Obsessive-Compulsive Disorder
Current Science and Clinical Practice
Herausgegeben von Zohar, Joseph
Obsessive-Compulsive Disorder
Current Science and Clinical Practice
Herausgegeben von Zohar, Joseph
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Obsessive compulsive disorder (OCD) remains one of the most challenging disorders of the brain.
Contemporary conceptualization and therapeutic strategies are undergoing a revolution as a result of new insights derived from modern technological advances. This book was conceived in order to present this revolution to the reader. It covers current theories regarding the etiology of OCD, what is known about the genetics of this disorder, evidence from neuroimaging and a discussion of potential endophenotypes. There is an evaluation of current treatment approaches for the disorder, encompassing…mehr
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Obsessive compulsive disorder (OCD) remains one of the most challenging disorders of the brain.
Contemporary conceptualization and therapeutic strategies are undergoing a revolution as a result of new insights derived from modern technological advances. This book was conceived in order to present this revolution to the reader. It covers current theories regarding the etiology of OCD, what is known about the genetics of this disorder, evidence from neuroimaging and a discussion of potential endophenotypes. There is an evaluation of current treatment approaches for the disorder, encompassing psychological, psychopharmacological and physical interventions, as well as a discussion of treatment resistance. The book considers methodological issues, plus reviews of OCD in pediatric populations. A summary chapter highlights some potential research avenues, in a discussion of the future directions in OCD.
Rather than provide comprehensive coverage, repeating material from standard psychiatry textbooks, this book focuses on recent information and its application, distinguishing it from other titles.
If you work in children with OCD,
If you are interested in genetics, neurocognition or brain imaging,
If you work with patients and would like to improve your assessment in OCD and OCD Spectrum disorders, to update your therapeutic strategies and to get a handle on cutting edge developments in this intriguing field,
If you are planning a research project in OCD and would like to get some hints from people who are research leaders in this field and also learn about methodological issues specific to OCD research,
then this book will be a valuable resource.
A concise overview of the current state of the art in OCD assessment and treatment, including physical interventions and treatment resistance
Focuses on scientific advances (including specific methodological issues) and how they can inform and benefit clinical practice
Looks critically and broadly at the diagnostic classification, including the ongoing revision of the two major international systems
Written by an A-list team of experts in the field who have a track record of being engaging authors
Hinweis: Dieser Artikel kann nur an eine deutsche Lieferadresse ausgeliefert werden.
Contemporary conceptualization and therapeutic strategies are undergoing a revolution as a result of new insights derived from modern technological advances. This book was conceived in order to present this revolution to the reader. It covers current theories regarding the etiology of OCD, what is known about the genetics of this disorder, evidence from neuroimaging and a discussion of potential endophenotypes. There is an evaluation of current treatment approaches for the disorder, encompassing psychological, psychopharmacological and physical interventions, as well as a discussion of treatment resistance. The book considers methodological issues, plus reviews of OCD in pediatric populations. A summary chapter highlights some potential research avenues, in a discussion of the future directions in OCD.
Rather than provide comprehensive coverage, repeating material from standard psychiatry textbooks, this book focuses on recent information and its application, distinguishing it from other titles.
If you work in children with OCD,
If you are interested in genetics, neurocognition or brain imaging,
If you work with patients and would like to improve your assessment in OCD and OCD Spectrum disorders, to update your therapeutic strategies and to get a handle on cutting edge developments in this intriguing field,
If you are planning a research project in OCD and would like to get some hints from people who are research leaders in this field and also learn about methodological issues specific to OCD research,
then this book will be a valuable resource.
A concise overview of the current state of the art in OCD assessment and treatment, including physical interventions and treatment resistance
Focuses on scientific advances (including specific methodological issues) and how they can inform and benefit clinical practice
Looks critically and broadly at the diagnostic classification, including the ongoing revision of the two major international systems
Written by an A-list team of experts in the field who have a track record of being engaging authors
Hinweis: Dieser Artikel kann nur an eine deutsche Lieferadresse ausgeliefert werden.
Produktdetails
- Produktdetails
- World Psychiatric Association .
- Verlag: Wiley & Sons
- 1. Auflage
- Seitenzahl: 360
- Erscheinungstermin: 13. August 2012
- Englisch
- Abmessung: 246mm x 175mm x 23mm
- Gewicht: 703g
- ISBN-13: 9780470711255
- ISBN-10: 0470711256
- Artikelnr.: 34743141
- World Psychiatric Association .
- Verlag: Wiley & Sons
- 1. Auflage
- Seitenzahl: 360
- Erscheinungstermin: 13. August 2012
- Englisch
- Abmessung: 246mm x 175mm x 23mm
- Gewicht: 703g
- ISBN-13: 9780470711255
- ISBN-10: 0470711256
- Artikelnr.: 34743141
Joseph Zohar is Department Chair of the Division of Psychiatry at Chaim Sheba Medical Center, Tel Hashomer, Israel. He is also Professor of Psychiatry at the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. He is President of the European College of Neuropharmacology, Associate editor of the World Journal of Biological Psychiatry and International editor of CNS. Dr. Zohar has received numerous awards, including: Fogarty International Research Fellowship Award, in 1984; A.E. Bennet Award for Clinical Research in 1986; European College of Neuropsychopharmacology - Lilly Neuroscience Award for Clinical Research in 1998; and World Federation Society of Biological Psychiatry on excellency in education in 2001.
