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National service for adolescents and adults with severe obsessive-compulsive and body dysmorphic disorders
- Authors:
- DRUMMOND L. M., et al
- Journal article citation:
- Psychiatric Bulletin, 32(9), September 2008, pp.333-326.
- Publisher:
- Royal College of Psychiatrists
National guidelines for the assessment and treatment of obsessive-compulsive disorder (OCD) and body dysmorphic disorder were published in 2005 by the National Institute for Health and Clinical Excellence (NICE). Local services are unable to treat a small but significant number of the most severely ill patients successfully, and the guidelines recommend that such patients should have access to highly specialised care. From 1 April 2007, the Department of Health decided to centrally fund treatment services for severe, chronic, refractory OCD and BDD. The authors describe a new National Service for Refractory OCD; its rationale, treatments offered, referral criteria and expected clinical outcomes. initial results from one centre show an average 42% reduction in OCD symptoms at the end of treatment. The operational challenges and potential generalisability of this model of healthcare delivery are discussed. The authors present a summary of the progress made so far in establishing a new, coherent National Service for Refractory OCD, 18 months after the NICE guideline was published. The aim of the paper is to educate clinicians about the service and describe its rationale, treatments offered, referral criteria and expected clinical outcomes.
Community model in treating obsessive-compulsive and body dysmorphic disorders
- Authors:
- DRUMMOND L. M., et al
- Journal article citation:
- Psychiatric Bulletin, 32(9), September 2008, pp.336-340.
- Publisher:
- Royal College of Psychiatrists
In 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. In 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.