ,Obsessive compulsive ,Meta-analysis ,medicine ,Humans ,Personality ,Psychology ,Psychiatry ,Clinical psychology ,media_common - Abstract
BackgroundThe overlap between obsessive compulsive personality disorder (OCPD) and obsessive compulsive disorder (OCD) has received increasing recognition and continues to be a source of much debate. With the advent of new research methodologies, researchers have attempted to distinguish whether OCPD and OCD are two distinct phenomena that can co-occur or whether they are similar, overlapping constructs.MethodsMEDLINE was used to systematically review the OCPD and OCD literature published between 1991 and 2004.ResultsUsing the more stringent DSM-IV criteria, results from OCD clinical samples suggest that the majority of individuals with OCD (75%) do not have OCPD. Similarly, results from personality disorder samples suggest that the majority of individuals with OCPD (80%) do not have OCD.ConclusionsWhile there is evidence that OCD and OCPD are linked, the literature does not support either one as a necessary or sufficient component of the other.
- Published
- 2005
30. Differential Parental Influence in the Familial Aggregation of Obsessive Compulsive Disorder
- Author
-
Maria C. Mancebo, Nicholas J. Sibrava, Caleb M. Pardue, Jane L. Eisen, Christina L. Boisseau, and Steven A. Rasmussen
- Subjects
Proband ,medicine.medical_specialty ,Family aggregation ,medicine.disease ,Comorbidity ,behavioral disciplines and activities ,humanities ,Article ,Parental influence ,Psychiatry and Mental health ,Clinical Psychology ,Obsessive compulsive ,mental disorders ,medicine ,Anxiety ,medicine.symptom ,Age of onset ,Psychiatry ,Psychology ,Clinical psychology ,Differential impact - Abstract
The familial nature of OCD has been well established. Clinical characteristics such as early age of onset, comorbidity with tic disorders, and higher rates of symmetry symptoms have been associated with the familial aggregation of OCD, though little research has examined the differential impact of paternal and maternal OCD. The current study explored parental influence on the expression of these characteristics and reports on 310 probands diagnosed with OCD as well as 1,580 of their biological first-degree relatives. The probands were evaluated by trained clinical raters using semi-structured assessments, and relative diagnoses were obtained based on probands' reports. Similar to previous findings, 10.13% of the 1,580 relatives (n = 160) were reported to have significant OCD symptoms. Only probands who reported having a father with OCD, rather than any first-degree relative, were more likely to have an early age of onset, symmetry and exactness obsessions, and higher rates of comorbidity. No significant differences were found with respect to the probands who reported their mothers as having OCD. These findings suggest that paternal OCD, rather than simply any first-degree relative having OCD, may influence whether probands exhibit the clinical characteristics commonly associated with the familial subtype of OCD.
- Published
- 2014
31. Who qualifies for deep brain stimulation for OCD? Data from a naturalistic clinical sample
- Author
-
Steven A. Rasmussen, Sarah L. Garnaat, Wayne K. Goodman, Maria C. Mancebo, Benjamin D. Greenberg, Nicholas J. Sibrava, and Jane L. Eisen
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Deep brain stimulation ,medicine.medical_treatment ,Deep Brain Stimulation ,Sample (statistics) ,Observation ,Severity of Illness Index ,Article ,Stereotactic ablation ,mental disorders ,medicine ,Humans ,Multicenter Studies as Topic ,Longitudinal Studies ,Treatment history ,Psychiatric Status Rating Scales ,Adult patients ,Patient Selection ,Baseline data ,Clinical trial ,Psychiatry and Mental health ,Female ,Neurology (clinical) ,Neurosurgery ,Psychology ,Clinical psychology - Abstract
A few patients with obsessive-compulsive disorder (OCD) remain severely impaired despite exhausting best-practice treatments. For them, neurosurgery (stereotactic ablation or deep brain stimulation) might be considered. The authors investigated the proportion of treatment-seeking OCD patients, in a naturalistic clinical sample, who met contemporary neurosurgery selection criteria. Using comprehensive baseline data on diagnosis, severity, and treatment history for adult patients from the NIMH-supported Brown Longitudinal OCD Study, only 2 of 325 patients met screening criteria for neurosurgery. This finding prompts consideration of new models for clinical trials with limited samples as well as methods of refining entry criteria for such invasive treatments.
