Intensive residential treatment for severe obsessive-compulsive disorder: Characterizing treatment course and predictors of response

Abstract

Background Intensive residential treatment (IRT) is effective for severe, treatment-resistant obsessive-compulsive disorder (OCD). We sought to characterize predictors and course of response to IRT. Methods Admission, monthly, and discharge data were collected on individuals receiving IRT. We examined the association between baseline characteristics and percent change in OCD symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) using linear regression. We compared baseline characteristics of IRT responders (≥35% reduction in Y-BOCS) versus non-responders, and of patients who did versus those who did not achieve wellness (Y-BOCS ≤12) using non-parametric tests. To examine the course of OCD severity over time, we used linear mixed-effects models with randomly varying intercepts and slopes. Results We evaluated 281 individuals admitted to an IRT program. Greater baseline Y-BOCS scores were associated with a significantly greater percent reduction in Y-BOCS scores (β = −1.49 ([95% confidence interval: −2.06 to −0.93]; P<.001). IRT responders showed significantly greater baseline Y-BOCS scores than non-responders (mean (SD) 28 (5.2) vs. 25.6 (5.8); P=.003) and lower past-year alcohol use scores than non-responders (1.4 (1.9) vs. 2.1 (2.2); P=.01). Participants who achieved wellness displayed lower hoarding factor scores than those who did not (5 (4.6) vs. 9.53 (6.3); P=.03). OCD symptoms declined rapidly over the first month but more slowly over the remaining two months. Conclusions Higher baseline OCD severity, lower past-year alcohol use, and fewer hoarding symptoms predicted better response to IRT. IRT yielded an initial rapid reduction in OCD symptoms, followed by a slower decline after the first month.

An Examination of Rostral Anterior Cingulate Cortex Function and Neurochemistry in Obsessive–Compulsive Disorder

“…Given the possibility that cerebral Glu levels may be affected by nicotine use (Licata and Renshaw, 2010), we cannot rule out the potential confounding effects of nicotine use on our findings. Finally, the OCD patients included in this study were being treated in an intensive residential treatment program and thus likely represent a severe, treatment-refractory subgroup (Brennan et al, 2014). Therefore, our findings may not be reflective of the broader OCD population.…”

Outcomes for residential or inpatient intensive treatment of obsessive–compulsive disorder: A systematic review and meta-analysis

“…We identified 41 studies that met our screening criteria of treatment of OCD in either an inpatient, day-patient or residential unit setting. Of these, 22 were excluded for failing to meet one of the criteria: one because patients were from an outpatient service (Olatunji et al, 2013); three for not using the Y-BOCS as an outcome measure (Kwee, Duivenvoorden, Trijsburg, & Thiel, 1986;Ruppert, Zaudig, Hauke, Thora, & Reinecker, 2001; Van den Hout, Emmelkamp, Kraaykamp, & Griez, 1988); four because they used the Y-BOCS self-report version (Cole Monaghan et al, 2015;Grøtte et al, 2015;Simpson et al, 2013), two because they were adolescent services (Arai, Ichikawa, Ejiri, & Watanabe, 2006;Bjorgvinsson et al, 2008); two because they reported on treatment outcomes for an eating disorders service, with only some patients having comorbid OCD (Cumella, Kally, & Wall, 2007;Olatunji, Tart, Shewmaker, Wall, & Smits, 2010); one for having a sample size of two patients (Carmin & Wiegartz, 2000); or nine patients (Drummond, Pillay, Kolb, & Rani, 2007); one for being a review rather than a research study (Winkelmann & Hohagen, 1995); two because they did not include CBT as part of the treatment (Haghighi et al, 2013;Shafti & Kaviani, 2015); one for not including data on post-treatment Y-BOCS scores (Brennan et al, 2014); and one as it was unpublished (Alosso, 2012).…”

“…In addition, we wanted to investigate predictors of treatment outcome and dropout rates during treatment (see Table 2). Therefore, 10 of the studies included in the meta-analysis which also included analysis of predictors of treatment outcome and dropout were combined with three studies that were excluded from the meta-analysis as they included only predictors of treatment outcome (Brennan et al, 2014;Stewart et al, 2009Stewart et al, , 2006.…”

Lower Posterior Cingulate Cortex Glutathione Levels in Obsessive-Compulsive Disorder

“…Given the possibility that cerebral GSH levels may be impacted by nicotine use (82), we cannot exclude a potential confounding effect of nicotine use on our findings. Finally, our OCD patients were recruited from an intensive residential treatment program, and thus likely represented a severe, treatment-refractory subgroup (83), potentially not representative of the broader OCD population.…”