Community model in treating obsessive–compulsive and body dysmorphic disorders

Abstract

Aims and MethodIn 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.ResultsIn 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 ImplicationsThe feasibility of extending this model of service organisation to other areas and other diagnoses is discussed.

Comparative Prevalence of Eating Disorders in Obsessive-Compulsive Disorder and Other Anxiety Disorders

“…Our sample included all patients who were 18 years or older ( N = 255) and assessed at a regional specialist unit for complex anxiety disorders over a period of 2.5 years (January 2008–June 2010). More details about this service are described elsewhere [ 29 – 31 ]. Referrals were received from general practitioners, primary care psychologists, and secondary care clinicians from southwest London (Kingston, Richmond, Merton, Sutton, and Wandsworth).…”

National service for adolescents and adults with severe obsessive–compulsive and body dysmorphic disorders

“…This leaves 3500 potentially to be treated at level 6. However, currently only a small percentage of individuals present for treatment and many prefer to manage for many years on their own before accepting treatment (Hollander & Wong, 1998).…”

CBT for OCD: habituation or cognitive shift?

“…community mental health settings (Drummond et al 2008). It remains the case that CBT does not work for all patients due to variables including the therapy process (Polman et al 2010), and the refusal of exposure and response prevention (ERP) and associated drop-out (Foa et al 2005).…”