- Published
- 2014
32. Excluding the typical patient: thirty years of pharmacotherapy efficacy trials for obsessive-compulsive disorder
- Author
-
Brian L, Odlaug, Eric, Weinhandl, Maria C, Mancebo, Erik L, Mortensen, Jane L, Eisen, Steven A, Rasmussen, Liana R N, Schreiber, and Jon E, Grant
- Subjects
Clinical Trials as Topic ,Obsessive-Compulsive Disorder ,Patient Selection ,Humans ,Article - Abstract
Over the past 30 years, clinical trials have resulted in several successful pharmacotherapies for obsessive-compulsive disorder (OCD), yet patients in clinical settings often report inadequate response. This study compares clinical characteristics of treatment-seeking OCD patients to the inclusion/exclusion criteria used in pharmacotherapy trials.The sample consisted of 325 community members with a DSM-IV diagnosis of OCD who underwent systematic interviews with clinicians knowledgeable in the diagnosis and treatment of OCD. We compiled pharmacotherapy studies for OCD published between 1980 and 2010 using Medline, PubMed, and library resources, and estimated the proportion of patients in each decade satisfying the most common inclusion/exclusion criteria.We included 39 clinical trials and found 72% of the 325 patients would have been excluded from trials conducted between 1980 and 2010. Exclusion was projected as dramatically lower for trials conducted between 1980 and 1989 (19.7%) compared with 74.8% for trials conducted between 1990 and 1999 and 76.9% for trials between 2000 and 2010.The majority of treatment-seeking individuals with OCD would not qualify for OCD treatment studies due to comorbid psychiatric disorders, and failure to meet OCD severity threshold criteria. This illustrates the need to include a more community-representative sample of OCD patients in clinical trials examining pharmacotherapy efficacy.
- Published
- 2014
33. Longitudinal course of pharmacotherapy in obsessive-compulsive disorder
- Author
-
Jon E. Grant, Brian L. Odlaug, Jane L. Eisen, Maria C. Mancebo, Eric D Weinhandl, and Steven A. Rasmussen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Longitudinal study ,Obsessive-Compulsive Disorder ,Community Mental Health Centers ,Serotonin reuptake inhibitor ,behavioral disciplines and activities ,Article ,Young Adult ,Pharmacotherapy ,mental disorders ,medicine ,Ambulatory Care ,Secondary Prevention ,Humans ,Pharmacology (medical) ,Cumulative incidence ,Longitudinal Studies ,Young adult ,Psychiatry ,Prospective cohort study ,Pharmacotherapy Discontinuation ,Psychiatric Status Rating Scales ,Remission Induction ,Middle Aged ,humanities ,Discontinuation ,Diagnostic and Statistical Manual of Mental Disorders ,Psychiatry and Mental health ,Female ,Drug Monitoring ,Psychology ,Selective Serotonin Reuptake Inhibitors - Abstract
BACKGROUND Although data fully support the use of serotonin reuptake inhibitors (SRIs) in the treatment of obsessive-compulsive disorder (OCD), investigations on pharmacotherapy discontinuation during the course of OCD are lacking. This 5-year prospective study sought to better understand the long-term course of SRI utilization among individuals with OCD. METHODS A total of 252 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, 4th ed. OCD, treated with medication in the community, were examined for discontinuation and resumption of SRIs. Data on weekly OCD symptoms, medications, and dosage changes were obtained annually using the Longitudinal Interval Follow-up Evaluation. RESULTS During the 5-year follow-up period, 151 patients had at least one trial of an SRI for 12 weeks or more. A total of 110 patients (43.7%) discontinued their medication (i.e. ceased taking medication for ≥4 weeks) at least once during the follow-up period. In patients symptomatic at the time of discontinuation, the cumulative incidence of worsening of OCD after SRI discontinuation was 9.8%, whereas in patients in partial or full remission at the time of discontinuation, the corresponding cumulative incidence was 33.3%. Among patients with worsening of OCD upon SRI discontinuation, the median time to worsening was 39 weeks. CONCLUSION This first longitudinal study on the use of SRIs in OCD found that patients who had achieved partial or full remission on SRIs were less likely to discontinue medication, and the cumulative incidence of worsening of OCD after discontinuation was negatively associated with OCD severity at the time of SRI discontinuation.