List of Contributors xii Introduction xvii SECTION 1 ASSESSMENT AND
TREATMENT 1 Assessment 3 Jose M. Menchon Introduction 3 Detecting OCD 5
Screening in clinical interview 7 Structured interviews 8 Clinical
assessment of obsessive-compulsive symptoms 9 Yale-brown
obsessive-compulsive scale 10 Dimensional yale-brown obsessive-compulsive
scale (DY-BOCS) 11 Leyton obsessional inventory (LOI) 12 Maudsley
obsessional-compulsive inventory (MOCI) 13 Padua inventory (PI) 13
Obsessive compulsive inventory (OCI) 14 Insight 14 Rating insight 15
Assessment of the risk of suicide 17 Differential diagnosis, comorbidities
and related disorders 18 Organic brain disorders 19 Schizophrenia 20
Depression 20 Hypochondriasis 20 Phobias 21 Tourette disorder and tic
disorders 21 Obsessive-compulsive personality disorder (OCPD) 21 Body
dysmorphic disorder (BDD) 21 Hoarding 22 Other disorders 22 Conclusions 22
References 23 2 Pharmacotherapy of obsessive-compulsive disorder 31 Eric H.
Decloedt and Dan J. Stein Introduction 31 Placebo-controlled studies of
clomipramine 32 Placebo-controlled studies of fluvoxamine 32
Placebo-controlled studies of fluoxetine 33 Placebo-controlled studies of
paroxetine 34 Placebo-controlled studies of sertraline 34
Placebo-controlled studies of citalopram/escitalopram 34 Placebo-controlled
studies of venlafaxine 35 Improving early response in OCD 35 Special
populations: children 36 Clomipramine 36 Fluvoxamine 36 Fluoxetine 36
Paroxetine 37 Sertraline 37 Citalopram 38 Meta-analyses 38 Tolerability of
clomipramine and serotonin reuptake inhibitors 40 Optimal dose of treatment
41 Duration of treatment 42 Refractory OCD 43 Increased dose of SSRI 43
Augmentation of SSRI treatment with antipsychotics 44 Other drugs 45
Alternative modes of administration of SSRIs 46 Combining SRIs 46 Switching
SSRIs 46 Adding psychotherapy 47 Future therapeutic options 47 Conclusion
48 References 48 3 Cognitive behavioural therapy in obsessive-compulsive
disorder: state of the art 58 Martin E. Franklin, Addie Goss and John S.
March Theoretical models 58 Treatment 60 Exposure plus response prevention
(ERP) 60 Cognitive therapies 63 ERP plus medication 63 OCD protocols 64
Assessment 64 Adult ERP protocol 65 Paediatric ERP protocol 67
Dissemination 67 Future research 69 Summary 69 References 70 4
Electroconvulsive therapy, transcranial magnetic stimulation and deep brain
stimulation in OCD 75 Rianne M. Blom, Martijn Figee, Nienke Vulink and
Damiaan Denys Introduction 75 Electroconvulsive therapy 75 Transcranial
magnetic stimulation 76 Mechanism of action 77 Efficacy of rTMS in OCD 77
Side effects and safety 84 Conclusion and future directions 85 Lesioning 85
Deep brain stimulation 86 Efficacy of DBS in OCD 86 Mechanism of action of
DBS in OCD 92 Side effects of DBS in OCD 92 Follow-up treatment 94
Conclusions: DBS 94 Conclusion 94 Acknowledgements 95 References 95 5
Approaches to treatment resistance 99 Stefano Pallanti, Giacomo Grassi and
Andrea Cantisani Terminological problems and operational definitions 100
Pharmacological strategies in resistant OCD 103 Switching 103 Infusion
therapy 104 Cognitive behavioural therapy 105 Serotoninergic agents 106
Dopaminergic agents 108 Glutamatergic agents 113 Opioids 115 Physical
therapies 115 Electroconvulsive therapy (ECT) 115 Repetitive transcranial
magnetic stimulation (rTMS) 116 Deep brain stimulation (DBS) 116 Family
intervention 117 Conclusions and future perspectives 117 References 118
SECTION 2 CLINICAL SPOTLIGHTS 6 Subtypes and spectrum issues 135 Eric
Hollander, Steven Poskar and Adriel Gerard The obsessive-compulsive
spectrum 135 Introduction 135 Cluster approach 135 Compulsivity and
impulsivity 137 Repetitive behaviour domain 138 Determining placement of
proposed OCSDs using cross-cutting domains 139 Obsessive-compulsive
spectrum nosology 144 OCD subtypes: understanding the heterogeneity of OCD
148 Dimensional approach 148 Associated symptom domains 150 Compulsive
hoarding: OCPD, OCD subtype, dimension, OCSD or something else? 151
Conclusion 154 References 154 7 Paediatric OCD: developmental aspects and
treatment considerations 160 Daniel A. Geller, Alyssa L. Faro, Ashley R.
