Specialist South London Service Successful In Treating People With Severe Obsessive Compulsive Disorder

Main Category: Mental Health
Also Included In: Psychology / Psychiatry
Article Date: 02 Sep 2008 - 1:00 PDT

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A specialist service in south London has proved successful in reducing the severity of symptoms among people with obsessive compulsive disorder (OCD) and body dysmorphic disorder.

In November 2005, the National Institute for Health and Clinical Excellence (NICE) published new guidelines for the treatment of OCD and body dysmorphic disorder. These guidelines propose a stepped-care approach, with six different levels depending on the severity of a person's symptoms and conditions.

South West London and St George's Mental Health NHS Trust devised a system of expert clinicians with special expertise in OCD/body dysmorphic disorder to help patients who were at level 5 of the NICE guidelines. These people are unlikely to be working due to disability, have been prescribed selective serotonin reuptake inhibitors (SSRIs), and have already unsuccessfully received cognitive behavioural therapy (CBT).

The service was established in April 2006 and, during the first year, 68 people were treated. Of these, 57 (28 men and 29 women) suffered from severe OCD. All had received appropriate treatment in their local areas but had failed to improve significantly.

The mean age was 39 and they had, on average, experienced OCD for the past 19 years. Many also had comorbid diagnoses, including clinical depression, other anxiety disorders, drug or alcohol misuse, secondary body dysmorphic disorder, eating disorder and post-traumatic stress disorder.

Each person was offered a course of CBT, with the emphasis on prolonged graded exposure in real life with self-imposed response prevention. Their medication was also reviewed.

After 28 weeks of treatment, the individuals all showed a clinically and statistically significant reduction in their OCD symptoms. The mean Yale-Brown Obsessive Compulsive Scale score for the 57 individuals dropped from 28 (which indicates severe OCD) to 19 (considerable OCD). There was also a decrease in their depressive symptoms.

The study authors concluded that the service, which concentrates on those people with the most severe illness, is extremely cost-effective. They suggest that each healthcare region could benefit from developing a similar specialist community treatment centre for people with OCD and body dysmorphic disorders.

Reference:

"Community model in treating obsessive-compulsive and body dysmorphic disorders."
Drummond LM, Pillay A, Kolb PJ, Benson S, Fogg R, Jones-Thomas E and Rani S (2008)
Psychiatric Bulletin, 32: 336-340

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Royal College of Psychiatrists