Zusammenfassung
Hintergrund
Zwangsstörungen werden hauptsächlich mit störungsspezifischer kognitiver Verhaltenstherapie mittels Expositionen und Reaktionsmanagement und/oder mit selektiven Serotoninwiederaufnahmehemmern behandelt. Eine relevante Patientensubgruppe profitiert hiervon jedoch nicht ausreichend.
Ziel der Arbeit
Diese Arbeit gibt eine Übersicht über therapieresistente Zwangsstörungen.
Material und Methoden
Diese narrative Übersicht beschäftigt sich mit der Definition, den Ursachen sowie der diagnostischen und therapeutischen Vorgehensweise bei therapieresistenten Zwangsstörungen.
Ergebnisse
Von einer Therapieresistenz kann ausgegangen werden bei einer fehlenden klinisch relevanten Verbesserung unter Therapie im Sinne einer Reduktion von < 25 % auf der Yale-Brown Obsessive Compulsive Scale und einem Score von 4 auf Clinical Global Impression – Improvement Scale („keine Veränderung“). Die für eine Therapieresistenz geforderte Anzahl an nicht erfolgreichen Therapieversuchen ist unterschiedlich definiert. Ursächliche Faktoren beinhalten eine falsche Diagnosestellung, einen hohen Schweregrad, komorbide Störungen, Substanzkonsum, spezielle Symptomkonstellationen, organische Ursachen, Umgebungsfaktoren und erschwerende Faktoren in der Psychotherapie und Pharmakotherapie. Vorschläge zum diagnostischen und therapeutischen Vorgehen basierend auf der deutschen S3-Leitlinie Zwangsstörungen wurden zusammengestellt.
Diskussion
Für Patienten mit Therapieresistenz auf die Erstlinienbehandlung liegen nützliche diagnostische und therapeutische Ansätze (psychotherapeutisch, psychopharmakologisch oder mit Neurostimulationsverfahren) vor.
Abstract
Background
Obsessive-compulsive disorders (OCD) are mainly treated with disorder-specific cognitive behavioral therapy using exposure and response management and/or selective serotonin reuptake inhibitors; however, a significant subgroup of patients does not sufficiently benefit from this approach.
Objective
This article provides an overview of treatment-resistant OCD.
Material and methods
In this narrative review the definition, causes, diagnostic and therapeutic approaches to treatment-resistant OCD are addressed.
Results
Treatment resistance can be assumed in the absence of clinically relevant improvement under therapy, in the sense of a reduction of < 25% on the Yale-Brown obsessive-compulsive scale and a score of 4 (no change) on the clinical global impression-improvement scale. The number of unsuccessful treatment attempts required to establish treatment resistance is defined differently. Causative factors include misdiagnosis, a high severity, comorbid disorders, substance use, specific symptom constellations, organic causes, environmental factors, and aggravating factors in psychotherapy and pharmacotherapy. Suggestions for diagnostic and therapeutic approaches based on the German S3 guideline on OCD are presented.
Conclusion
For patients with treatment resistance to first-line therapy, useful diagnostic and therapeutic recommendations are available (psychotherapeutic, psychopharmacological and neurostimulation procedures).