Brown and Hannah C. Levy Introduction 160 Epidemiology 160 Aetiological
considerations 161 Genetic factors 161 Non-genetic factors 164 Aetiology:
summary 167 Clinical features 167 Gender and age at onset 168 Elaboration
of phenotypic dimensions 168 Comorbid conditions 169 Neuropsychological
endophenotypes 170 Clinical features: summary 170 Clinical assessment 171
Differential diagnosis 172 Normal development 172 Other psychiatric
disorders 172 Treatment 173 Pharmacotherapy 174 Moderating effect of
comorbid conditions 175 Multimodal treatment 176 Medication augmentation
strategies in treatment resistance 177 Safety and tolerability 178
Treatment: summary 178 Course and prognosis 179 Conclusions and future
research 179 Acknowledgements 180 References 180 SECTION 3 RESEARCH
SPOTLIGHTS 8 Methodological issues for clinical treatment trials in
obsessive-compulsive disorder 193 Samar Reghunandanan and Naomi A. Fineberg
Introduction 193 Randomized controlled trials 194 The rationale of placebo
196 Recruitment criteria 199 Diagnosis 199 OCD dimensions and subtypes 200
The problem of comorbidity 201 Rating scales for OCD trials 203 Evaluating
anxiety and depression in OCD 204 Measuring response and remission 205
Relapse prevention 207 Treatment-resistant OCD 208 Psychological treatment
trials 209 Integrated pharmacological and psychological treatments in OCD
210 Health-related quality of life 211 Summary 211 References 212 9
Serotonin and beyond: a neurotransmitter perspective of OCD 220 Anat Abudy,
Alzbeta Juven-Wetzler, Rachel Sonnino and Joseph Zohar Serotonin 221
Serotonin and metabolite concentrations in OCD - 30 years later 222
Pharmacological challenge tests 224 Pharmacotherapy 225 Animal models and
the role of serotonin 226 Dopamine 227 Dopamine and metabolite
concentrations in humans 227 Pharmacological challenge tests 228
Pharmacotherapy 229 Animal models and the role of dopamine 231 Glutamate
232 The glutamatergic influence 232 Glutamate and metabolite concentrations
in humans 232 Animal models and the role of glutamate 233 Serotonin: is it
the one to blame? 233 The puzzle of antipsychotics and OCD: Is dopamine the
answer? 234 So, is it a question of location? (Or . . . location, location,
location?) 234 References 235 10 Brain imaging 244 David R. Rosenberg,
Phillip C. Easter and Georgia Michalopoulou Neuroimaging modalities 244
Structural assessment 244 Functional neurochemical assessment 245
Structural assessment of OCD 246 Total brain volume/ventricles 246 Basal
ganglia 246 Prefrontal cortex 248 Medial temporal-limbic cortex 252
Pituitary 253 Supramarginal gyrus 253 White matter 254 Functional
neuroimaging studies of OCD 255 Neurochemistry 258 Serotonin 258
N-acetyl-aspartate 258 Choline 259 Creatine/phosphocreatine 262 Glutamate
262 Conclusion 266 Acknowledgements 267 References 268 11 The genetics of
obsessive-compulsive disorder: current status 277 David L. Pauls
Introduction 277 Twin studies 277 Family studies 279 Family history studies
280 Family interview studies 280 Segregation analyses 284 Candidate gene
studies 285 Genetic linkage studies 290 Future work 291 Acknowledgements
292 References 292 12 Neurocognitive angle: the search for endophenotypes
300 Samuel R. Chamberlain and Lara Menzies Introduction 300 Heritability of
OCD 301 The concept of an endophenotype 302 Applying the endophenotype
construct to OCD 305 Domains of interest in hierarchical modelling of OCD
307 Cognition 307 Neuroimaging 308 Searching for endophenotypes of OCD 311
Cognition 311 Neuroimaging 313 Other potential endophenotypes 316 Summary
317 Acknowledgements and disclosures 319 References 320 13 Conclusion and
future directions 327 Joseph Zohar References 329 Index 331
TREATMENT 1 Assessment 3 Jose M. Menchon Introduction 3 Detecting OCD 5
Screening in clinical interview 7 Structured interviews 8 Clinical
assessment of obsessive-compulsive symptoms 9 Yale-brown
obsessive-compulsive scale 10 Dimensional yale-brown obsessive-compulsive
scale (DY-BOCS) 11 Leyton obsessional inventory (LOI) 12 Maudsley
obsessional-compulsive inventory (MOCI) 13 Padua inventory (PI) 13
Obsessive compulsive inventory (OCI) 14 Insight 14 Rating insight 15
Assessment of the risk of suicide 17 Differential diagnosis, comorbidities
and related disorders 18 Organic brain disorders 19 Schizophrenia 20
Depression 20 Hypochondriasis 20 Phobias 21 Tourette disorder and tic
disorders 21 Obsessive-compulsive personality disorder (OCPD) 21 Body
dysmorphic disorder (BDD) 21 Hoarding 22 Other disorders 22 Conclusions 22
References 23 2 Pharmacotherapy of obsessive-compulsive disorder 31 Eric H.
