Cyclic versus continuous deep brain stimulation in patients with obsessive compulsive disorder: A randomized controlled trial

BackgroundDeep brain stimulation (DBS) of the ventral anterior limb of the internal capsule (vALIC) is effective for refractory obsessive-compulsive disorder (OCD), but patients typically require high stimulation voltages and DBS comes with a risk for adverse events (AE).ObjectiveThe aim of the present study was to advance DBS for OCD by optimizing energy efficiency and minimize adverse events using a cyclic form of stimulationMethodsThis double blind, randomized crossover trial compares 2 weeks of continuous versus cyclic DBS (0.1 s ON, 0.2 s OFF) in 16 patients with OCD. We compared OCD symptoms (Yale-Brown Obsessive-Compulsive Scale, Y-BOCS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), AEs, battery life, cognitive performance and quality of life.ResultsAverage Y-BOCS scores at baseline increased significantly with 5.5 points (p = 0.006) in the cyclic condition. Average HAM-D and HAM-A scores increased with 2.2 (p = 0.088) and 2.8 points (p = 0.018). The overall health scale of quality of life worsened during cyclic DBS (p = 0.044). Patients reported on average 3.3 AEs during continuous stimulation and 4.4 AEs during cyclic stimulation (p = 0.175), though stimulation-related AEs such as headache and concentration problems reduced during cyclic DBS. Battery usage during continuous DBS was 0.021 V per hour compared to 0.008 V per hour during cyclic DBS.ConclusionThough specific stimulation-related AEs improved, cyclic stimulation (0.1 s ON, 0.2 s OFF) comes with a high relapse risk in patients with DBS for OCD. Cyclic DBS is no alternative for standard DBS treatment, but applicable in case of debilitating AEs.     

A retrospective review of clinical characteristics and treatment response in body dysmorphic disorder versus obsessive-compulsive disorder

BACKGROUND: Although body dysmorphic disorder (BDD) has many features in common with obsessive-compulsive disorder (OCD) and is frequently comorbid with OCD, few studies have directly compared the 2 disorders. Although BDD and OCD respond to similar medications and cognitive-behavioral therapy (CBT), their response to treatment has never been directly compared. METHOD: We studied 107 consecutive patients with DSM-III-R OCD (N = 96) or BDD (N = 11) treated openly for 6 weeks with intensive CBT, medication, and psychosocial rehabilitation, in a specialized partial hospitalization program for severely ill OCD patients. All patients were assessed, before and after treatment, with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Global Assessment Scale (GAS). Retrospectively, we compared the clinical characteristics, symptom severity, and response to treatment of BDD patients with those of OCD patients. RESULTS: BDD patients and OCD patients had similar sex ratio, age, treatment duration, prevalence of comorbid major depression, and pretreatment Y-BOCS and GAS scores. BDD patients had significantly higher pretreatment HAM-D and HAM-A scores. The proportions of patients treated with serotonin reuptake inhibitors and antipsychotics did not differ between groups. Both groups improved with treatment, with significant (p < .001) changes in Y-BOCS, HAM-D, HAM-A, and GAS scores. Change in Y-BOCS did not differ between groups, but changes in HAM-D and HAM-A were significantly greater in BDD patients than in OCD patients. CONCLUSION: While BDD may be associated with greater severity of depressive and anxiety symptoms than OCD, this study suggests that BDD may respond to intensive, multimodal treatment.     

Riluzole augmentation in treatment-resistant obsessive-compulsive disorder: an open-label trial.

BACKGROUND: Most patients with obsessive-compulsive disorder (OCD) show only partial reduction of symptoms with standard therapy. Recent imaging data suggests glutamatergic dysfunction in the corticostriatal pathway in OCD. We investigated the efficacy of augmentation therapy with riluzole, a glutamate-modulating agent, in treatment-resistant OCD. METHODS: Thirteen patients aged between 18 and 65 years with a primary diagnosis of OCD that had proven resistant to standard treatment were treated with the addition of riluzole to their existing pharmacotherapy. Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression Inventory (HAM-D), and Hamilton Anxiety Inventory (HAM-A) scores were obtained weekly. RESULTS: Thirteen treatment-resistant OCD patients received riluzole 50 mg twice a day. Y-BOCS scores improved significantly over time. Of 13 patients, 7 (54%) demonstrated a >35% reduction in Y-BOCS scores, and 5 (39%) were categorized as treatment responders. HAM-D and HAM-A scores for the group also significantly improved over time. Riluzole was well tolerated with no serious adverse effects noted. CONCLUSIONS: Riluzole appears to have significant antiobsessional, antidepressant, and antianxiety properties. The addition of this agent may be of practical clinical benefit in patients with OCD.     

Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder

BackgroundTwenty years after the first use of Deep Brain Stimulation (DBS) in obsessive-compulsive disorder (OCD), our knowledge of the long-term effects of this therapeutic option remains very limited.ObjectiveOur study aims to assess the long-term effectiveness and tolerability of DBS in OCD patients and to look for possible predictors of long-term response to this treatment.MethodsWe studied the course of 25 patients with severe refractory OCD treated with DBS over an average follow-up period of 6.4 years (±3.2) and compared them with a control group of 25 patients with severe OCD who refused DBS and maintained their usual treatment. DBS was implanted at the ventral anterior limb of the internal capsule and nucleus accumbens (vALIC-Nacc) in the first six patients and later at the bed nucleus of stria terminalis (BNST) in the rest of patients. Main outcome was change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score between the two groups assessed using mixed models. Secondary effectiveness outcomes included Hamilton Depression Rating Scale (HDRS) and Global Assessment of Functioning (GAF) scores.ResultsObsessive symptoms fell by 42.5% (Y-BOCS score) in patients treated with DBS and by 4.8% in the control group. Fifty-six per cent of DBS-treated patients could be considered responders at the end of follow-up and 28% partial responders. Two patients among those who rejected DBS were partial responders (8%), but none of the non-DBS group achieved criteria for complete response. HDRS and GAF scores improved significantly in 39.2% and 43.6% among DBS-treated patients, while did not significantly change in those who rejected DBS (improvement limited to 6.2% in HDRS and 4.2% in GAF scores). No statistically significant predictors of response were found. Mixed models presented very large comparative effect sizes for DBS (4.29 for Y-BOCS, 1.15 for HDRS and 2.54 for GAF). Few patients experienced adverse effects and most of these effects were mild and transitory.ConclusionsThe long-term comparative effectiveness and safety of DBS confirm it as a valid option for the treatment of severe refractory OCD.     

The effect of treatment on quality of life and functioning in OCD

BackgroundGiven that obsessive compulsive disorder (OCD) is associated with impaired quality of life (QoL) and functioning, it is important examine whether therapeutic recovery from OCD leads to improvements on these important secondary outcomes. Only a few studies have examined how measures of OCD symptom severity relate to QoL and functioning among patients receiving treatment for OCD.MethodsOCD severity was measured with the Obsessive–Compulsive Inventory-Revised (OCI-R), a self-report scale of OCD, and the Yale–Brown Obsessive Compulsive Scale (Y-BOCS), an interview measure of OCD. Participants were 100 adults with a primary diagnosis of OCD on serotonin reuptake inhibitors (SRIs) enrolled in a randomized clinical trial comparing SRI augmentation with either exposure and response prevention (EX/RP) therapy, risperidone, or pill placebo. At baseline, mid-treatment, and post-treatment, patients completed assessments for OCD symptoms and QoL/functioning measures. Multilevel modeling was used to assess changes in QoL/functioning over the course of treatment and to compare such changes across treatment conditions.ResultsImprovements in QoL/functioning were significantly greater among those receiving EX/RP compared to those receiving risperidone. Compared to pill placebo, EX/RP performed better on measures of functioning but not QoL. Greater improvement in individual OCI-R scores was associated with greater improvements in QoL/functioning, regardless of condition. In addition, Y-BOCS scores appeared to moderate improvements in QoL over the course of all treatment conditions, such that those with higher Y-BOCS scores showed the greatest improvements in QoL over time.ConclusionsImprovements in QoL/functioning were associated with reduction in OCD symptom severity. The implications on OCD treatment and clinical research are discussed.     