Literatur
AACAP (2012) Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 51(1):98–113. https://doi.org/10.1016/j.jaac.2011.09.019
Carmi L, Tendler A, Bystritsky A et al (2019) Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. Am J Psychiatry 176(11):931–938. https://doi.org/10.1176/appi.ajp.2019.18101180
Denys D, Graat I, Mocking R et al (2020) Efficacy of deep brain stimulation of the ventral anterior limb of the internal capsule for refractory obsessive-compulsive disorder: a clinical cohort of 70 patients. Am J Psychiatry 177(3):265–271. https://doi.org/10.1176/appi.ajp.2019.19060656
Denys D, van der Wee N, van Megen HJ, Westenberg HG (2003) A double blind comparison of venlafaxine and paroxetine in obsessive-compulsive disorder. J Clin Psychopharmacol 23(6):568–575. https://doi.org/10.1097/01.jcp.0000095342.32154.54
DGPPN (2022) AWMF S3-Leitlinie Zwangsstörungen. https://register.awmf.org/de/leitlinien/detail/038-017. Zugegriffen: 30. Okt. 2023
Endres D, Mertens L, Berger B et al (2022a) Autoimmune obsessive-compulsive disorder with novel anti-basal ganglia antibodies. Psychother Psychosom 91(3):214–216. https://doi.org/10.1159/000522136
Endres D, Pollak TA, Bechter K et al (2022b) Immunological causes of obsessive-compulsive disorder: is it time for the concept of an “autoimmune OCD” subtype? Transl Psychiatry 12(1):5. https://doi.org/10.1038/s41398-021-01700-4
Endres D, Domschke K, Schiele MA (2022c) Neurobiology of obsessive-compulsive disorder. Nervenarzt 93(7):670–677. https://doi.org/10.1007/s00115-022-01331-0
Evey KJ, Steinman SA (2023) A systematic review of the use of acceptance and commitment therapy to treat adult obsessive-compulsive disorder. Behav Ther 54(6):1006–1019. https://doi.org/10.1016/j.beth.2022.02.009
Foa EB, Simpson HB, Rosenfield D et al (2015) Six-month outcomes from a randomized trial augmenting serotonin reuptake inhibitors with exposure and response prevention or risperidone in adults with obsessive-compulsive disorder. J Clin Psychiatry 76(4):440–446. https://doi.org/10.4088/JCP.14m09044
Gadot R, Najera R, Hirani S et al (2022) Efficacy of deep brain stimulation for treatment-resistant obsessive-compulsive disorder: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. https://doi.org/10.1136/jnnp-2021-328738
Göbel T, Maier A, Schlump A et al (2023) Obsessive-compulsive symptoms and 15q11.2q13.1 duplication syndrome. Eur Neuropsychopharmacol 78:67–69. https://doi.org/10.1016/j.euroneuro.2023.09.009
Grabe HJ, Meyer C, Hapke U et al (2000) Prevalence, quality of life and psychosocial function in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany. Eur Arch Psychiatry Clin Neurosci 250(5):262–268. https://doi.org/10.1007/s004060070017
Guzick AG, McCabe RE, Storch EA (2021) A review of motivational interviewing in cognitive behavioral therapy for obsessive-compulsive disorder. J Cogn Psychother 35(2):116–132. https://doi.org/10.1891/JCPSY-D-20-00027
Hirschtritt ME, Bloch MH, Mathews CA (2017) Obsessive-compulsive disorder: advances in diagnosis and treatment. JAMA 317(13):1358–1367. https://doi.org/10.1001/jama.2017.2200
Howes OD, Thase ME, Pillinger T (2022) Treatment resistance in psychiatry: state of the art and new directions. Mol Psychiatry 27(1):58–72. https://doi.org/10.1038/s41380-021-01200-3
Jacobi F, Höfler M, Strehle J et al (2014) Mental disorders in the general population : study on the health of adults in Germany and the additional module mental health (DEGS1–MH). Nervenarzt 85(1):77–87. https://doi.org/10.1007/s00115-013-3961-y
Jelinek L, Balzar A, Moritz S et al (2022) Therapists’ thought-action fusion beliefs predict utilization of exposure in obsessive-compulsive disorder. Behav Ther 53(1):23–33. https://doi.org/10.1016/j.beth.2021.05.004
Külz AK, Lumpp A, Herbst N et al (2010) Welche Funktionen erfüllen Zwangssymptome? – Ergebnisse einer Analyse im stationären Setting. Verhaltenstherapie 20(2):101–108. https://doi.org/10.1159/000295428
Mack S, Jacobi F, Gerschler A et al (2014) Self-reported utilization of mental health services in the adult German population−evidence for unmet needs? Results of the DEGS1-Mental Health Module (DEGS1-MH). Int J Methods Psychiatr Res 23(3):289–303. https://doi.org/10.1002/mpr.1438
Marazziti D, Golia F, Consoli G et al (2008) Effectiveness of long-term augmentation with citalopram to clomipramine in treatment-resistant OCD patients. CNS Spectr 13(11):971–976. https://doi.org/10.1017/s1092852900014024