- Published
- 2013
34. Design and Rationale for a Randomized Controlled Trial Testing the Efficacy of Aerobic Exercise for Patients with Obsessive-Compulsive Disorder
- Author
-
Julie Desaulniers, David R. Strong, Ana M. Abrantes, Maria C. Mancebo, Richard A. Brown, Deborah Riebe, Steven A. Rasmussen, Benjamin D. Greenberg, and Nicole C.R. McLaughlin
- Subjects
medicine.medical_specialty ,Exercise intervention ,business.industry ,Alternative medicine ,Psychological intervention ,behavioral disciplines and activities ,humanities ,Article ,law.invention ,Psychiatry and Mental health ,Pharmacotherapy ,Randomized controlled trial ,Obsessive compulsive ,law ,mental disorders ,Physical therapy ,Medicine ,Aerobic exercise ,In patient ,business ,Applied Psychology - Abstract
BACKGROUND: Over the last two decades very few advances have been made in the development of new treatments for obsessive-compulsive disorder (OCD). While patients with OCD improve with available treatments (pharmacotherapy and/or cognitive-behavioral therapy), moderate levels of OCD symptoms often persist even with adequate doses and durations of these treatments. Building on the growing body of evidence for the efficacy of exercise in the treatment of other psychiatric disorders, interventions to increase aerobic exercise in patients with OCD represent a potentially useful yet relatively unexplored strategy in OCD. METHODS/DESIGN: One hundred and two (102) patients with clinically significant OCD symptoms despite current engagement in recommended treatments (pharmacotherapy and/or CBT) will be randomly assigned to receive either a 12-week moderate intensity aerobic exercise (AE) intervention or a health education control (HEC) intervention. Follow-up interviews will be conducted at the end of treatment and at 3-, 6- and 12-months post-intervention. They will assess OCD severity, nonspecific anxiety, depression, quality of life, cardiorespiratory fitness and cognition (executive function). DISCUSSION: If efficacy is established, patients with OCD who have clinically significant residual symptoms despite current pharmacotherapy or CBT would gain a valuable and practical treatment augmentation option.
- Published
- 2012
35. Patient utilization of cognitive-behavioral therapy for OCD
- Author
-
Maria C. Mancebo, Ingrid R. Dyck, Steven A. Rasmussen, Jane L. Eisen, and Nicholas J. Sibrava
- Subjects
Adult ,Male ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Patient Dropouts ,medicine.medical_treatment ,behavioral disciplines and activities ,Article ,mental disorders ,medicine ,Humans ,Psychiatry ,Clinical Trials as Topic ,Cognitive Behavioral Therapy ,Public health ,Process Assessment, Health Care ,Social environment ,Patient Acceptance of Health Care ,medicine.disease ,Mental health ,Clinical trial ,Cognitive behavioral therapy ,Clinical Psychology ,Benchmarking ,Cognitive therapy ,Patient Compliance ,Observational study ,Female ,Self Report ,Psychology ,Anxiety disorder - Abstract
The current study examined utilization of cognitive-behavioral therapy (CBT) by individuals receiving treatment for obsessive-compulsive disorder (OCD). Participants were 202 adults with primary DSM-IV OCD who enrolled in a longitudinal, observational study of the course of OCD and completed 2 years of annual follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. One hundred twenty participants reported that a mental health professional recommended CBT for their OCD symptoms at some point during the 2-year follow-up period. One quarter (n = 31) of these participants did not initiate CBT despite receiving a treatment recommendation. Thirty-one percent of the 89 participants who entered CBT endorsed dropping out of CBT prematurely and less than one third received an adequate "dose" of CBT sessions. Self-reported CBT drop-out rates were significantly greater than attrition rates reported in clinical trials using intensive schedules of exposure and ritual prevention (EX/RP). Perceived environmental barriers and fears regarding treatment participation were the most frequently endorsed reasons for not participating or dropping out of CBT. Despite its efficacy for OCD, many individuals with clinically significant symptoms fail to initiate CBT when recommended by a mental health professional, receive treatments that are less intensive than those used in clinical trials, or drop out of treatment prematurely. Financial costs of CBT, difficulty attending sessions, and fears regarding treatment are significant barriers to initiating and completing therapy.