Decloedt and Dan J. Stein Introduction 31 Placebo-controlled studies of
clomipramine 32 Placebo-controlled studies of fluvoxamine 32
Placebo-controlled studies of fluoxetine 33 Placebo-controlled studies of
paroxetine 34 Placebo-controlled studies of sertraline 34
Placebo-controlled studies of citalopram/escitalopram 34 Placebo-controlled
studies of venlafaxine 35 Improving early response in OCD 35 Special
populations: children 36 Clomipramine 36 Fluvoxamine 36 Fluoxetine 36
Paroxetine 37 Sertraline 37 Citalopram 38 Meta-analyses 38 Tolerability of
clomipramine and serotonin reuptake inhibitors 40 Optimal dose of treatment
41 Duration of treatment 42 Refractory OCD 43 Increased dose of SSRI 43
Augmentation of SSRI treatment with antipsychotics 44 Other drugs 45
Alternative modes of administration of SSRIs 46 Combining SRIs 46 Switching
SSRIs 46 Adding psychotherapy 47 Future therapeutic options 47 Conclusion
48 References 48 3 Cognitive behavioural therapy in obsessive-compulsive
disorder: state of the art 58 Martin E. Franklin, Addie Goss and John S.
March Theoretical models 58 Treatment 60 Exposure plus response prevention
(ERP) 60 Cognitive therapies 63 ERP plus medication 63 OCD protocols 64
Assessment 64 Adult ERP protocol 65 Paediatric ERP protocol 67
Dissemination 67 Future research 69 Summary 69 References 70 4
Electroconvulsive therapy, transcranial magnetic stimulation and deep brain
stimulation in OCD 75 Rianne M. Blom, Martijn Figee, Nienke Vulink and
Damiaan Denys Introduction 75 Electroconvulsive therapy 75 Transcranial
magnetic stimulation 76 Mechanism of action 77 Efficacy of rTMS in OCD 77
Side effects and safety 84 Conclusion and future directions 85 Lesioning 85
Deep brain stimulation 86 Efficacy of DBS in OCD 86 Mechanism of action of
DBS in OCD 92 Side effects of DBS in OCD 92 Follow-up treatment 94
Conclusions: DBS 94 Conclusion 94 Acknowledgements 95 References 95 5
Approaches to treatment resistance 99 Stefano Pallanti, Giacomo Grassi and
Andrea Cantisani Terminological problems and operational definitions 100
Pharmacological strategies in resistant OCD 103 Switching 103 Infusion
therapy 104 Cognitive behavioural therapy 105 Serotoninergic agents 106
Dopaminergic agents 108 Glutamatergic agents 113 Opioids 115 Physical
therapies 115 Electroconvulsive therapy (ECT) 115 Repetitive transcranial
magnetic stimulation (rTMS) 116 Deep brain stimulation (DBS) 116 Family
intervention 117 Conclusions and future perspectives 117 References 118
SECTION 2 CLINICAL SPOTLIGHTS 6 Subtypes and spectrum issues 135 Eric
Hollander, Steven Poskar and Adriel Gerard The obsessive-compulsive
spectrum 135 Introduction 135 Cluster approach 135 Compulsivity and
impulsivity 137 Repetitive behaviour domain 138 Determining placement of
proposed OCSDs using cross-cutting domains 139 Obsessive-compulsive
spectrum nosology 144 OCD subtypes: understanding the heterogeneity of OCD
148 Dimensional approach 148 Associated symptom domains 150 Compulsive
hoarding: OCPD, OCD subtype, dimension, OCSD or something else? 151
Conclusion 154 References 154 7 Paediatric OCD: developmental aspects and
treatment considerations 160 Daniel A. Geller, Alyssa L. Faro, Ashley R.