A placebo-controlled cross-over trial of adjunctive EPA in OCD

Several clinical studies showed beneficial effects of omega-3 fatty acids in major affective disorders, including resistant depression. Some antidepressants are also effective, albeit less so, in obsessive-compulsive disorder (OCD). We therefore undertook a preliminary placebo-controlled cross-over trial of adjunctive eicosapentaenoic acid (EPA) in OCD. Eleven patients with current obsessive-compulsive disorder, who were on a stable maximally tolerated dose of SSRI with no further improvement over at least the last two months, were recruited. Subjects were randomly allocated to begin 6 weeks of placebo (2 g liquid paraffin per day) followed by 6 weeks of 2 g of EPA or EPA followed by placebo. Patients continued their prior SSRIs at the same dose. Assessments were performed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and the Hamilton Rating Scales for depression (HAM-D) and anxiety (HAM-A). There were no effects of order of treatment. Time had a main effect of YBOCS scores; mean scores declined from 26.0 (+/-5) to 17.6 (+/-6) by week 6 on placebo and to 18.5 (+/-4) on EPA. There were no effects on HAM-D and HAM-A. No clinically relevant side effects were reported. The results of this study suggest that adjunctive EPA is ineffective against OCD.     

脑波治疗仪治疗强迫症的临床研究

目的:探讨脑波治疗仪治疗强迫症的疗效。方法:将96例强迫症患者随机分为氯米帕明合并脑波治疗组49例和单用氯米帕明组47例。疗程6周。用强迫症量表(Y-BOCS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效。结果:治疗结束时两组Y-BOCS、HAMD、HAMA评分均显著降低,以合并治疗组明显。结论:脑波治疗仪可提高氯米帕明对强迫症的临床疗效。     

氯丙咪嗪合并利培酮治疗强迫症的对照研究

目的探讨利培酮对于氯丙咪嗪治疗强迫症的增效作用。方法将70例强迫症随机分为2组,氯丙咪嗪同时合并利培酮和单独使用氯丙咪嗪治疗,治疗8周。采用强迫症量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评定疗效。结果合并利培酮组有31例完成试验,氯丙咪嗪组有32例完成试验。治疗8周后,两组Y-BOCS平均总分有明显下降,合并利培酮组优于氯丙咪嗪组,两组无显著性差异(P<0.05);HAMA、HAMD的评分均显著下降,两组无显著性差异(P>0.05)。结论合并利培酮对于氯丙咪嗪治疗强迫症有增效作用。     

氟伏沙明合并氯氮平治疗强迫症的疗效比较

目的探讨氟伏沙明合并氯氮平治疗强迫症的疗效。方法45例强迫症患者随机分为氟伏沙明合并氯氮平治疗组和单独氟伏沙明治疗组。疗程8周。采用强迫症量表（Y—BOCS）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评定疗效。结果治疗结束时两组Y—BOCS、HAMA、HAMD的评分均显著降低,更以合并氯氮平组明显。结论氟伏沙明合并氯氮平治疗强迫症可以增加疗效。     

利培酮合并帕罗西汀治疗强迫症疗效分析

目的：探讨利培酮合并帕罗西汀治疗强迫症的疗效。方法：40例强迫症患者随机分为利培酮合并帕罗西汀组和帕罗西汀组,治疗8周。采用强迫症量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评定疗效。结果：治疗结束时两组Y-BOCs、HAMA、HAMD的评分均显著降低,更以合用利培酮组明显。结论：利培酮合并帕罗西汀治疗强迫症可以增加疗效。     

Deep Brain Stimulation Reduces Conflict-Related Theta and Error-Related Negativity in Patients With Obsessive–Compulsive Disorder

ObjectivesObsessive–compulsive disorder (OCD) is a psychiatric disorder with alterations of cortico-striato-thalamo-cortical loops and impaired performance monitoring. Electrophysiological markers such as conflict-related medial frontal theta (MFT) and error-related negativity (ERN) may be altered by clinically effective deep brain stimulation (DBS) of the anterior limb of the internal capsule and nucleus accumbens (ALIC/NAc). We hypothesized that ALIC/NAc DBS modulates electrophysiological performance monitoring markers.Materials and MethodsFifteen patients (six male) with otherwise treatment-refractory OCD receiving ALIC/NAc DBS performed a flanker task with EEG recordings at three sessions: presurgery and at follow-up with DBS on and off. We examined MFT, ERN, and task performance. Furthermore, we investigated interrelations with clinical efficacy and then explored the influence of the location of individual stimulation volumes on EEG modulations.ResultsMFT and ERN were significantly attenuated by DBS with differences most pronounced between presurgery and DBS-on states. Also, we observed reaction time slowing for erroneous responses during DBS-off. Larger presurgery ERN amplitudes were associated with decreased clinical efficacy. Exploratory anatomical analyses suggested that stimulation volumes encompassing the NAc were associated with MFT modulation, whereas ALIC stimulation was associated with modulation of the ERN and clinical efficacy.ConclusionALIC/NAc DBS diminished MFT and ERN, demonstrating modulation of the medial frontal performance monitoring system in OCD. Furthermore, our findings encourage further studies to explore the ERN as a potential predictor for clinical efficacy.     