- Published
- 2010
36. Impulse control disorders in children and adolescents with obsessive compulsive disorder
- Author
-
Jon E. Grant, Jane L. Eisen, Maria C. Mancebo, and Steven A. Rasmussen
- Subjects
Male ,medicine.medical_specialty ,Tic disorder ,Obsessive-Compulsive Disorder ,Impulse control disorder ,Adolescent ,Comorbidity ,behavioral disciplines and activities ,Severity of Illness Index ,Article ,Severity of illness ,mental disorders ,medicine ,Humans ,Psychiatry ,Child ,Biological Psychiatry ,Nail biting ,Psychiatric Status Rating Scales ,medicine.disease ,humanities ,Substance abuse ,Disruptive, Impulse Control, and Conduct Disorders ,Psychiatry and Mental health ,Dual diagnosis ,Female ,Psychology ,Anxiety disorder ,Clinical psychology - Abstract
The aim of this study was to examine current prevalences, clinical correlates and patterns of co-occurrence of impulse control disorders (ICDs) in children and adolescents with obsessive compulsive disorder (OCD). We examined rates and clinical correlates of comorbid ICDs in 70 consecutive child and adolescent subjects with lifetime DSM-IV OCD (32.9% females; mean age = 13.8 ± 2.9 years). Comorbidity data were obtained with structured clinical interviews using DSM-IV criteria. OCD severity was assessed with the Child Yale-Brown Obsessive Compulsive Scale. All variables were compared in OCD subjects with and without current ICDs. 12 (17.1%) subjects met criteria for a current ICD. Pathological skin picking and compulsive nail biting were the most common ICDs with current rates of 12.8% and 10.0%, respectively. OCD subjects with current ICDs were significantly more likely to have a co-occurring tic disorder (66.7% vs. 20.7%; p=.003). Although having an ICD was associated with greater numerical scores of OCD symptomatology, these differences were not statistically significant. There were no sex-specific patterns of ICD occurrence in children and adolescents with OCD. Certain ICDs are common among children and adolescents with OCD. Better identification of ICDs in children and adolescents with OCD is needed, as are empirically validated treatments for youth with co-occurring ICDs.
- Published
- 2009
37. Obsessive-Compulsive Disorder in Young Adults
- Author
-
Maria C. Mancebo, Steven A. Rasmussen, and Jane L. Eisen
- Subjects
Obsessive compulsive ,Young adult ,Clinical psychology - Published
- 2009
38. A 2-year prospective follow-up study of the course of obsessive-compulsive disorder
- Author
-
Steven A. Rasmussen, Maria E. Orlando, Ingrid R. Dyck, Jane L. Eisen, Maria C. Mancebo, and Anthony Pinto
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,medicine.medical_treatment ,Comorbidity ,Severity of Illness Index ,Article ,Recurrence ,mental disorders ,Severity of illness ,Outcome Assessment, Health Care ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Psychiatry ,Depression (differential diagnoses) ,Probability ,Psychiatric Status Rating Scales ,Cognitive Behavioral Therapy ,medicine.disease ,Prognosis ,Survival Analysis ,Clinical trial ,Substance abuse ,Cognitive behavioral therapy ,Diagnostic and Statistical Manual of Mental Disorders ,Psychiatry and Mental health ,Treatment Outcome ,Female ,Psychology ,Anxiety disorder ,Follow-Up Studies - Abstract
Obsessive-compulsive disorder (OCD) is a common and frequently debilitating psychiatric disorder with considerable burden to both the individual and society in terms of lost productivity. Despite the increased recognition of the public health significance of OCD over the last 2 decades, surprisingly little is known about the long-term course and prognosis of the disorder. Clinical trials of cognitive-behavioral therapy (CBT) and/or serotonin reuptake inhibitors (SRIs), and much less frequently neurosurgery, document sustained effects of treatment.1–6 Prospective, observational studies of illness course have several advantages over follow-up studies of treatment trials. Most treatment trials, due to sample size, have limited power to address the likelihood of remission and relapse over time or which clinical characteristics affect these probabilities. Efficacy studies also have more stringent inclusion criteria and often exclude comorbid disorders such as depression, substance abuse, personality disorders, and medical problems, limiting the generalizability of the sample. Observational studies of illness course are designed to detect patterns of remission and relapse in representative clinical samples. These studies, which now exist for the other psychiatric disorders, have added valuable, new, unanticipated information on prognosis, patterns