Mataix-Cols D, Fernández de la Cruz L, Nordsletten AE et al (2016) Towards an international expert consensus for defining treatment response, remission, recovery and relapse in obsessive-compulsive disorder. World Psychiatry 15(1):80–81. https://doi.org/10.1002/wps.20299
Mataix-Cols D, Jenike MA (1999) Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. Am J Psychiatry. https://doi.org/10.1176/ajp.156.9.1409
Moritz S, Külz A, Voderholzer U et al (2019) Phobie à deux and other reasons why clinicians do not apply exposure with response prevention in patients with obsessive-compulsive disorder. Cogn Behav Ther 48(2):162–176. https://doi.org/10.1080/16506073.2018.1494750
Ninan PT, Koran LM, Kiev A et al (2006) High-dose sertraline strategy for nonresponders to acute treatment for obsessive-compulsive disorder: a multicenter double-blind trial. J Clin Psychiatry 67(1):15–22. https://doi.org/10.4088/jcp.v67n0103
Pallanti S, Hollander E, Bienstock C et al (2002) Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol 5(2):181–191. https://doi.org/10.1017/S1461145702002900
Runge K, Reisert M, Feige B et al (2023) Deep clinical phenotyping of patients with obsessive-compulsive disorder: an approach towards detection of organic causes and first results. Transl Psychiatry 13(1):83. https://doi.org/10.1038/s41398-023-02368-8
Ruscio AM, Stein DJ, Chiu WT, Kessler RC (2010) The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 15(1):53–63. https://doi.org/10.1038/mp.2008.94
Schirmbeck F, Zink M (2022) Obsessive-compulsive symptoms in psychotic disorders: pathogenesis and treatment. Nervenarzt 93(7):688–694. https://doi.org/10.1007/s00115-022-01332-z
Shakeri J, Farnia V, Karimi AR et al (2016) The prevalence and clinical features of amphetamine-induced obsessive compulsive disorder. Drug Alcohol Depend 160:157–162. https://doi.org/10.1016/j.drugalcdep.2015.12.034
Simpson HB, Foa EB, Liebowitz MR et al (2013) Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiatry 70(11):1190–1199. https://doi.org/10.1001/jamapsychiatry.2013.1932
Skapinakis P, Caldwell DM, Hollingworth W et al (2016) Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry 3(8):730–739. https://doi.org/10.1016/S2215-0366(16)30069-4
Stein DJ, Costa DLC, Lochner C et al (2019) Obsessive-compulsive disorder. Nat Rev Dis Primers 5(1):52. https://doi.org/10.1038/s41572-019-0102-3
Steuber ER, McGuire JF (2023) A meta-analysis of transcranial magnetic stimulation in obsessive-compulsive disorder. Biol Psychiatry Cogn Neurosci Neuroimaging. https://doi.org/10.1016/j.bpsc.2023.06.003
Swedo SE, Leonard HL, Garvey M et al (1998) Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 155(2):264–271. https://doi.org/10.1176/ajp.155.2.264
Voderholzer U, Favreau M, Rubart A et al (2022) Treatment of obsessive-compulsive disorders: recommendations of the revised S3 guidelines on obsessive-compulsive disorders. Nervenarzt 93(7):678–687. https://doi.org/10.1007/s00115-022-01336-9
Wang G, Si T, Imperato JS et al (2021) Impact of sertraline daily treatment regimen on adherence, persistence and healthcare resource utilisation in patients with major depressive disorder or obsessive-compulsive disorder: a real-world evidence analysis from the United States. Int J Clin Pract 75(10):e14522. https://doi.org/10.1111/ijcp.14522
Zhou DD, Zhou XX, Li Y et al (2019) Augmentation agents to serotonin reuptake inhibitors for treatment-resistant obsessive-compulsive disorder: A network meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 90:277–287. https://doi.org/10.1016/j.pnpbp.2018.12.009
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
D. Endres, L. Jelinek und U. Voderholzer geben an, dass kein Interessenkonflikt besteht. K. Domschke: Innerhalb der letzten drei Jahre: Mitglied ‚Steering Committee Neurosciences‘ und Referentenhonorare, Janssen-Cilag.
Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Additional information
Hinweis des Verlags
Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.
Hinweis
Zur besseren Lesbarkeit wurde auf die gleichzeitige Verwendung der Sprachformen weiblich, männlich und divers verzichtet. Sämtliche Personenbezeichnungen gelten gleichermaßen für alle Geschlechter.
QR-Code scannen & Beitrag online lesen
Rights and permissions
About this article
Cite this article
Endres, D., Jelinek, L., Domschke, K. et al. Therapieresistente Zwangsstörungen. Nervenarzt 95, 432–439 (2024). https://doi.org/10.1007/s00115-024-01629-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00115-024-01629-1