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).
According to a new paper
published in the September issue of the Psychiatric
Bulletin, 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.