of remission and relapse, factors affecting these patterns, and the underutilization of effective treatments.7–11 Early retrospective reports of OCD course suggested the illness is usually chronic and lifelong.12 In contrast, a study by Skoog and Skoog13 on the course of OCD in 144 inpatients treated prior to the introduction of current OCD treatments reported low remission rates within the first decade (11% full remission; 17% partial remission) but slightly higher rates at the 40-year follow-up (20% full remission; 28% partial remission). Despite these low remission rates, two-thirds of the inpatients were improved within a decade after onset of OCD, and 83% were improved at the 40-year follow-up. Course findings from studies of adults with OCD conducted since the 1990s, when effective treatments of OCD (namely, CBT and SRIs) became widely available, have been inconsistent.4,14–19 Four prospective studies in particular have reported on the long-term course of treatment-seeking adults with OCD in naturalistic clinical settings.14–16,18 Rates of achieving at least partial remission (subclinical OCD symptoms) range from 52% of 66 outpatients treated over a 2-year prospective period in a US OCD specialty clinic15 to 76% of 75 patients followed up 11–13 years after initial treatment at a psychiatric hospital in India.18 Rates of full remission (no OCD symptoms) in these studies range from 17%15 to 43%.18 Differences in methodology may account for some of the variability in remission rates across studies. For example, in the study conducted by Reddy and colleagues,18 the majority of subjects were drug treatment–naive at study intake. All but one study were limited by small sample sizes,15,16,18 and the study with the largest sample size (N = 100) comprised patients ascertained for an anxiety disorder other than OCD.14 This article presents the first 2 years of longitudinal observation from the Brown Longitudinal Obsessive Compulsive Study (BLOCS). In this prospective study, we followed 214 patients whose primary reason for seeking clinical treatment was OCD and who reported that OCD was the most problematic disorder over their lifetime. On the basis of previous findings,13,15 we hypothesized that a substantial proportion of subjects would improve to the point of partial remission (subclinical symptoms), but full remission (no symptoms) would be observed less frequently. On the basis of our clinical experience and a review of putative predictors of outcome in OCD,17,19–21 we also hypothesized that greater symptom severity and the presence of hoarding as principal obsession would be associated with a lower likelihood of remission of OCD. Finally, consistent with previous findings that poor insight in OCD does not predict treatment response,22 we hypothesized that the presence of poor insight would not be associated with likelihood of remission.
- Published
- 2008
39. Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder
- Author
-
Amy M. Cohn, David R. Strong, Richard A. Brown, Ana M. Abrantes, Amy Y. Cameron, Maria C. Mancebo, and Benjamin D. Greenberg
- Subjects
Adult ,Male ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Physical exercise ,Anxiety ,Affect (psychology) ,behavioral disciplines and activities ,Intervention (counseling) ,mental disorders ,medicine ,Aerobic exercise ,Humans ,Psychiatry ,Exercise ,Middle Aged ,medicine.disease ,Psychiatry and Mental health ,Clinical Psychology ,Affect ,Mood ,Treatment Outcome ,Compulsive behavior ,Compulsive Behavior ,Female ,medicine.symptom ,Obsessive Behavior ,Psychology ,Anxiety disorder ,Clinical psychology ,Follow-Up Studies - Abstract
Aerobic exercise can acutely influence anxious and depressive mood in both clinical and nonclinical populations. However, there are no existing studies that have examined the acute effect of exercise on mood, anxiety, obsessions, and compulsions in patients with OCD. The primary aim of this study was to examine acute changes in these symptoms after engaging in single exercise sessions during a 12-week exercise intervention for 15 (53% female; mean age=41.9 years) patients with OCD. Participants reported reductions in negative mood, anxiety, and OCD symptoms at the end of each exercise session relative to the beginning. Changes in the magnitude of the effect of exercise in reducing negative mood and anxiety remained fairly stable while levels of self-reported obsessions and compulsions decreased over the duration of the intervention. Results of this study point toward the promising effect of exercise for acute symptom reduction in patients with OCD.
