Screening young people for obsessive-compulsive disorder

Uher, Rudolf; Heyman, Isobel; Mortimore, Catherine; Frampton, Ian; Goodman, Robert

doi:10.1192/bjp.bp.106.034967

Cited by 49 publications

(51 citation statements)

References 14 publications

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“…In these settings OCS has usually been measured by means of various OCD screening questionnaires, the most commonly used being the 20-item survey form of the Leyton Obsessional Inventory-Children's Version (20-item LOI-CV) . Unlike other OCD screening tools, which in order to facilitate use consist of few items and are as a result unidimensional in nature (Hudziak et al 2006;Uher et al 2007), there is evidence to suggest that the factor structure of the 20-item LOI-CV is multidimensional (Bamber et al 2002;Berg et al 1988;Maggini et al 2001;Mathews et al 2007). Studies are inconsistent, however, in the number and nature of factors identified.…”

Section: Introductionmentioning

confidence: 88%

Alternative Factor Models and Heritability of the Short Leyton Obsessional Inventory—Children’s Version

Moore

Smith

Shevlin

et al. 2010

J Abnorm Child Psychol

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An alternative models framework was used to test three confirmatory factor analytic models for the Short Leyton Obsessional Inventory-Children's Version (Short LOI-CV) in a general population sample of 517 young adolescent twins (11-16 years). A one-factor model as implicit in current classification systems of Obsessive-Compulsive Disorder (OCD), a two-factor obsessions and compulsions model, and a multidimensional model corresponding to the three proposed subscales of the Short LOI-CV (labelled Obsessions/Incompleteness, Numbers/Luck and Cleanliness) were considered. The three-factor model was the only model to provide an adequate explanation of the data. Twin analyses suggested significant quantitative sex differences in heritability for both the Obsessions/Incompleteness and Numbers/Luck dimensions with these being significantly heritable in males only (heritability of 60% and 65% respectively). The correlation between the additive genetic effects for these two dimensions in males was 0.95 suggesting they largely share the same genetic risk factors.

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Section: Introductionmentioning

confidence: 88%

Alternative Factor Models and Heritability of the Short Leyton Obsessional Inventory—Children’s Version

Moore

Smith

Shevlin

et al. 2010

J Abnorm Child Psychol

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“…17,29 The results showed that patients with higher SOCS scores had somewhat lesser improvement in HAI scores with CBT-HA over the 5-year period ( Figure 5) and that at 5 years the difference between CBT-HA and standard care was not significant (see Table 13). …”

Section: Influence Of Obsessional Symptoms On Outcomementioning

confidence: 96%

“…The first of these was that health anxietyfocused CBT (CBT-HA) would be less effective in patients who had additional comorbid pathology in the form of obsessional symptomatology [measured using the Short Obsessive-Compulsive disorder Screener (SOCS)]. 17 We also hypothesised that personality status would have an impact on the effectiveness of treatment, and that those with dependent personalities [measured using the Dependent Personality Questionnaire (DPQ)] 18 and other personality disorders 19 [measured using the Quick Personality Assessment Schedule (PAS-Q)], 20 which were subsequently converted into International Statistical Classification of Diseases, Eleventh Edition (ICD-11) 21 personality disorder categories, 22 would have a worse outcome with CBT-HA. We also expected that these comorbid disorders would be associated with increased costs.…”

Section: Research Objectivesmentioning

confidence: 99%

Cognitive–behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years

Tyrer

Šalkovskis

Tyrer

et al. 2017

Health Technol Assess

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BackgroundHealth anxiety is an under-recognised but frequent cause of distress that is potentially treatable, but there are few studies in secondary care.ObjectiveTo determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive–behaviour therapy (CBT) for health anxiety (CBT-HA) compared with standard care in medical outpatients.DesignRandomised controlled trial.SettingFive general hospitals in London, Middlesex and Nottinghamshire.ParticipantsA total of 444 patients aged 16–75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored ≥ 20 points on the Health Anxiety Inventory (HAI) and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded, but those with concurrent medical illnesses were not.InterventionsCognitive–behaviour therapy for health anxiety – between 4 and 10 1-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care.Main outcome measuresPrimary – researchers masked to allocation assessed patients at baseline, 3, 6, 12, 24 months and 5 years. The primary outcome was change in the HAI score between baseline and 12 months. Main secondary outcomes – costs of care in the two groups after 24 and 60 months, change in health anxiety (HAI), generalised anxiety and depression [Hospital Anxiety and Depression Scale (HADS)] scores, social functioning using the Social Functioning Questionnaire and quality of life using the EuroQol-5 Dimensions (EQ-5D), at 6, 12, 24 and 60 months, and deaths over 5 years.ResultsOf the 28,991 patients screened over 21 months, 5769 had HAI scores of ≥ 20 points. Improvement in HAI scores at 3 months was significantly greater in the CBT-HA group (mean number of sessions = 6) than in the standard care, and this was maintained over the 5-year period (overallp < 0.0001), with no loss of efficacy between 2 and 5 years. Differences in the generalised anxiety (p = 0.0018) and depression scores (p = 0.0065) on the HADS were similar in both groups over the 5-year period. Gastroenterology and cardiology patients showed the greatest CBT gains. The outcomes for nurses were superior to those of other therapists. Deaths (n = 24) were similar in both groups; those in standard care died earlier than those in CBT-HA. Patients with mild personality disturbance and higher dependence levels had the best outcome with CBT-HA. Total costs were similar in both groups over the 5-year period (£12,590.58 for CBT-HA; £13,334.94 for standard care). CBT-HA was not cost-effective in terms of quality-adjusted life-years, as measured using the EQ-5D, but was cost-effective in terms of HAI outcomes, and offset the cost of treatment.LimitationsMany eligible patients were not randomised and the population treated may not be representative.ConclusionsCBT-HA is a highly effective treatment for pathological health anxiety with lasting benefit over 5 years. It also improves generalised anxiety and depressive symptoms more than standard care. The presence of personality abnormality is not a bar to successful outcome. CBT-HA may also be cost-effective, but the high costs of concurrent medical illnesses obscure potential savings. This treatment deserves further research in medical settings.Trial registrationCurrent Controlled Trials ISRCTN14565822.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 50. See the NIHR Journals Library website for further project information.

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“…While self-report screening measures are available for the detection of OCD in children and adolescents (Bamber, Tamplin, Park, Kyte, & Goodyer, 2002;Berg, Rapoport, & Flament, 1986;Hudziak et al, 2006;Uher, Heyman, Mortimore, Frampton, & Goodman, 2007), these measures are not validated to discriminate between varying levels of OCD severity. Currently, the assessment of OCD severity in children and adolescents relies on structured clinical interviews and the most widely used measure is the interviewbased child version of the Yale-Brown ObsessiveCompulsive Scale (CY-BOCS, Goodman et al, 1989; Journal of Anxiety Disorders 22 (2008) 979-990 Scahill et al, 1997).…”

Section: Introductionmentioning

confidence: 98%

Self-, parent-report and interview measures of obsessive–compulsive disorder in children and adolescents

Uher

Heyman

Turner

et al. 2008

Journal of Anxiety Disorders

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Screening young people for obsessive-compulsive disorder

Cited by 49 publications

References 14 publications

Alternative Factor Models and Heritability of the Short Leyton Obsessional Inventory—Children’s Version

Alternative Factor Models and Heritability of the Short Leyton Obsessional Inventory—Children’s Version

Cognitive–behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years

Self-, parent-report and interview measures of obsessive–compulsive disorder in children and adolescents

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