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Titolo:
Combined behavioral and pharmacological treatment for obsessive-compulsivedisorders: Research findings and clinical practice
Autore:
Hand, I; Peter, H; Rufer, M;
Indirizzi:
Univ Hamburg, Klinikum Eppendorf, Abt Psychiat Verhaltenstherapie, D-20246Hamburg, Germany Univ Hamburg Hamburg Germany D-20246 nstherapie, D-20246Hamburg, Germany
Titolo Testata:
VERHALTENSTHERAPIE
fascicolo: 3, volume: 11, anno: 2001,
pagine: 206 - 215
SICI:
1016-6262(200109)11:3<206:CBAPTF>2.0.ZU;2-D
Fonte:
ISI
Lingua:
GER
Soggetto:
FOLLOW-UP; COGNITIVE THERAPY; CLOMIPRAMINE; EXPOSURE; METAANALYSIS; EFFICACY; RITUALS; DISCONTINUATION; INHIBITORS;
Keywords:
obsessive-compulsive disorders; exposure treatment; serotonin reuptake inhibitors; meta-analyses;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Social & Behavioral Sciences
Citazioni:
52
Recensione:
Indirizzi per estratti:
Indirizzo: Hand, I Univ Hamburg, Klinikum Eppendorf, Abt Psychiat Verhaltenstherapie,Martinistr 52, D-20246 Hamburg, Germany Univ Hamburg Martinistr 52 Hamburg Germany D-20246 mburg, Germany
Citazione:
I. Hand et al., "Combined behavioral and pharmacological treatment for obsessive-compulsivedisorders: Research findings and clinical practice", VERHALTENST, 11(3), 2001, pp. 206-215

Abstract

In obsessive-compulsive disorders (OCD), when are Behavior Therapy (BT) and Pharmacotherapy (PhT) to be applied simultaneously or sequentially? The answer still largely depends on the expert's professional orientation. This paper reviews the actual state of the art as published (including the latest meta-analyses) for BT and PhT separately, as well as for their combined application. In most studies direct comparison, exposure treatment, one SRI,and several SSRIs do not differ significantly in pre-post outcome. Yet, some studies do imply a better effectiveness of the only SRI investigated; nevertheless, most authors do not regard this a clinical superiority because of the more risky and unpleasant side effects compared to the SSRls. Long-term effectiveness has only been shown for BT, as no relevant long-term PhT studies have been published. Simultaneous use of BT and PhT has significantly superior pre-post effects compared to BT alone in compulsions with high secondary depression and in predominant obsessions. Whether this holds trueat follow-up is currently under investigation. Several studies showed better numerical pre-post improvement of the combination, the clinical meaning of which is judged differently in the publications. To sum up, BT alone clearly comes out as first-choice treatment (also with regard to cost-effectiveness) for the majority of OCD patients, even though in most countries it is the least applied. In spite of this apparently 'evidence-based' conclusion from reviewing the very recent literature, several problems remain: outcomes of meta-analyses have been far too much dependent on the varying methodology applied; reports about 'treatment responders' are still difficult to compare, as different operationalizations of 'response' have been used; thereported percentages of 'responders' do not necessarily indicate the percentage of relevant improvement from a clinician's perspective or with regardto daily life functioning. Finally, almost all the studies reviewed were conducted by Anglo-American or Dutch authors - and the treatments used in these publications were very different in intensity and duration from those applied in outpatient and inpatient BT therapy in Germany. Implications for treatment and research are discussed.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/01/20 alle ore 04:54:01