- Published
- 2008
40. Juvenile-Onset OCD: Clinical Features in Children, Adolescents and Adults
- Author
-
Joshua S. Kane, Steven A. Rasmussen, Jennifer B. Freeman, Robert L. Stout, Abbe Garcia, Anthony Pinto, Jane L. Eisen, Maria C. Mancebo, and Amy Przeworski
- Subjects
Adult ,Male ,Parents ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Self Disclosure ,Adolescent ,Substance-Related Disorders ,Comorbidity ,behavioral disciplines and activities ,Severity of Illness Index ,Article ,Feeding and Eating Disorders ,Surveys and Questionnaires ,mental disorders ,Severity of illness ,medicine ,Juvenile ,Humans ,Age of Onset ,Sex Distribution ,Psychiatry ,Child ,Aged ,Retrospective Studies ,Psychiatric Status Rating Scales ,Mood Disorders ,Middle Aged ,medicine.disease ,humanities ,Intake interview ,Psychiatry and Mental health ,Eating disorders ,Cross-Sectional Studies ,Mood disorders ,Attention Deficit Disorder with Hyperactivity ,Female ,Age of onset ,Psychology ,Anxiety disorder ,Follow-Up Studies - Abstract
Objective: To examine clinical correlates of juvenile-onset OCD across the lifespan. Method: Data collected at the intake interview from 257 consecutive participants with juvenile-onset OCD (20 children, 44 adolescents and 193 adults) in a naturalistic study of the clinical course of OCD were examined. Participants and parents of juvenile participants completed a structured diagnostic interview, rater-administered severity measures and self-report questionnaires. Results: Children and adolescents (i.e. juveniles) shared similar features with the exception of age at onset and OCD symptom expression. Clinically meaningful differences between juvenile and adult participants were also found. Compared with adults, juveniles were more likely to be male, recall an earlier age at OCD onset and have different lifetime comorbidity patterns. Conclusion: Juvenile-onset OCD symptom expression is remarkably similar across the lifespan. However, findings also suggest clinically meaningful differences between juveniles and adults. Future work using a prospective design will improve our understanding of course patterns of juvenile-onset OCD.
- Published
- 2008
41. Substance use disorders in an obsessive compulsive disorder clinical sample
- Author
-
Anthony Pinto, Jon E. Grant, Jane L. Eisen, Steven A. Rasmussen, and Maria C. Mancebo
- Subjects
Adult ,Male ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Substance-Related Disorders ,Comorbidity ,Personal Satisfaction ,Affect (psychology) ,behavioral disciplines and activities ,Severity of Illness Index ,Article ,Surveys and Questionnaires ,Severity of illness ,mental disorders ,medicine ,Prevalence ,Humans ,Psychiatry ,Borderline personality disorder ,Demography ,Mental Disorders ,Patient Acceptance of Health Care ,medicine.disease ,humanities ,Intake interview ,Substance abuse ,Diagnostic and Statistical Manual of Mental Disorders ,Psychiatry and Mental health ,Clinical Psychology ,Observational study ,Female ,Psychology ,Anxiety disorder ,Clinical psychology ,Follow-Up Studies - Abstract
The prevalence and clinical correlates of substance use disorders (SUDs) were examined in a clinical sample of Obsessive Compulsive Disorder (OCD). As part of their intake interview into an observational study of the course of OCD, 323 participants completed a battery of standardized measures. Twenty-seven percent of the sample met lifetime criteria for a SUD. 70% of participants with comorbid SUDs reported that OCD preceded SUD onset by at least one year. Younger age at OCD onset and presence of Borderline Personality Disorder (BPD) were each associated with increased risk of alcohol use disorders but only BPD was associated with increased risk of drug use disorders. SUDs affect more than one-quarter of individuals who seek treatment for OCD. Individuals with a juvenile-onset of OCD or comorbid BPD may be especially vulnerable to SUDs. Further research is needed to identify risk factors for SUDs and to better understand their impact on OCD course.
- Published
- 2007
42. A comparison of quality of life and psychosocial functioning in obsessive-compulsive disorder and body dysmorphic disorder
- Author
-
Mary M. Walters, Katharine A. Phillips, Anthony Pinto, Steven A. Rasmussen, Jane L. Eisen, Maria C. Mancebo, Elizabeth R. Didie, and William Menard
- Subjects
medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Health Status ,Emotions ,behavioral disciplines and activities ,Interviews as Topic ,Quality of life (healthcare) ,Obsessive compulsive ,Surveys and Questionnaires ,mental disorders ,medicine ,Humans ,Longitudinal Studies ,Psychiatry ,Social Behavior ,Somatoform Disorders ,General Medicine ,medicine.disease ,humanities ,Psychiatry and Mental health ,Body dysmorphic disorder ,Quality of Life ,Psychology ,Psychosocial ,Social Adjustment ,Clinical psychology - Abstract
Obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) are possibly related disorders characterized by poor functioning and quality of life. However, few studies have compared these disorders in these important domains.We compared functioning and quality of life in 210 OCD subjects, 45 BDD subjects, and 40 subjects with comorbid BDD+OCD using reliable and valid measures.OCD and BDD subjects had very poor scores across all measures, with no statistically significant differences between the groups. However, comorbid BDD+OCD subjects had greater impairment than OCD subjects on 11 scales/subscales, which remained significant after controlling for OCD severity. Comorbid BDD+OCD subjects had greater impairment than BDD subjects on 2 scales/subscales, which were no longer significant after controlling for BDD severity, suggesting that BDD severity may have accounted for greater morbidity in the comorbid BDD+OCD group.Functioning and quality of life were poor across all three groups, although individuals with comorbid BDD+OCD had greater impairment on a number of measures. It is important for clinicians to be aware that patients with these disorders--and, in particular, those with comorbid BDD and OCD--tend to have very poor functioning and quality of life across a broad range of domains.