Brown and Hannah C. Levy Introduction 160 Epidemiology 160 Aetiological
considerations 161 Genetic factors 161 Non-genetic factors 164 Aetiology:
summary 167 Clinical features 167 Gender and age at onset 168 Elaboration
of phenotypic dimensions 168 Comorbid conditions 169 Neuropsychological
endophenotypes 170 Clinical features: summary 170 Clinical assessment 171
Differential diagnosis 172 Normal development 172 Other psychiatric
disorders 172 Treatment 173 Pharmacotherapy 174 Moderating effect of
comorbid conditions 175 Multimodal treatment 176 Medication augmentation
strategies in treatment resistance 177 Safety and tolerability 178
Treatment: summary 178 Course and prognosis 179 Conclusions and future
research 179 Acknowledgements 180 References 180 SECTION 3 RESEARCH
SPOTLIGHTS 8 Methodological issues for clinical treatment trials in
obsessive-compulsive disorder 193 Samar Reghunandanan and Naomi A. Fineberg
Introduction 193 Randomized controlled trials 194 The rationale of placebo
196 Recruitment criteria 199 Diagnosis 199 OCD dimensions and subtypes 200
The problem of comorbidity 201 Rating scales for OCD trials 203 Evaluating
anxiety and depression in OCD 204 Measuring response and remission 205
Relapse prevention 207 Treatment-resistant OCD 208 Psychological treatment
trials 209 Integrated pharmacological and psychological treatments in OCD
210 Health-related quality of life 211 Summary 211 References 212 9
Serotonin and beyond: a neurotransmitter perspective of OCD 220 Anat Abudy,
Alzbeta Juven-Wetzler, Rachel Sonnino and Joseph Zohar Serotonin 221
Serotonin and metabolite concentrations in OCD - 30 years later 222
Pharmacological challenge tests 224 Pharmacotherapy 225 Animal models and
the role of serotonin 226 Dopamine 227 Dopamine and metabolite
concentrations in humans 227 Pharmacological challenge tests 228
Pharmacotherapy 229 Animal models and the role of dopamine 231 Glutamate
232 The glutamatergic influence 232 Glutamate and metabolite concentrations
in humans 232 Animal models and the role of glutamate 233 Serotonin: is it
the one to blame? 233 The puzzle of antipsychotics and OCD: Is dopamine the
answer? 234 So, is it a question of location? (Or . . . location, location,
location?) 234 References 235 10 Brain imaging 244 David R. Rosenberg,
Phillip C. Easter and Georgia Michalopoulou Neuroimaging modalities 244
Structural assessment 244 Functional neurochemical assessment 245
Structural assessment of OCD 246 Total brain volume/ventricles 246 Basal
ganglia 246 Prefrontal cortex 248 Medial temporal-limbic cortex 252
Pituitary 253 Supramarginal gyrus 253 White matter 254 Functional
neuroimaging studies of OCD 255 Neurochemistry 258 Serotonin 258
N-acetyl-aspartate 258 Choline 259 Creatine/phosphocreatine 262 Glutamate
262 Conclusion 266 Acknowledgements 267 References 268 11 The genetics of
obsessive-compulsive disorder: current status 277 David L. Pauls
Introduction 277 Twin studies 277 Family studies 279 Family history studies
280 Family interview studies 280 Segregation analyses 284 Candidate gene
studies 285 Genetic linkage studies 290 Future work 291 Acknowledgements
292 References 292 12 Neurocognitive angle: the search for endophenotypes
300 Samuel R. Chamberlain and Lara Menzies Introduction 300 Heritability of
OCD 301 The concept of an endophenotype 302 Applying the endophenotype
construct to OCD 305 Domains of interest in hierarchical modelling of OCD
307 Cognition 307 Neuroimaging 308 Searching for endophenotypes of OCD 311
Cognition 311 Neuroimaging 313 Other potential endophenotypes 316 Summary
317 Acknowledgements and disclosures 319 References 320 13 Conclusion and
future directions 327 Joseph Zohar References 329 Index 331
List of Contributors xii Introduction xvii SECTION 1 ASSESSMENT AND
TREATMENT 1 Assessment 3 Jose M. Menchon Introduction 3 Detecting OCD 5
Screening in clinical interview 7 Structured interviews 8 Clinical
assessment of obsessive-compulsive symptoms 9 Yale-brown
obsessive-compulsive scale 10 Dimensional yale-brown obsessive-compulsive
scale (DY-BOCS) 11 Leyton obsessional inventory (LOI) 12 Maudsley
obsessional-compulsive inventory (MOCI) 13 Padua inventory (PI) 13
Obsessive compulsive inventory (OCI) 14 Insight 14 Rating insight 15
Assessment of the risk of suicide 17 Differential diagnosis, comorbidities
and related disorders 18 Organic brain disorders 19 Schizophrenia 20
Depression 20 Hypochondriasis 20 Phobias 21 Tourette disorder and tic
disorders 21 Obsessive-compulsive personality disorder (OCPD) 21 Body
dysmorphic disorder (BDD) 21 Hoarding 22 Other disorders 22 Conclusions 22
References 23 2 Pharmacotherapy of obsessive-compulsive disorder 31 Eric H.
Decloedt and Dan J. Stein Introduction 31 Placebo-controlled studies of
clomipramine 32 Placebo-controlled studies of fluvoxamine 32
Placebo-controlled studies of fluoxetine 33 Placebo-controlled studies of
paroxetine 34 Placebo-controlled studies of sertraline 34
Placebo-controlled studies of citalopram/escitalopram 34 Placebo-controlled
studies of venlafaxine 35 Improving early response in OCD 35 Special
populations: children 36 Clomipramine 36 Fluvoxamine 36 Fluoxetine 36
Paroxetine 37 Sertraline 37 Citalopram 38 Meta-analyses 38 Tolerability of
clomipramine and serotonin reuptake inhibitors 40 Optimal dose of treatment
41 Duration of treatment 42 Refractory OCD 43 Increased dose of SSRI 43
Augmentation of SSRI treatment with antipsychotics 44 Other drugs 45
Alternative modes of administration of SSRIs 46 Combining SRIs 46 Switching
SSRIs 46 Adding psychotherapy 47 Future therapeutic options 47 Conclusion
48 References 48 3 Cognitive behavioural therapy in obsessive-compulsive
disorder: state of the art 58 Martin E. Franklin, Addie Goss and John S.
