Early intervention for obsessive compulsive disorder: An expert consensus statement |
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| Affiliation: | 1. Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, Hertfordshire AL8 6HG, UK;2. Center for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK;3. School of Clinical Medicine, University of Cambridge, Cambridge, UK;4. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy;5. Department of Psychiatry, ASST Fatebenefratelli-Sacco, Via GB Grassi 74, 20157, Milan, Italy;6. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA;7. Fondazione IRCCS Ca’ Granda, CRC “Aldo Ravelli” for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy;8. School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel;9. Department of Psychiatry, Stanford University, CA, USA;10. Department of Neuroscience, Psychology, Drug Research and Child Health – Neurofarba, University of Florence, Italy;11. Department of Psychiatry and Compulsive, Impulsive and Autism Spectrum Program, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA;12. Department of Psychiatry, Bellvitge University Hospital, IDIBELL, Cibersam, University of Barcelona, Barcelona, Spain;13. Department of Psychiatry, University of Cambridge, Cambridge, UK;14. Cambridge & Peterborough NHS Foundation Trust, Cambridge, UK;15. Department of Psychiatry and Mental Health, South African MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa;p. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada;q. Sackler Medical School, Tel Aviv University, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel;r. Department & Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil;s. INS, Institute of Neuroscience, Florence, Italy;t. Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy;u. Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy;v. Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, D''Or Institute for Research and Education Rio de Janeiro, Federal University of Rio de Janeiro, Brazil;w. Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy;x. San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy;y. Western Sydney Area Health Service, Obsessive-Compulsive and Related Disorders Service, Blacktown Hospital, Blacktown, Sydney, Australia;z. Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland;11. RUG and UMC Groningen, Department of Psychiatry, GGZ Drenthe Mental Health Institute, The Netherlands;12. Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA;13. Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK;14. Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands;15. Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia;16. Orchard, 66 Devonshire Road, Cambridge, CB1 2BL, UK;1. Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria 3168, Australia;2. Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista (UNESP), Brazil;3. Department of Psychiatry, Federal University of Health Sciences of Porto Alegre (UFCSPA), Brazil;4. Department and Institute of Psychiatry, University of São Paulo (USP), Brazil;5. Department of Psychiatry, Federal University of São Paulo (UNIFESP), Brazil;6. Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ) & D''Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil |
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| Abstract: | Obsessive-compulsive disorder (OCD) is common, emerges early in life and tends to run a chronic, impairing course. Despite the availability of effective treatments, the duration of untreated illness (DUI) is high (up to around 10 years in adults) and is associated with considerable suffering for the individual and their families. This consensus statement represents the views of an international group of expert clinicians, including child and adult psychiatrists, psychologists and neuroscientists, working both in high and low and middle income countries, as well as those with the experience of living with OCD. The statement draws together evidence from epidemiological, clinical, health economic and brain imaging studies documenting the negative impact associated with treatment delay on clinical outcomes, and supporting the importance of early clinical intervention. It draws parallels between OCD and other disorders for which early intervention is recognized as beneficial, such as psychotic disorders and impulsive-compulsive disorders associated with problematic usage of the Internet, for which early intervention may prevent the development of later addictive disorders. It also generates new heuristics for exploring the brain-based mechanisms moderating the ‘toxic’ effect of an extended DUI in OCD. The statement concludes that there is a global unmet need for early intervention services for OC related disorders to reduce the unnecessary suffering and costly disability associated with under-treatment. New clinical staging models for OCD that may be used to facilitate primary, secondary and tertiary prevention within this context are proposed. |
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