Characteristics of Included Studies

MethodsParticipantsOutcomesInterventionsNotes
DEHAAN1998
Study Type: RCT

Study Description: Allocation: random (no details)
Duration of study: 12 weeks

Blindness:

Duration (days):

Setting: Outpatient

Notes: Country of study: the Netherlands; Analysis: completer

Info on Screening Process: 32, 4 refused treatment, 1 was admitted to hospital, 1 left the country		N= 22

Age: Mean 14

Sex: 11 males 11 females

Diagnosis:
  • OCD by DSM-III-R
Exclusions: Aged <8 and >18 years, OCD duration<6 months, diagnosis of organic mental disorders, psychotic disorders, Tourette's disorder, autism, mental retardation, or a primary diagnosis of major depressive disorder, receiving behavior therapy or seotonergic antidepressants within 6 months of study

Notes: Mean OCD duration 2.47 years; comorbid anxiety disorder (n=2), eating disorder (n=1), tic disorder (n=1); mean baseline CY-BOCS 22.65		Data Used
  • Leaving study early
  • Responders (30% Y-BOCS)
  • Child Depression Inventory - patient
  • Child Behaviour Checklist
  • Leyton Obsessional Inventory - Child version
  • Children's Yale-Brown Obsessive-Compulsive
  • Scale
Group 1 N= 13
  • Individual BT - 12 weekly sessions, administered by behavior therapists or trained child psychiatrists, consisted of ERP aimed at reducing anxiety, constructing a hierarchy of rituals, homework assignments, explaining mechanisms by which rituals are preserved
Group 2 N= 10
  • Clomipramine - 12 weekly sessions, 25mg for first week, increased to a maximum 200mg/d
FOA2005
Study Type: RCT

Study Description: Allocation: random (no details); indepentent assessor blind to randomization

Duration of study: acute phase 12 weeks + discontinuation phase 12 weeks

Blindness: Single blind

Duration (days):

Setting: Outpatient

Notes: Country of study: US

Info on Screening Process: 833 screened, 312 did not meet criteria: no OCD (93), received EX/RP or CMI (117), excluded for medical reason (22), comorbidity (75), other reasons (5), unwilling to participate (65), refused to receive CMI (56), or EX/RP (54) or placebo (6), other (191)		N= 122

Age: Mean 35

Sex: 64 males 58 females

Diagnosis:
  • Obsessive-compulsive neurosis by DSM-III-R
Exclusions: Aged <18 and >70 years, OCD duration <1 year, Y-BOCS<17, current major depression, HAM-D>18, substance abuse or dependence within past 6 months, current schizotypal or borderline personality disorder, previous intensive treatment with CMI or ERP

Notes: Duration of illness 16.4 years, baseline Y-BOCS scores 25		Data Used
  • Responders (CGI)
  • Yale-Brown Obsessive-Compulsive Scale: total
  • Leaving study early
  • Clinical Global Impressions
  • Adverse events
  • NIMH-OC
Group 1 N= 36
  • Clomipramine - Fixed dose first 5 weeks, starting at 25mg/d, increasing to 200mg/d, increased to 250mg/d as tolerated, mean final dose 196mg/d
Group 2 N= 26
  • Placebo - Mean final dose for 209mg/d
Group 3 N= 29
  • Exposure + response prevention - 15 2-hr sessions over first 3 weeks and 2 home visits, weekly 45 min meetings for remaining 8 weeks, imaginal and in vivo exposure performed
Group 4 N= 31
  • BT + clomipramine - ERP + CMI, patients met individually with both a therapist and a psychopharmacologist, mean final dose 163+-65mg/d
Responders: CGI=<2
MARKS1980
Study Type: RCT

Study Description: Allocation: random (no details), assessors blind to treatment group Study duration: 4 weeks drug only + 3 weeks exposure or relax + 3 weeks exposure

Blindness: Single blind

Duration (days):

Setting: Initial 4 weeks drugs-only phase in outpatient setting, 6 weeks of psychological treatment in inpatient setting, after which patients were discharged

Notes: Country of study: UK; analysis: ITT Patients referred by psychiatrists and GPs Follow-up at 8, 16, 52 and 104 weeks post treatment		N= 40