Temperament and character in subjects with obsessive-compulsive disorder

Background

The aims of this study were to evaluate the differences between personality traits of patients with obsessive-compulsive disorder (OCD) and normal controls using the Temperament and Character Inventory (TCI) and to examine the relationship of personality traits and the severity of obsessive-compulsive (OC) symptoms. We also aimed to examine the influence a particular personality trait might have on the 5 factor-analyzed symptom dimension scores of OCD.

Method

We recruited 130 patients with OCD and 185 age- and sex-matched normal controls. All subjects completed the TCI. Patients with OCD were assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale, and the factor-analyzed symptom dimension scores from the Y-BOCS checklist.

Results

Patients with OCD had higher harm avoidance scores and lower self-directedness (SD), reward dependence (RD), and cooperativeness (C) scores than the controls. Lower SD scores and lower C scores were associated with OC symptom severity measured by the Y-BOCS after adjusting for age and depression severity. Hoarding dimension of OC symptoms was associated with lower SD scores and higher persistence (P) scores after adjusting for age, OC symptom severity, and depression severity.

Conclusions

There were significant differences in TCI subscales between patients with OCD and controls. Particular personality traits may have an influence on the severity and the dimensions of OC symptoms.     

Quality of life and burden in caregivers of youth with obsessive-compulsive disorder presenting for intensive treatment

BackgroundPediatric obsessive-compulsive disorder (OCD) is associated with deleterious familial effects; caregivers are often enmeshed in the disorder and can experience considerable burden and decreased quality of life (QoL). Consequently, this study examined burden and QoL in caregivers of youth with OCD enrolled in an intensive outpatient or partial hospitalization program.MethodThe relationships between caregiver QoL and burden and the following variables were investigated: OCD symptom severity, functioning (youth functional impairment, general family functioning), family (family accommodation, parental relationship satisfaction, positive aspects of caregiving), and comorbid psychopathology (caregiver anxiety and depressive symptoms, youth internalizing and externalizing behaviors). Seventy-two child and caregiver dyads completed clinician- and self-rated questionnaires.ResultsComponents of caregiver QoL correlated with caregiver-rated functional impairment, family accommodation, youth externalizing behaviors, and caregiver psychopathology. Aspects of caregiver burden correlated with child OCD symptom severity, functional impairment related to OCD, as well as caregiver and child comorbid psychopathology. Caregiver depressive symptoms predicted caregiver QoL, and caregiver depressive symptoms and child externalizing symptoms both predicted caregiver burden. Caregiver burden did not mediate the relationship between obsessive-compulsive symptom severity and caregiver QoL.ConclusionUltimately, elucidating factors associated with increased caregiver burden and poorer QoL is pertinent for identifying at-risk families and developing targeted interventions.     

Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: psychopathological and neuropsychological outcome in three cases

OBJECTIVE: Investigation of deep brain stimulation (DBS) as a last-resort treatment alternative to capsulotomy in treatment-refractory obsessive-compulsive disorder (OCD). METHOD: Prospective single-case based design with evaluation of DBS impact on emotions, behaviour, personality traits and executive function in three patients with OCD. RESULTS: Two patients experienced sustained improvement of OCD symptoms with DBS. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) dropped 12 points and 23 points to baseline and Y-BOCS self-rating scale (Y-BOCS-SRS) and Profile of Mood States (POMS) for depression and tension decreased with increasing stimulation amplitude. Total Maladjustment Score on the Brief Psychiatric Rating Scale reduced with 44 and 59% to baseline. Reduction in psychopathology was sustained under continuous stimulation. No deleterious impact of DBS on neuropsychological testing or personality traits measured on a self-rated personality inventory was detected. CONCLUSION: These preliminary findings demonstrate that DBS may have important therapeutic benefits on psychopathology in OCD. No harmful side-effects were detected during follow-up (33/33/39 months, respectively).     

