Archetypal compulsive disorders (obsessive-compulsive related disorders, and gambling disorder) are common, and associated with long typical duration of untreated illness. Even after presenting, patients may not tolerate first-line interventions or experience adequate symptom remission, and are not always offered other treatments. This symposium will consider what is known of illness duration and chronicity in compulsive disorders and how these can be minimised, including via innovations in treatment. Professor Fineberg will consider the typically long duration of untreated illness in OCD and its consequences; and will present first-line evidence-based approaches (CBT, SSRIs) as well as additional options (including showing novel data from the FEATSOCS study). Professor Grant will examine hair pulling disorder and skin picking disorder, describing what is known of longitudinal symptom course. He will survey treatments of CBT with habit reversal, plus opioid and glutamate modulators (including from a new memantine clinical trial). Professor Chamberlain will review harms arising from gambling disorder when left untreated. Gambling disorder is now an NHS long-term priority. He will consider factors associated with treatment resistance (including from pooled analysis of clinical trials), and evidence-based interventions of CBT with motivational interviewing; as well as pharmacological interventions, informed by a new network meta-analysis.

 

• Describe core symptoms of compulsive disorders
• Understand the typically long duration of untreated illness in compulsive disorders and its consequences (including symptom chronicity and negative outcomes)
• Describe first-line interventions for compulsive disorders
• Describe innovative treatment options for compulsive disorders when first-line interventions are not tolerated or are not effective