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The Treatment of Severe, Chronic, Resistant Obsessive-Compulsive Disorder

An Evaluation of an In-patient Programme Using Behavioural Psychotherapy in Combination with Other Treatments

Published online by Cambridge University Press:  02 January 2018

Lynne M. Drummond
Lynne M. Drummond*
Affiliation:
Department of Mental Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE
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Abstract

This study examined 49 in-patients with obsessive-compulsive disorder who were treated over three years. The patients had failed to respond to previous treatment. Treatment consisted of in-patient exposure, occasionally combined with other interventions individually tailored to the patient's specific difficulties. This resulted in significant clinical improvements and an average 40% reduction in rituals in 31 (63.3%) of these chronic patients. These gains were maintained at an average 19-month follow-up. Checking rituals were more likely to be associated with good outcome. Women had a later onset of the disorder and a slight tendency to better prognosis. No other predictors of outcome were found.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 163 , Issue 2 , August 1993 , pp. 223 - 229
Copyright
Copyright © Royal College of Psychiatrists, 1993 

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References

Adshead, G. A., Drummond, L. M. & Mercer, S. (1988) Paradoxical intention and anti-exposure: a case report of its use in a non-com pliant, negativistic obsessive-compulsive ritualiser. British Journal of Psychiatry, 153, 821–823.CrossRefGoogle Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Psychiatric Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Bartlett, A. E. A. & Drummond, L. M. (1990) Hysterical conversion and dissociation arising as a complication of behavioural psychotherapy treatment of obsessive-compulsive disorder. British Journal of Medical Psychology, 163, 109–115.CrossRefGoogle Scholar
Beck, A. T., Rial, W. Y. & Rickels, K. (1974) Short form of the depression inventory: cross validation. Psychological Reports, 34, 1184–1186.Google Scholar
Drummond, L. M. & Gravestock, S. (1988) Delayed emergence of obsessive-compulsive neurosis following head injury: case report and review of its theoretical implications. British Journal of Psychiatry, 153, 839–842.CrossRefGoogle ScholarPubMed
Foa, E. B. (1979) Failures in treating obsessive-compulsives. Behaviour Research and Therapy, 17, 169–176.Google Scholar
Foa, E. B. & Goldstein, A. (1978) Continuous exposure and complete response prevention in the treatment of obsessive-compulsive neurosis. Behaviour Therapy, 9, 821–829.Google Scholar
Goodman, W. K., Price, L. H., Delgado, P. L., et al (1990) Specificity of serotonin reuptake inhibitors in the treatment of obsessive disorder: comparison of fluvoxamine and desipramine. Archives of General Psychiatry, 47, 277–585.Google Scholar
Headland, K. & McDonald, R. (1987) Rapid audiotaped treatment of obsessional ruminations. Behavioural Psychotherapy, 15, 188–192.CrossRefGoogle Scholar
Hoogduin, C. A. L. & Hoogduin, W. A. (1984) The out-patient treatment of patients with an obsessive-compulsive disorder. Behaviour Research and Therapy, 22, 455–459.CrossRefGoogle Scholar
Insel, T. R., Murphy, D. L., Cohen, R., et al (1983) Clomipramine and clorygyline in OCD. Archives of General Psychiatry, 40, 605–612.Google Scholar
Lovell, K., Marks, I. M., Noshirvani, H. F., et al (1993) Should treatment distinguish anxiogenic from anxiolytic obsessive-compulsive ruminations? Results of a pilot controlled study and clinical audit. (Submitted.) Google Scholar
Marks, I. M. (1983) Are there anticompulsive or antiphobic drugs? Review of the evidence. British Journal of Psychiatry, 143, 338–347.Google Scholar
Marks, I. M., Hodgson, R. & Rachman, S. (1975) Treatment of chronic obsessive-compulsive disorder 2 years after in vivo exposure. British Journal of Psychiatry, 127, 349–364.CrossRefGoogle Scholar
Marks, I. M., Stern, R. S., Mawson, D., et al (1980) Clomipramine and exposure for obsessive-compulsive rituals. British Journal of Psychiatry, 136, 1–25.Google Scholar
Marks, I. M., Leluot, P., Basoglu, M., et al (1988) Clomipramine, selfexposure and therapist-aided exposure for obsessive-compulsive rituals. British Journal of Psychiatry, 152, 522–534.Google Scholar
Mavikassalion, M., Turner, S., Michelson, L., et al (1985) Tricyclic antidepressants in obsessive-compulsive disorder: antiobsessional or antidepressant agents? American Journal of Psychiatry, 142, 572–576.Google Scholar
Mawson, D., Marks, I. M. & Ramm, E. (1982) Clomipramine and exposure for chronic oc rituals: III. Two-year follow-up. British Journal of Psychiatry, 140, 11–18.CrossRefGoogle Scholar
McDougle, C. J. & Goodman, W. K. (1991) Obsessive-compulsive disorder: pharmacotherapy and pathophysiology. Current Opinion in Psychiatry, 4, 267–272.Google Scholar
Montgomery, S. A. (1980) Clomipramine in obsessional neurosis: a placebo controlled trial. Pharmaceutical Medicine, 1, 189–192.Google Scholar
Noshirvani, H. F., Kasvikis, Y., Marks, I. M., et al (1991) Gender divergent aetiological factors in obsessive-compulsive disorder. British Journal of Psychiatry, 158, 260–263.Google Scholar
Pigott, T. A., Pato, M. T., Berstein, S. E., et al (1990) Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder. Archives of General Psychiatry, 47, 926–932.Google Scholar
Rachman, S. (1976) obsessional-compulsive checking. Behaviour Research and Therapy, 14, 269–277.Google Scholar
Rachman, S. & Hodgson, R. J. (1980) Obsessions and Compulsions. New Jersey: Prentice-Hall.Google Scholar
Rasmussen, S. A. & Tsuang, M. T. (1986) Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. American Journal of Psychiatry, 143, 317–322.Google Scholar
Salkovskis, P. M. (1983) Treatment of an obsessional patient using habituation to audiotaped ruminations. British Journal of Clinical Psychology, 22, 311–313.Google Scholar
Salkovskis, P. M. & Warwick, H. M. C. (1985) Cognitive therapy of obsessive-compulsive disorder: treating treatment failures. Behavioural Psychotherapy, 13, 243–255.Google Scholar
Stern, R. S. & Cobb, J. P. (1978) Phenomenology of obsessive-compulsive neurosis. British Journal of Psychiatry, 132, 233–239.Google Scholar
Thornicroft, G., Colson, L. & Marks, I. M. (1991) An in-patient behavioural psychotherapy unit: description and audit. British Journal of Psychiatry, 158, 362–367.Google Scholar
World Health Organization (1978) Glossary of Mental Disorders and Guide for their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). Geneva: WHO.Google Scholar
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