帕罗西汀单用与帕罗西汀合并喹硫平对强迫症疗效的对照研究

目的探讨帕罗西汀合并喹硫平治疗强迫症的疗效。方法50例强迫症患者随机分为帕罗西汀组和帕罗西汀合并喹硫平组,疗程8周。采用强迫症量表(Y-BOCS),汉密尔顿焦虑量表(HAMA),汉密尔顿抑郁量表(HAMD),评定疗效。结果治疗结束时两组Y-BOCS,HAMA,HAMD的评分均显著下降,而合并喹硫平组更明显。结论帕罗西汀合并喹硫平治疗强迫症可以提高疗效。     

Quality of Life in 833 outpatients with major depression treated with open-label venlafaxine extended release: An observational 24-week study

BACKGROUND Quality of Life (QoL) assessments are common in medicine and, recently, in psychiatry, mostly in patients with chronic mental illness. We evaluated QoL in depressed outpatients treated with venlafaxine-XR over a period of 24 weeks. METHOD We evaluated 833 patients with DSM-IV major depression using the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Montgomery-Åsberg Depression Rating Scale (MÅDRS), and the QoL in Depression Scale (QLDS). The patients received venlafaxine-XR and we evaluated them after 4, 8, and 24 weeks of treatment. RESULTS HAM-D scores decreased from a baseline of 24.6 &#45 6.3 to 6.0 &#45 5.5 (mean &#45 SD; P <0.0001) after 24 weeks. HAM-A scores decreased from a baseline of 32.3 &#45 7.9 to 6.8 &#45 6.8 ( P <0.0001) after 24 weeks. QLDS scores decreased from a baseline of 25.8 &#45 5.8 to 6.6 &#45 7.5 ( P <0.0001) after 24 weeks, indicating improvement in QoL. The response after 4 weeks was also significant and continued improving during the study. Venlafaxine-XR was shown to be safe and well tolerated. DISCUSSION Open-label venlafaxine-XR was safe, effective, well tolerated, and improved not only depression and anxiety symptoms, but also QoL, in outpatients with major depression. This study has the limitations of any non-randomized, non-blinded multiple-site clinical trial.     

瑞典大学人格量表在强迫症患者中的应用

目的采用瑞典大学人格量表（SSP）探讨强迫症患者的人格特质及其与不同临床特征的关系。方法收集33例符合DSM-IV诊断标准的强迫症患者及31例健康对照,采用瑞典大学人格量表（SSP）评估两组样本的人格特质,采用Yale-Brown强迫量表（Y-BOCS）、汉密尔顿焦虑量表（HA-MA）和汉密尔顿抑郁量表（HAMD）评估强迫症患者临床特征。结果强迫症组躯体性焦虑、精神性焦虑、应激敏感性、怨恨、兴奋性和不信任分量表分别为57.70±11.64、63.19±10.41、66.77±10.31、61.14±7.56、54.09±9.13、57.15±11.57,健康对照组分别为46.18±8.30、52.08±8.42、55.79±7.69、56.37±7.92、48.03±7.69、51.59±9.97,强迫症组高于对照组,差异有统计学意义。其余分量表的差异无统计学意义。强迫症患者SSP社交愿望分与Y-BOCS总分呈正相关（r=0.349,P〈0.05）;躯体性焦虑、精神性焦虑和应激敏感性分与HAMA、HAMD总分呈正相关;社交愿望分与HAMA呈正相关;怨恨分与HAMD呈正相关。结论强迫症患者具有神经质和攻击性人格特质;强迫症患者的人格特质与强迫、焦虑和抑郁症状之间可能存在一定的相关性。     

Personality dimensions in obsessive-compulsive disorder: relation to clinical variables