March Theoretical models 58 Treatment 60 Exposure plus response prevention
(ERP) 60 Cognitive therapies 63 ERP plus medication 63 OCD protocols 64
Assessment 64 Adult ERP protocol 65 Paediatric ERP protocol 67
Dissemination 67 Future research 69 Summary 69 References 70 4
Electroconvulsive therapy, transcranial magnetic stimulation and deep brain
stimulation in OCD 75 Rianne M. Blom, Martijn Figee, Nienke Vulink and
Damiaan Denys Introduction 75 Electroconvulsive therapy 75 Transcranial
magnetic stimulation 76 Mechanism of action 77 Efficacy of rTMS in OCD 77
Side effects and safety 84 Conclusion and future directions 85 Lesioning 85
Deep brain stimulation 86 Efficacy of DBS in OCD 86 Mechanism of action of
DBS in OCD 92 Side effects of DBS in OCD 92 Follow-up treatment 94
Conclusions: DBS 94 Conclusion 94 Acknowledgements 95 References 95 5
Approaches to treatment resistance 99 Stefano Pallanti, Giacomo Grassi and
Andrea Cantisani Terminological problems and operational definitions 100
Pharmacological strategies in resistant OCD 103 Switching 103 Infusion
therapy 104 Cognitive behavioural therapy 105 Serotoninergic agents 106
Dopaminergic agents 108 Glutamatergic agents 113 Opioids 115 Physical
therapies 115 Electroconvulsive therapy (ECT) 115 Repetitive transcranial
magnetic stimulation (rTMS) 116 Deep brain stimulation (DBS) 116 Family
intervention 117 Conclusions and future perspectives 117 References 118
SECTION 2 CLINICAL SPOTLIGHTS 6 Subtypes and spectrum issues 135 Eric
Hollander, Steven Poskar and Adriel Gerard The obsessive-compulsive
spectrum 135 Introduction 135 Cluster approach 135 Compulsivity and
impulsivity 137 Repetitive behaviour domain 138 Determining placement of
proposed OCSDs using cross-cutting domains 139 Obsessive-compulsive
spectrum nosology 144 OCD subtypes: understanding the heterogeneity of OCD
148 Dimensional approach 148 Associated symptom domains 150 Compulsive
hoarding: OCPD, OCD subtype, dimension, OCSD or something else? 151
Conclusion 154 References 154 7 Paediatric OCD: developmental aspects and
treatment considerations 160 Daniel A. Geller, Alyssa L. Faro, Ashley R.
Brown and Hannah C. Levy Introduction 160 Epidemiology 160 Aetiological
considerations 161 Genetic factors 161 Non-genetic factors 164 Aetiology:
summary 167 Clinical features 167 Gender and age at onset 168 Elaboration
of phenotypic dimensions 168 Comorbid conditions 169 Neuropsychological
endophenotypes 170 Clinical features: summary 170 Clinical assessment 171
Differential diagnosis 172 Normal development 172 Other psychiatric
disorders 172 Treatment 173 Pharmacotherapy 174 Moderating effect of
comorbid conditions 175 Multimodal treatment 176 Medication augmentation
strategies in treatment resistance 177 Safety and tolerability 178
Treatment: summary 178 Course and prognosis 179 Conclusions and future
research 179 Acknowledgements 180 References 180 SECTION 3 RESEARCH
SPOTLIGHTS 8 Methodological issues for clinical treatment trials in
obsessive-compulsive disorder 193 Samar Reghunandanan and Naomi A. Fineberg
Introduction 193 Randomized controlled trials 194 The rationale of placebo
196 Recruitment criteria 199 Diagnosis 199 OCD dimensions and subtypes 200
The problem of comorbidity 201 Rating scales for OCD trials 203 Evaluating
anxiety and depression in OCD 204 Measuring response and remission 205
Relapse prevention 207 Treatment-resistant OCD 208 Psychological treatment
trials 209 Integrated pharmacological and psychological treatments in OCD
210 Health-related quality of life 211 Summary 211 References 212 9
Serotonin and beyond: a neurotransmitter perspective of OCD 220 Anat Abudy,
Alzbeta Juven-Wetzler, Rachel Sonnino and Joseph Zohar Serotonin 221
Serotonin and metabolite concentrations in OCD - 30 years later 222
Pharmacological challenge tests 224 Pharmacotherapy 225 Animal models and
the role of serotonin 226 Dopamine 227 Dopamine and metabolite
concentrations in humans 227 Pharmacological challenge tests 228
Pharmacotherapy 229 Animal models and the role of dopamine 231 Glutamate
232 The glutamatergic influence 232 Glutamate and metabolite concentrations
in humans 232 Animal models and the role of glutamate 233 Serotonin: is it
the one to blame? 233 The puzzle of antipsychotics and OCD: Is dopamine the
answer? 234 So, is it a question of location? (Or . . . location, location,
location?) 234 References 235 10 Brain imaging 244 David R. Rosenberg,
Phillip C. Easter and Georgia Michalopoulou Neuroimaging modalities 244
Structural assessment 244 Functional neurochemical assessment 245
Structural assessment of OCD 246 Total brain volume/ventricles 246 Basal
ganglia 246 Prefrontal cortex 248 Medial temporal-limbic cortex 252
Pituitary 253 Supramarginal gyrus 253 White matter 254 Functional
neuroimaging studies of OCD 255 Neurochemistry 258 Serotonin 258
N-acetyl-aspartate 258 Choline 259 Creatine/phosphocreatine 262 Glutamate
262 Conclusion 266 Acknowledgements 267 References 268 11 The genetics of
