New Guidelines For OCD Treatment

New guidelines set to improve identification, diagnosis and treatment of obsessive-compulsive disorder in children and adults, UK
The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health have today (23 November) launched a clinical guideline on the identification, treatment and management of obsessive-compulsive disorder and body dysmorphic disorder in children and adults. Obsessive-compulsive disorder (OCD) is characterised by the presence of obsessions (unwanted intrusive thoughts, images or urges, which repeatedly enter the person's mind) and/or compulsions (unwanted, unnecessary behaviours such as repeated washing or cleaning, checking electrical appliances or locks, etc). It can occur in people of all ages, and commonly starts in childhood or adolescence. Body dysmorphic disorder (BDD) is characterised by a distressing preoccupation with an imagined defect in one's appearance or, in the case of a slight physical anomaly, the person's concern is markedly excessive. The most common preoccupations concern the skin, hair, nose, eyes, eyelids, mouth, lips, jaw, and chin. The guideline recommends that: • Cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) should be offered as first line therapy for children, young people and adults with mild to moderate OCD • Drug treatments (selective serotonin re-uptake inhibitors (SSRIs)) should be offered as an alternative to CBT (including ERP) for patients with more severe OCD or who decline, or do not respond to, psychological treatments • Adults with BDD should be offered the choice of either a course of an SSRI or CBT (including ERP) that addresses key features of BDD. Andrew Dillon, Chief Executive of NICE and Executive Lead for this guideline says: “OCD is very common. Some studies suggest it is the fourth most common mental disorder after depression, alcohol and substance abuse, and social phobia with a lifetime prevalence of about 1-2%. The condition often goes unrecognised and untreated and we hope the guideline will help raise awareness of this distressing condition which in most cases can be effectively treated.” Dr Tim Kendall, Joint Director of the National Collaborating Centre for Mental Health who developed the guideline on behalf of NICE says: “This is the seventh mental health guideline where we have recommended psychological treatments as key treatments for a mental health condition, and the fourth where we have recommended them as the first line treatment. We know that there are currently not enough people to deliver psychological therapies. Now is the time to increase our capacity and provide real help for those people that need it.” Professor Mark Freeston, Chair Guideline Development Group and Professor of Clinical Psychology, University of Newcastle upon Tyne says: “The World Health Organisation rank OCD in the top 10 of the most disabling illnesses by lost income and decreased quality of life. Despite this we know many people with OCD don't come forward for treatment for many years, often because of the stigma attached to the condition. Because people may not spontaneously talk about their difficulties, health professionals need to be better at asking the right questions and offering the right treatments. Accurate and early diagnosis, as well as effective treatment, can make a real difference.” Dr Isobel Heyman, Consultant Child and Adolescent Psychiatrist, Maudsley and Great Ormond Street Hospitals, London says “About 1% of children and young people suffer from OCD. If OCD is left undetected and untreated it can cause marked psychological distress, and also disrupt social, educational and emotional development, leading to significant disability. This guideline should help raise awareness amongst the parents and carers of young people of the signs to look out for to ensure young people with OCD receive access to the treatments they need.” Ms Gillian Knight, representative of people with OCD on the Guideline Development Group says: ”OCD hijacks peoples lives and has a serious impact on quality of life. Yet effective treatments do exist which can transform lives and bring people back into society. Raising awareness of OCD and de-stigmatising the condition is vital if people are to be persuaded to seek help. The NICE guideline gives new found hope to the many thousands of people with OCD who no longer need to suffer in silence.” Piers Watson, Chairman of OCD Action says “I am delighted that these guidelines recognise the need for informed diagnosis and targeted treatment for OCD and BDD. They also make it clear that OCD and BDD can be addressed with great success. These guidelines, however, are only a first step in making appropriate treatment available to all sufferers. How quickly can the yawning gap be bridged, that presently exists between the many sufferers and the few available healthcare practitioners specifically trained to treat these illnesses? This is now the challenge.” Ashley Fulwood, Chief Executive of OCD-UK says “OCD-UK are delighted that the new NICE guidelines for OCD have been released and hope they will lead to more consistent treatment for this often disabling condition. We are also pleased that the guidelines recommend psychological treatments such as Cognitive Behaviour Therapy (CBT) as the first line of treatment for OCD. The NICE guidelines are undoubtedly a step in the right direction and we hope they will also lead to accurate and earlier diagnosis of OCD, which on average is only diagnosed some 7 to 12 years after its onset.” About NICE1. On 1 April 2005 the National Institute for Clinical Excellence took on the functions of the Health Development Agency to form the National Institute for Health and Clinical Excellence (NICE). NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. 2. NICE produces guidance in three areas of health: • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector • health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.