Research on the relationship between personality factors and obsessive-compulsive disorder (OCD) has proved difficult to interpret due to conceptual problems including a lack of consensus on the model of personality employed as a framework as well as a failure to consider the clinical heterogeneity of the disorder. The aim of this study was to examine the dimensional personality profile associated with OCD and to determine whether any relationship exists between personality factors and clinical variables in a sample of 60 OCD outpatients who were administered Cloninger's Temperament and Character Inventory (TCI). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale (HDRS) and the Y-BOCS symptom checklist were used to assess the severity of obsessive-compulsive and depressive symptoms and the presence of the main OCD symptom dimensions. OCD patients showed significantly higher scores in harm avoidance and lower scores in novelty-seeking, self-directedness and cooperativeness than healthy subjects. These results remained unchanged when only pure OCD patients without comorbid psychiatric conditions were considered. Comorbid depressive symptoms and hoarding obsessions and compulsions were significantly associated with high harm avoidance scores. These results support the existence of a dimensional personality profile associated with OCD and characterized by high harm avoidance and low novelty-seeking, self-directedness and cooperativeness scores, but also emphasize the importance of considering the influence of comorbid clinical conditions or symptom subtypes in addressing the role of personality factors in OCD.     

Adjunctive high-frequency right prefrontal repetitive transcranial magnetic stimulation (rTMS) was not effective in obsessive–compulsive disorder but improved secondary depression

BackgroundThere is preliminary evidence that repetitive transcranial magnetic stimulation (rTMS) may be useful in obsessive–compulsive disorder (OCD) patients.MethodsOur objective was to examine efficacy of adjunctive right prefrontal high-frequency (rapid) rTMS treatment in OCD patients. 42 patients with OCD were randomly assigned to 10 sessions of add-on high-frequency right prefrontal active rTMS (10 Hz, 110% of motor threshold, 4 s per train, 20 trains per session) or sham stimulation. They were rated on Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A) and Clinical Global Impression-Severity of Illness (CGI-S) at baseline, day 14 and day 28. The dose of antiobsessive drug was kept constant throughout the period of assessment.ResultsFor YBOCS scores, repeated measures ANOVA showed significant main effect of treatment, but no effect of treatment over time (Pillai's Trace F = 1.39, p = .262). However, significant effect of treatment over time as shown by interaction effect for both HAM-D (Pillai's Trace F = 3.67, p = .035, η² = .158) and HAM-A scores (Pillai's Trace F = 5.22, p = .01, η² = .211) were seen.ConclusionAdjunctive high-frequency right prefrontal rTMS does not have any significant effect in the treatment of OCD. However, it is modestly effective in the treatment of comorbid depressive symptoms in patients with OCD.     

Obsessive-compulsive hoarding: symptom severity and response to multimodal treatment

BACKGROUND: Compulsive hoarding and saving symptoms, found in many patients with obsessive-compulsive disorder (OCD), are part of a clinical syndrome that has been associated with poor response to medications and cognitive-behavioral therapy (CBT). We sought to determine whether patients with the compulsive hoarding syndrome had more severe symptoms and functional impairment than nonhoarding OCD patients and whether they would respond to intensive, multimodal treatment previously found to be effective for treatment-refractory OCD. METHOD: We studied 190 consecutive patients with DSM-IV OCD treated openly for approximately 6 weeks with intensive CBT, medication, and psychosocial rehabilitation in a partial hospitalization program for severely ill OCD patients. Twenty of the 190 patients (11%) were identified as having the compulsive hoarding syndrome. All patients were assessed before and after treatment with the Yale-Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D). Hamilton Rating Scale for Anxiety (HAM-A). and Global Assessment Scale (GAS). We compared the symptom severity and response to treatment of compulsive hoarders versus nonhoarding OCD patients. RESULTS: Compulsive hoarders were significantly older than nonhoarders (p < .001). Hoarders had significantly lower GAS scores and higher HAM-A scores than nonhoarders both before (p = .04) and after (p = .002) treatment, but had similar pretreatment YBOCS scores. Both groups improved significantly with treatment as assessed by YBOCS score (p < .001), but nonhoarders had significantly greater decreases in YBOCS scores than hoarders (p = .02). CONCLUSION: While the compulsive hoarding syndrome appears to be a distinct, more disabling, variant of OCD that does not respond as robustly to treatment, it may still improve significantly with intensive, multimodal treatment tailored to its specific features and associated deficits.