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Community model in treating obsessive–compulsive and body dysmorphic disorders

  • L. M. Drummond (a1), A. Pillay (a2), P. J. Kolb (a2), S. Benson (a2), R. Fogg (a2), E. Jones-Thomas (a2) and S. Rani (a2)...
Abstract
Aims and Method

In November 2005, the National Institute for Health and Clinical Excellence published guidelines for the treatment of obsessive–compulsive disorder (OCD) and body dysmorphic disorder. These guidelines incorporated a stepped care approach with different interventions advised throughout the patient pathway. 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 deliver this model of care. To aid the delivery of service it was decided to operationalise the definitions of severity of OCD/body dysmorphic disorder at each of the stepped-care levels. Examples are given as to how this has been applied in practice. Outcome is presented in terms of clinical hours in the first year of operation.

Results

In total, 108 patients were referred to the service in the first year. Many of these patients were treated by offering advice and support and joint working with the community mental health team and psychotherapy in primary care teams who had referred. Sixty-eight patients were treated by a member of the specialist service alone and 57 of these suffered from severe OCD. Outcome data from these 57 patients is presented using an intention-to-treat paradigm. They showed a clinically and statistically significant reduction in OCD symptoms after 24 weeks of cognitive–behavioural therapy comprising graded exposure and self-imposed response prevention. the mean Yale–Brown Obsessive Compulsive Scale score dropped from 28 (severe OCD) to 19 (considerable OCD). Depressive symptoms on the Beck Depression Inventory also decreased by an average 24% over the same period.

Clinical Implications

The feasibility of extending this model of service organisation to other areas and other diagnoses is discussed.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Angst, J., Gamma, A., Endrass, J., et al (2005) Obsessive–compulsive syndromes and disorders: significance of comorbidity with bipolar and anxiety syndromes. European Archives of Psychiatry Clinical Neuroscience, 255, 6571.
American Psychiatric Association (1994) Diagnostic and Statistical Manual for Psychiatric Disorders (4th edn) (DSM–IV). APA.
Beck, A.T. (1978) Depression Inventory. Center for Cognitive Therapy.
Drummond, L. M., Pillay, A., Kolb, P., et al (2007) Specialised in-patient treatment for severe, chronic, resistant obsessive–compulsive disorder. Psychiatric Bulletin, 31, 4952.
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989) The Yale–Brown Obsessive Compulsive Scale II. Validity. Archives of General Psychiatry, 46, 10061011.
Karno, M., Golding, J. M., Sorenson, S. B., et al (1988) The epidemiology of obsessive–compulsive disorder in five US communities. Archives of General Psychiatry, 45, 10941099.
National Institute of Health and Clinical Excellence (2006) Obsessive–Compulsive Disorder: Core Interventions in the Treatment of Obsessive–Compulsive Disorder and Body Dysmorphic Disorder. NICE.
Pallanti, S., Hollander, E., Bienstock, C., et al (2002) Treatment non-response in OCD: methodological issues and operational definitions. International Journal of Neuropsychopharmacology, 5, 181191.
World Health Organization (1992) ICD–10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines (9th revision). WHO.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Community model in treating obsessive–compulsive and body dysmorphic disorders

  • L. M. Drummond (a1), A. Pillay (a2), P. J. Kolb (a2), S. Benson (a2), R. Fogg (a2), E. Jones-Thomas (a2) and S. Rani (a2)...
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