Over the past three decades, obsessive-compulsive disorder(OCD) has moved from an almost untreatable,life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children an...Over the past three decades, obsessive-compulsive disorder(OCD) has moved from an almost untreatable,life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments(which appears to be only a portion of the overall population) are not effectively treated.Suggestions for future avenues of research are also presented. These are primarily focused on(1) increased dissemination of effective therapies;(2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and(3) the impact of comorbid disorders on treatment outcome.展开更多
It is difficult to accurately assess and differentially diagnose the anxiety disorders.The current system of assessment relies heavily on the subjective measures of client self-report,clinical observation,and clinical...It is difficult to accurately assess and differentially diagnose the anxiety disorders.The current system of assessment relies heavily on the subjective measures of client self-report,clinical observation,and clinical judgment.Fortunately,recent technological advances may enable practitioners to utilize objective,biobehavioral measures of assessment in a clinical setting.The current body of literature on two of these biobehavioral tools(eyetracking and electrocardiogram devices) is promising,but more validation and standardization research is needed to maximize the utility of these devices.Eye-tracking devices are uniquely capable of providing data that can be used to differentially diagnose anxiety disorders from both other commonly comorbid and misdiagnosed disorders.Both eye-tracking and electrocardiogram devices are able to provide change-sensitive assessment information.This objective,real-time feedback can assist clinicians and researchers in assessing treatment efficacy and symptom fluctuation.Recently developed wearable and highly portable electrocardiogram devices,like the wearable fitness and behavior tracking devices used by many consumers,may be particularly suited for providing this feedback to clinicians.Utilizing these biobehavioral devices would supply an objective,dimensional component to the current categorical diagnostic assessment system.We posit that if adequate funding and attention are directed at this area of research,it could revolutionize diagnostic and on-going assessment practices and,in doing so,bring the field of diagnosis out of the 20 th century.展开更多
文摘Over the past three decades, obsessive-compulsive disorder(OCD) has moved from an almost untreatable,life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments(which appears to be only a portion of the overall population) are not effectively treated.Suggestions for future avenues of research are also presented. These are primarily focused on(1) increased dissemination of effective therapies;(2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and(3) the impact of comorbid disorders on treatment outcome.
文摘It is difficult to accurately assess and differentially diagnose the anxiety disorders.The current system of assessment relies heavily on the subjective measures of client self-report,clinical observation,and clinical judgment.Fortunately,recent technological advances may enable practitioners to utilize objective,biobehavioral measures of assessment in a clinical setting.The current body of literature on two of these biobehavioral tools(eyetracking and electrocardiogram devices) is promising,but more validation and standardization research is needed to maximize the utility of these devices.Eye-tracking devices are uniquely capable of providing data that can be used to differentially diagnose anxiety disorders from both other commonly comorbid and misdiagnosed disorders.Both eye-tracking and electrocardiogram devices are able to provide change-sensitive assessment information.This objective,real-time feedback can assist clinicians and researchers in assessing treatment efficacy and symptom fluctuation.Recently developed wearable and highly portable electrocardiogram devices,like the wearable fitness and behavior tracking devices used by many consumers,may be particularly suited for providing this feedback to clinicians.Utilizing these biobehavioral devices would supply an objective,dimensional component to the current categorical diagnostic assessment system.We posit that if adequate funding and attention are directed at this area of research,it could revolutionize diagnostic and on-going assessment practices and,in doing so,bring the field of diagnosis out of the 20 th century.