obsessive-compulsive disorder: current status 277 David L. Pauls
Introduction 277 Twin studies 277 Family studies 279 Family history studies
280 Family interview studies 280 Segregation analyses 284 Candidate gene
studies 285 Genetic linkage studies 290 Future work 291 Acknowledgements
292 References 292 12 Neurocognitive angle: the search for endophenotypes
300 Samuel R. Chamberlain and Lara Menzies Introduction 300 Heritability of
OCD 301 The concept of an endophenotype 302 Applying the endophenotype
construct to OCD 305 Domains of interest in hierarchical modelling of OCD
307 Cognition 307 Neuroimaging 308 Searching for endophenotypes of OCD 311
Cognition 311 Neuroimaging 313 Other potential endophenotypes 316 Summary
317 Acknowledgements and disclosures 319 References 320 13 Conclusion and
future directions 327 Joseph Zohar References 329 Index 331
TREATMENT 1 Assessment 3 Jose M. Menchon Introduction 3 Detecting OCD 5
Screening in clinical interview 7 Structured interviews 8 Clinical
assessment of obsessive-compulsive symptoms 9 Yale-brown
obsessive-compulsive scale 10 Dimensional yale-brown obsessive-compulsive
scale (DY-BOCS) 11 Leyton obsessional inventory (LOI) 12 Maudsley
obsessional-compulsive inventory (MOCI) 13 Padua inventory (PI) 13
Obsessive compulsive inventory (OCI) 14 Insight 14 Rating insight 15
Assessment of the risk of suicide 17 Differential diagnosis, comorbidities
and related disorders 18 Organic brain disorders 19 Schizophrenia 20
Depression 20 Hypochondriasis 20 Phobias 21 Tourette disorder and tic
disorders 21 Obsessive-compulsive personality disorder (OCPD) 21 Body
dysmorphic disorder (BDD) 21 Hoarding 22 Other disorders 22 Conclusions 22
References 23 2 Pharmacotherapy of obsessive-compulsive disorder 31 Eric H.
Decloedt and Dan J. Stein Introduction 31 Placebo-controlled studies of
clomipramine 32 Placebo-controlled studies of fluvoxamine 32
Placebo-controlled studies of fluoxetine 33 Placebo-controlled studies of
paroxetine 34 Placebo-controlled studies of sertraline 34
Placebo-controlled studies of citalopram/escitalopram 34 Placebo-controlled
studies of venlafaxine 35 Improving early response in OCD 35 Special
populations: children 36 Clomipramine 36 Fluvoxamine 36 Fluoxetine 36
Paroxetine 37 Sertraline 37 Citalopram 38 Meta-analyses 38 Tolerability of
clomipramine and serotonin reuptake inhibitors 40 Optimal dose of treatment
41 Duration of treatment 42 Refractory OCD 43 Increased dose of SSRI 43
Augmentation of SSRI treatment with antipsychotics 44 Other drugs 45
Alternative modes of administration of SSRIs 46 Combining SRIs 46 Switching
SSRIs 46 Adding psychotherapy 47 Future therapeutic options 47 Conclusion
48 References 48 3 Cognitive behavioural therapy in obsessive-compulsive
disorder: state of the art 58 Martin E. Franklin, Addie Goss and John S.
March Theoretical models 58 Treatment 60 Exposure plus response prevention
(ERP) 60 Cognitive therapies 63 ERP plus medication 63 OCD protocols 64
Assessment 64 Adult ERP protocol 65 Paediatric ERP protocol 67
Dissemination 67 Future research 69 Summary 69 References 70 4
Electroconvulsive therapy, transcranial magnetic stimulation and deep brain
stimulation in OCD 75 Rianne M. Blom, Martijn Figee, Nienke Vulink and
Damiaan Denys Introduction 75 Electroconvulsive therapy 75 Transcranial
magnetic stimulation 76 Mechanism of action 77 Efficacy of rTMS in OCD 77
Side effects and safety 84 Conclusion and future directions 85 Lesioning 85
Deep brain stimulation 86 Efficacy of DBS in OCD 86 Mechanism of action of
DBS in OCD 92 Side effects of DBS in OCD 92 Follow-up treatment 94
Conclusions: DBS 94 Conclusion 94 Acknowledgements 95 References 95 5
Approaches to treatment resistance 99 Stefano Pallanti, Giacomo Grassi and
Andrea Cantisani Terminological problems and operational definitions 100
Pharmacological strategies in resistant OCD 103 Switching 103 Infusion
therapy 104 Cognitive behavioural therapy 105 Serotoninergic agents 106
Dopaminergic agents 108 Glutamatergic agents 113 Opioids 115 Physical
therapies 115 Electroconvulsive therapy (ECT) 115 Repetitive transcranial
magnetic stimulation (rTMS) 116 Deep brain stimulation (DBS) 116 Family
intervention 117 Conclusions and future perspectives 117 References 118
SECTION 2 CLINICAL SPOTLIGHTS 6 Subtypes and spectrum issues 135 Eric
Hollander, Steven Poskar and Adriel Gerard The obsessive-compulsive
spectrum 135 Introduction 135 Cluster approach 135 Compulsivity and
impulsivity 137 Repetitive behaviour domain 138 Determining placement of
proposed OCSDs using cross-cutting domains 139 Obsessive-compulsive
spectrum nosology 144 OCD subtypes: understanding the heterogeneity of OCD
148 Dimensional approach 148 Associated symptom domains 150 Compulsive
hoarding: OCPD, OCD subtype, dimension, OCSD or something else? 151
Conclusion 154 References 154 7 Paediatric OCD: developmental aspects and
treatment considerations 160 Daniel A. Geller, Alyssa L. Faro, Ashley R.