- Published
- 2007
43. Obsessive-Compulsive Personality Disorder
- Author
-
Maria C. Mancebo, Jane L. Eisen, Anthony Pinto, and Steven A. Rasmussen
- Subjects
Psychotherapist ,medicine.medical_treatment ,media_common.quotation_subject ,Orderliness ,medicine.disease ,Personality disorders ,Obsessive–compulsive personality disorder ,DSM-5 ,Metacognitive therapy ,Distress ,medicine ,Cognitive therapy ,Personality ,Psychology ,Clinical psychology ,media_common - Abstract
Publisher Summary This chapter reviews the phenomenology of obsessive-compulsive personality disorder (OCPD), the disorder's controversial relationship with OCD, and the appropriateness of its inclusion in OCDs. The clinical diagnosis of OCPD is a chronic maladaptive pattern of excessive perfectionism, preoccupation with orderliness and detail, and need for control over one's environment that leads to significant distress or impairment, particularly in areas of interpersonal functioning. Individuals with this disorder are often characterized as rigid and overly controlling. They may find it difficult to relax, feel obligated to plan out their activities to the minute, and find unstructured time intolerable. Even though it is one of the most frequently diagnosed personality disorders across community and clinical samples, OCPD has received little empirical attention. There have been many theories regarding the etiology of OCPD, including biological and psychological models, but limited empirical data are available to support them. There are no empirically based treatments for OCPD. Clearly more systematic research are needed to further investigate treatment options for OCPD.
- Published
- 2007
44. Correlates of occupational disability in a clinical sample of obsessive-compulsive disorder
- Author
-
Anthony Pinto, Jon E. Grant, Benjamin D. Greenberg, Jane L. Eisen, Maria C. Mancebo, Steven A. Rasmussen, and Ingrid R. Dyck
- Subjects
Adult ,Employment ,Male ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,lcsh:RC435-571 ,Substance-Related Disorders ,medicine.medical_treatment ,Population ,Severity of Illness Index ,Article ,Quality of life (healthcare) ,lcsh:Psychiatry ,Mentally Ill Persons ,Activities of Daily Living ,medicine ,Humans ,Interpersonal Relations ,Longitudinal Studies ,education ,Psychiatry ,Depression (differential diagnoses) ,Aged ,education.field_of_study ,Cognitive Behavioral Therapy ,Depression ,Middle Aged ,medicine.disease ,Cognitive behavioral therapy ,Substance abuse ,Psychiatry and Mental health ,Clinical Psychology ,Quality of Life ,Anxiety ,Regression Analysis ,Female ,medicine.symptom ,Psychology ,Anxiety disorder ,Selective Serotonin Reuptake Inhibitors ,Psychopathology - Abstract
Results— At the time of interview, 38% of the sample reported being unable to work due to psychopathology. OCD with occupational disability was associated with greater functional impairment in completing household duties, social functioning, and quality of life. Few differences in treatments received were found among individuals with and without occupational disability. Although number of years on psychotropic medications was similar among the two groups, those with disability had been on a greater number of serotonin-reuptake inhibitors (SRIs) lifetime. Half of individuals with occupational disability had entered cognitive-behavioral therapy (CBT) at some point but only one-third had received at least 13 sessions. Regression analyses revealed that OCD severity was the most powerful predictor of occupational disability, followed by depression severity, and presence of a lifetime substance use disorder. Conclusions—A substantial proportion of individuals in our sample were unable to work. CBT treatment was underutilized and reasons for this remain unclear. Comorbid depression and substance use present additional risk factors for disability. Further advances in biological and psychosocial treatments are needed to improve functioning and the overall prognosis of the disorder. OCD is a chronic psychiatric illness that affects from 1.6–3% of the worldwide population (1,2). The disorder is characterized by persistent, intrusive thoughts (obsessions), and repetitive intentional behaviors (compulsions). These symptoms persist despite individuals’ attempts to eliminate them, and are accompanied by marked and often overwhelming anxiety. Typical obsessions are unrealistic concerns with cleanliness, order, and harm avoidance that, in the extreme, can occupy nearly every waking moment. Typical compulsive behaviors are excessive hand washing, counting and checking rituals that can disrupt all routine activities.
