Trials in Obsessive Compulsive Disorder Highlight Group Therapy, Escitalopram, and Anticonvulsants: Presented at CPA

(November 19, 2006) - MONTREAL, CANADA -- -- The latest research on the management of obsessive compulsive disorder (OCD) suggests that cognitive behaviour therapy (CBT) can be as effective in groups and in the office as it is in one-on-one sessions and in the home. Also, the antidepressant escitalopram and anticonvulsants topiramate and lamotrigine may play a more important therapeutic role than has previously been recognised.

Pratap Chokka, MD, Associate Clinical Professor, University of Alberta, Psychiatrist, Grey Nuns Hospital, Edmonton, Canada, presented the latest findings on the management of OCD here on November 17 at the 57th Annual Conference of the Canadian Psychiatric Association (CPA).

Currently, CBT is a mainstay of treatment for OCD. As a stand-alone treatment, it has been found in some studies to be as effective as antidepressants. While one-on-one CBT therapy was believed until recently to be the most effective option, 2007 data has revealed that, in fact, both individual and group therapy are effective. While response rates were faster with individual therapy, overall response rates were similar with both modalities. This is an important finding for a real world setting, where patients are often on waiting lists to receive CBT, said Dr. Chokka.

Office-based CBT, in another 2007 trial, was found to be as effective as home-based CBT. "We have this idea that if you have a therapist that comes home with you and can work through your rituals at home that maybe that's going to be a better outcome," said Dr. Chokka during his presentation "The good news is that you can actually have this kind of very systematised psychotherapy in office, which can then be translated into a positive outcome."

In terms of pharmacotherapy, 2006 Canadian guidelines recommend fluvoxamine, fluoxetine, paroxetine, sertraline, or clomipramine as first-line options for OCD. Since then, recent data have demonstrated potential benefits for escitalopram as well as some anticonvulsants.

In a head-to-head trial with paroxetine, escitalopram was shown to offer an earlier response rate, higher rate of remission, and better tolerability. Other recent trials showed that escitalopram is beneficial for preventing OCD relapses and is effective for treating pathological skin picking, a notoriously difficult-to-treat subtype of OCD.

A retrospective, open-label, case series showed that addition of the anticonvulsant topiramate is an effective augmentation strategy in patients with OCD who are nonresponsive or partially responsive to serotonin reuptake inhibitors (SRIs). Also, the anticonvulsant lamotrigine was effective for pathological skin picking in a recent open-label study.

Looking to the future, said Dr. Chokka, novel approaches to therapy will be developed as the neurobiology of OCD is better understood. It is also clinically important to conceptualise OCD as a spectrum disorder associated with multiple comorbidities.

By Alison Palkhivala
Source: Doctor's Guide

Last updated: 11/07

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