Functional interventions as augmentation strategies for obsessive-compulsive disorder (OCD): scoping review and expert survey from the international college of obsessive-compulsive spectrum disorders (ICOCS)

Abstract

Background

Patients with obsessive-compulsive disorder (OCD) commonly exhibit a range of functional difficulties, presumed linked to neurocognitive changes. Evidence-based first-line treatments have limited effect on improving these cognitive-functional problems. Candidate interventions could be used to augment evidence-based treatments by the multi-professional mental health team.

Methods

A scoping review was performed to identify any intervention with at least one peer-reviewed report of clinical improvement in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13). Next, an online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders was conducted.

Results

Forty-four studies were identified reporting a positive outcome for 27 different kinds of intervention. Twenty-six experts from 12 different countries, including at least one expert from each continent, completed the opinion survey. Five interventions were identified as ‘highly promising’, none of which was moderated by rater-related factors, suggesting global applicability.

Conclusion

Patients with OCD may benefit from a detailed functional assessment, to identify areas of unmet need. A variety of interventions show theoretical promise for treating the complex functional difficulties in OCD as adjuncts to first-line treatments, but the published evidence is weak. Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.

Highlights

• Functional-cognitive problems are common in patients with OCD.

• First-line evidence-based treatments have limited effect on these functionalcognitive difficulties.

• In our scoping review we found 44 studies reporting of improved clinical outcomes in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13).

• An online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) was conducted and identified five interventions as “highly promising” candidate treatments for functional-cognitive problems in OCD.

• Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.

Keywords:

• Obsessive-compulsive disorder
• functional-cognitive problems
• functional interventions
• augmentation strategies
• International College of Obsessive-Compulsive Spectrum Disorders
• ICOCS

Acknowledgements

This paper and the research behind it would not have been possible without the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) (www.ICOCS.org), who have contributed, through providing networking opportunities, to the development of this work.

Author contributions

All authors were involved in drafting the manuscript and agreed to its publication. All authors read and approved their sections of the final version of the manuscript.

Disclosure statement

Prof. Naomi A. Fineberg declares that in the past 3 years she has held research or networking grants from the ECNP, UK NIHR, EU H2020, MRC, University of Hertfordshire; she has accepted travel and/or hospitality expenses from the BAP, ECNP, RCPsych, CINP, International Forum of Mood and Anxiety Disorders, World Psychiatric Association, Indian Association for Biological Psychiatry, Sun; she has received payment from Taylor and Francis and Elsevier for editorial duties. In the past 3 years, she has accepted a paid speaking engagement in a webinar sponsored by Abbott. Previously, she has accepted paid speaking engagements in various industry supported symposia and has recruited patients for various industry-sponsored studies in the field of OCD treatment. She leads an NHS treatment service for OCD. She holds Board membership for various registered charities linked to OCD. She gives expert advice on psychopharmacology to the UK MHRA and NICE.

Prof. Bernardo Dell’Osso declares that in the past 3 years he has received lecture honoraria from Lundbeck, Angelini, Janssen, Neuraxpharma, Arcapharma and Livanova.

Prof. Umberto Albert declares that in the past 3 years he has been a consultant and/or a speaker for Angelini, Neuraxpharm, Janssen Cilag, Lundbeck, Innova Pharma.

Dr. Alberto Varinelli, Dr. Valentina Caricasole, Dr. Luca Pellegrini, Dr. Natalie Hall, Dr. Kabir Garg and Dr. Davis Mpavaenda report no financial relationships with commercial interests.