Age: Mean 35

Sex: 11 males 29 females

Diagnosis:
  • OCD
Exclusions: Mild obsessive-compulsive rituals less than one year's duration, aged <18 and >59 years, history of psychosis, did not agree to involve relatives in treatment, previous adequate behavioural treatment

Notes: Mean duration of illness 11.75 years,		Data Used
  • Wakefield Inventory
  • Hamilton Rating Scale for Depression
  • Behavioural avoidance test - Performance
  • Behavioural Avoidance Test - Discomfort
  • Compulsive activity checlist
  • Target rituals (self rated): time
  • Target rituals (self rated): discomfort
  • Target rituals (assessor rated): time
  • Target rituals (assessor rated): discomfort
Group 1 N= 10
  • BT + clomipramine - CMI: initial dose 10mg raised to 225mg, continued for next 8 months
  • Exposure: Included modelling and retraining of day-to-day ritualistic habits, patients instructed to carrout out exposure tasks between sessions and to keep records of their performance
Group 2 N= 10
  • Placebo + relaxation - Pbo: initial dose 10mg raised to 225mg, continued for next 8 months
  • Relaxation: 45 min daily, after 15 sessions (week 7) switched to exposure, patients instructed by tape-recorder and modelling by therapist to tense and relax body parts alternately
Group 3 N= 10
  • Clomipramine + relaxation - CMI: initial dose 10mg raised to 225mg, continued for next 8 months
  • Relaxation: 45 min daily, after 15 sessions (week 7) switched to exposure, patients instructed by tape-recorder and modelling by therapist to tense and relax body parts alternately
Group 4 N= 10
  • BT + Placebo - Therapist modelled activities which the patient avoided, then refrained from ritualizing. Patients practiced this on day-to-day rituals and were instructed to carry out exposure tasks between sessions and to keep records of their performance
Anxiety, lesiure, sex, family, social life and work adjustment was rated on 0-8 point scales used by Gelder and Marks (1966) Wakefield Inventory is a modified and shortened version of the Zung depression rating scale
POTS2004
Study Type: RCT

Study Description: Allocation: random (computer-generated sequence in blocks of 4), double-blind concealment in medication conditions only, assessors blind to treatment

Blindness: Double blind

Duration (days):

Followup: 12 weeks

Setting: Outpatient

Notes: Country of study: US, conducted at 3 sites, Analysis: ITT

Info on Screening Process: 154 screened, 31 deemed ineligible, 10 not interested, 1 asymptomatic at baseline		N= 112

Age: Mean 12

Sex: 56 males 56 females

Diagnosis:
  • OCD by DSM-IV
Exclusions: Aged <7 and >17 years, CY-BOCS<17, NIMH Global Severity Score<8, IQ<81 as measured by Block Design and Vocabulary subtests in Wechesler Intelligence Scale for Children, major depression, bipolar illness, primary diagnosis of Tourette disorder, pervasive developmental disorder, psychosis, concurrent treatment with psychotropic medication, previous failed trials with SRIs or CBT, sertraline intolerance, medical or neurological disorder, pregnancy, history of remission following medication, CBT or combination

Notes: Baseline CY-BOCS 24.6, 80% had at least 1 psychiatric comorbid disorder, 63% had affective or anxiety disorders, 27% had ADHD, oppositional defiant disorder or conduct disorder, 16% had comorbid tic disorder		Data Used
  • Children's Yale-Brown Obsessive-Compulsive Scale
  • Leaving study early due to adverse events
  • Leaving study early
Group 1 N= 28
  • Cognitive Behavioural Therapy - 14 1-hour visits over 12 weeks, involved psychoeducation, cognitive training, mapping of OCD target symptoms, ERP
Group 2 N= 28
  • Sertraline - Initial dose 25mg/d, increased to 200mg/d over 6 weeks in a fixed flexible upward titration, after which dosage could be adjusted as tolerated
Group 3 N= 28
  • CBT + Medication - CBT and sertraline treatment began simultaneously and followed the same protocol as for the individual interventions
Group 4 N= 28
  • Placebo

From: Appendix 16, Characteristics of reviewed studies

Cover of Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder.
NICE Clinical Guidelines, No. 31.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society (UK); 2006.
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