- Published
- 2006
45. Taboo thoughts and doubt/checking: a refinement of the factor structure for obsessive-compulsive disorder symptoms
- Author
-
Steven A. Rasmussen, Robert L. Stout, Anthony Pinto, Benjamin D. Greenberg, Maria C. Mancebo, and Jane L. Eisen
- Subjects
Adult ,Male ,Obsessive-Compulsive Disorder ,Psychometrics ,Personality Inventory ,media_common.quotation_subject ,Culture ,Hoarding ,Poison control ,Article ,Developmental psychology ,Thinking ,medicine ,Taboo ,Humans ,Biological Psychiatry ,media_common ,Observer Variation ,Principal Component Analysis ,Aggression ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Exploratory factor analysis ,Psychiatry and Mental health ,Female ,Personality Assessment Inventory ,medicine.symptom ,Stereotyped Behavior ,Psychology ,Anxiety disorder - Abstract
The purpose of this report was to improve upon earlier factor analyses of obsessive-compulsive disorder (OCD) symptom categories by minimizing the heterogeneity in the aggressive obsessions category. An exploratory factor analysis was conducted on data from 293 adults with primary OCD. The resulting five factors (Symmetry/Ordering, Hoarding, Doubt/Checking, Contamination/Cleaning, and Taboo Thoughts) are phenomenologically more homogeneous than prior category-based factors and are consistent with those derived in previous item-level analyses.
- Published
- 2006
46. Impulse control disorders in adults with obsessive compulsive disorder
- Author
-
Steven A. Rasmussen, Jane L. Eisen, Jon E. Grant, Anthony Pinto, and Maria C. Mancebo
- Subjects
Adult ,Male ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Impulse control disorder ,Comorbidity ,behavioral disciplines and activities ,Severity of Illness Index ,Quality of life ,Obsessive compulsive ,mental disorders ,Epidemiology ,Severity of illness ,medicine ,Humans ,Psychiatry ,Biological Psychiatry ,Nail biting ,Aged ,Psychiatric Status Rating Scales ,Middle Aged ,medicine.disease ,humanities ,Diagnostic and Statistical Manual of Mental Disorders ,Disruptive, Impulse Control, and Conduct Disorders ,Psychiatry and Mental health ,Quality of Life ,Female ,Psychology ,Anxiety disorder ,Clinical psychology - Abstract
Little is known about impulse control disorders (ICDs) in individuals with obsessive compulsive disorder (OCD). Although studies have examined ICD comorbidity in OCD, no previous studies have examined clinical correlates of ICD comorbidity in a large sample of individuals with a primary diagnosis of OCD. We examined rates and clinical correlates of comorbid ICDs in 293 consecutive subjects with lifetime DSM-IV OCD (56.8% females; mean age=40.6+/-12.9 years). Comorbidity data were obtained with the Structured Clinical Interview for DSM-IV. ICDs were diagnosed with structured clinical interviews using DSM-IV criteria. OCD severity was assessed with the Yale-Brown Obsessive-Compulsive Scale. Quality of life and social/occupational functioning were examined using the Quality of Life Enjoyment and Satisfaction Questionnaire and the Social and Occupational Functioning Assessment Scale. All variables were compared in OCD subjects with and without lifetime and current ICDs. Forty-eight (16.4%) OCD subjects had a lifetime ICD, and 34 (11.6%) had a current ICD. Skin picking was the most common lifetime (10.4%) and current (7.8%) ICD, followed by nail biting with lifetime and current rates of 4.8% and 2.4%, respectively. OCD subjects with current ICDs had significantly worse OCD symptoms and poorer functioning and quality of life. These preliminary results suggest that there is a low prevalence of ICDs among individuals with OCD, although certain ICDs (skin picking) appear to be more common.
- Published
- 2005
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