View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Veterinary medicine - Repository of PHD, master's thesis UNIVERSITY OF ZAGREB SCHOOL OF MEDICINE Veronika Nives Zoric Cognitive-Behavioural Therapy of Obsessive- Compulsive Disorder GRADUATE THESIS Zagreb, 2017. This graduate thesis was made at the Department of Psychiatry KBC Zagreb, University of Zagreb School of Medicine, mentored by prof. dr. sc. Dražen Begić and was submitted for evaluation in the 2016/2017 academic year. Mentor: prof. dr. sc. Dražen Begić ABBREVIATIONS USED IN THE TEXT: Behaviour Therapy (BT) Bibliotherapy administered CBT (bCBT) Cognitive-Behavioural Therapy (CBT) Cognitive Therapy (CT) Computerized CBT (cCBT) Danger Ideation Reduction Therapy (DIRT) Deep Brain Stimulation (DBS) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Exposure and Response Prevention (ERP) Generalized Anxiety Disorder (GAD) International Classification of Disease (ICD-10) Internet-administered CBT (iCBT) Major Depressive Disorder (MDD) Monoamine Oxidase Inhibitors (MAO) Obsessive-Compulsive Disorder (OCD) Obsessive-Compulsive Personality Disorder (OCPD) Selective Serotonin Reuptake Inhibitor (SSRI) Serotonin; 5-hydroxytryptamine (5HT) Serotonin Reuptake Inhibitor (SRI) Subjective Units of Distress Scale (SUDS) Telephone administered CBT (tCBT) Tricyclic Antidepressants (TCA) Videoconferencing administered CBT (vCBT) Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) TABLE OF CONTENTS 1. SUMMARY 2. SAŽETAK 3. INTRODUCTION ............................................................................................................. 1 4. EPIDEMIOLOGY ............................................................................................................ 3 5. ETIOLOGY ....................................................................................................................... 4 5.1. Psychological Etiologies .............................................................................................. 4 5.1.1. Psychodynamic Theory ........................................................................................ 4 5.1.2. Behavioural Theory .............................................................................................. 4 5.1.3. Cognitive Theory .................................................................................................. 4 5.2. Biological Etiologies ................................................................................................... 5 5.2.2. Association with Hypothalamic Lesions .............................................................. 5 5.2.3. Metabolic Changes in Corticostriatal Circuitry ................................................... 6 5.2.4. Amygdalocentric Models ..................................................................................... 6 5.2.5. The Serotonergic Hypothesis ............................................................................... 6 5.2.6. The Glutamatergic Hypothesis ............................................................................. 7 5.2.7. Genetics ................................................................................................................ 7 6. CLINICAL PICTURE ...................................................................................................... 8 7. DIAGNOSIS .................................................................................................................... 10 7.1. ICD-10 ....................................................................................................................... 10 7.2. DSM-5 ....................................................................................................................... 10 8. DIFFERENTIAL DIAGNOSIS ..................................................................................... 13 8.1. Generalized Anxiety Disorder ................................................................................... 13 8.2. Specific Phobias ........................................................................................................ 13 8.3. Major Depressive Disorder ........................................................................................ 14 8.4. Trichotillomania ........................................................................................................ 14 8.5. Hoarding Disorder ..................................................................................................... 14 8.6. Tic Disorders ............................................................................................................. 15 8.7. Obsessive-Compulsive Personality Disorder ............................................................ 15 9. TREATMENT ................................................................................................................. 16 9.1. Psychological Treatment ........................................................................................... 17 9.1.1. Cognitive-behavioural Therapy .......................................................................... 17 9.1.1.1. Behavioural Treatment ................................................................................ 18 9.1.1.2. Cognitive Therapy ...................................................................................... 19 9.1.1.2.1. Danger Ideation Reduction Therapy ........................................................ 20 9.1.2. The Future of CBT: Remote Treatment ............................................................. 21 9.1.2.1. Videoconferencing administered CBT ...................................................... 22 9.1.2.2. Telephone administered CBT .................................................................... 22 9.1.2.3. Computerized CBT .................................................................................... 22 9.1.2.4. Internet-administered CBT ........................................................................ 23 9.1.2.5. Bibliotherapy administered CBT ............................................................... 23 9.2. Biological Treatment ................................................................................................. 24 9.2.1. Pharmacotherapy ................................................................................................ 24 9.2.1.1. Selective Serotonin Reuptake Inhibitors ..................................................... 24 9.2.1.1.1. Fluoxetine ................................................................................................ 25 9.2.1.1.2. Escitalopram ............................................................................................ 25 9.2.1.1.3. Sertraline ................................................................................................. 26 9.2.1.1.4. Paroxetine ................................................................................................ 26 9.2.1.1.5. Fluvoxamine ............................................................................................ 26 9.2.1.2. Clomipramine ............................................................................................ 27 9.2.1.3. Other Medication ........................................................................................ 27 9.2.2. Electroconvulsive Therapy ................................................................................. 27 9.2.3. Surgical Treatment ............................................................................................. 28 9.3. Social Therapy ........................................................................................................... 29 9.3.1. Work Therapy .................................................................................................... 29 9.3.2. Art Therapy ........................................................................................................ 29 10. COURSE AND PROGNOSIS ........................................................................................ 30 11. ACKNOWLEDGMENTS .............................................................................................. 31 12. REFERENCES ................................................................................................................ 32 13. BIOGRAPHY .................................................................................................................. 36 1. SUMMARY Title: Cognitive-Behavioural Therapy of Obsessive-Compulsive Disorder Author: Veronika Nives Zoric Obsessive-Compulsive disorder is a severe and debilitating psychiatric disorder affecting more and more people worldwide. As the fourth most common psychiatric disorder, its history can be traced back to the 16th century. Although previously classified as an anxiety disorder in DSM-IV, it has recently been given its own chapter with related disorders in DSM-5. In ICD-10, OCD is grouped with neurotic, stress-related and somatoform disorders, and given the code F42. ICD-10 subdivides OCD into three types: predominantly obsessive type, predominantly compulsive type, and the most commonly found mixed type. Obsessions can be defined as repetitive and persistent thoughts or feelings that are viewed by the patient as intrusive and inappropriate and cause marked anxiety or distress. Typical obsessions include: fears of being contaminated by germs or poisons, fears of causing harm to oneself or others, and fears of committing some unacceptable action. Compulsions, on the other hand, are repetitive acts or behaviours that the patient deems necessary to