Brown and Hannah C. Levy Introduction 160 Epidemiology 160 Aetiological
considerations 161 Genetic factors 161 Non-genetic factors 164 Aetiology:
summary 167 Clinical features 167 Gender and age at onset 168 Elaboration
of phenotypic dimensions 168 Comorbid conditions 169 Neuropsychological
endophenotypes 170 Clinical features: summary 170 Clinical assessment 171
Differential diagnosis 172 Normal development 172 Other psychiatric
disorders 172 Treatment 173 Pharmacotherapy 174 Moderating effect of
comorbid conditions 175 Multimodal treatment 176 Medication augmentation
strategies in treatment resistance 177 Safety and tolerability 178
Treatment: summary 178 Course and prognosis 179 Conclusions and future
research 179 Acknowledgements 180 References 180 SECTION 3 RESEARCH
SPOTLIGHTS 8 Methodological issues for clinical treatment trials in
obsessive-compulsive disorder 193 Samar Reghunandanan and Naomi A. Fineberg
Introduction 193 Randomized controlled trials 194 The rationale of placebo
196 Recruitment criteria 199 Diagnosis 199 OCD dimensions and subtypes 200
The problem of comorbidity 201 Rating scales for OCD trials 203 Evaluating
anxiety and depression in OCD 204 Measuring response and remission 205
Relapse prevention 207 Treatment-resistant OCD 208 Psychological treatment
trials 209 Integrated pharmacological and psychological treatments in OCD
210 Health-related quality of life 211 Summary 211 References 212 9
Serotonin and beyond: a neurotransmitter perspective of OCD 220 Anat Abudy,
Alzbeta Juven-Wetzler, Rachel Sonnino and Joseph Zohar Serotonin 221
Serotonin and metabolite concentrations in OCD - 30 years later 222
Pharmacological challenge tests 224 Pharmacotherapy 225 Animal models and
the role of serotonin 226 Dopamine 227 Dopamine and metabolite
concentrations in humans 227 Pharmacological challenge tests 228
Pharmacotherapy 229 Animal models and the role of dopamine 231 Glutamate
232 The glutamatergic influence 232 Glutamate and metabolite concentrations
in humans 232 Animal models and the role of glutamate 233 Serotonin: is it
the one to blame? 233 The puzzle of antipsychotics and OCD: Is dopamine the
answer? 234 So, is it a question of location? (Or . . . location, location,
location?) 234 References 235 10 Brain imaging 244 David R. Rosenberg,
Phillip C. Easter and Georgia Michalopoulou Neuroimaging modalities 244
Structural assessment 244 Functional neurochemical assessment 245
Structural assessment of OCD 246 Total brain volume/ventricles 246 Basal
ganglia 246 Prefrontal cortex 248 Medial temporal-limbic cortex 252
Pituitary 253 Supramarginal gyrus 253 White matter 254 Functional
neuroimaging studies of OCD 255 Neurochemistry 258 Serotonin 258
N-acetyl-aspartate 258 Choline 259 Creatine/phosphocreatine 262 Glutamate
262 Conclusion 266 Acknowledgements 267 References 268 11 The genetics of
obsessive-compulsive disorder: current status 277 David L. Pauls
Introduction 277 Twin studies 277 Family studies 279 Family history studies
280 Family interview studies 280 Segregation analyses 284 Candidate gene
studies 285 Genetic linkage studies 290 Future work 291 Acknowledgements
292 References 292 12 Neurocognitive angle: the search for endophenotypes
300 Samuel R. Chamberlain and Lara Menzies Introduction 300 Heritability of
OCD 301 The concept of an endophenotype 302 Applying the endophenotype
construct to OCD 305 Domains of interest in hierarchical modelling of OCD
307 Cognition 307 Neuroimaging 308 Searching for endophenotypes of OCD 311
Cognition 311 Neuroimaging 313 Other potential endophenotypes 316 Summary
317 Acknowledgements and disclosures 319 References 320 13 Conclusion and
future directions 327 Joseph Zohar References 329 Index 331