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Community model in treating obsessive-compulsive and body dysmorphic disorders

^*Division of Mental Health, St George’s, University of London, London SW17 ORE, email: lynnemd{at}sgul.ac.uk, and Behavioural Cognitive Psychotherapy Unit, Springfield University Hospital

A. Pillay, Cognitive Behavioural Psychotherapist, P. J. Kolb, Cognitive Behavioural Psychotherapist, S. Benson, Cognitive Behavioural Psychotherapist, R. Fogg, Cognitive Behavioural Psychotherapist, E. Jones - Thomas, Cognitive Behavioural Psychotherapist and S. Rani, Associate Specialist

Behavioural Cognitive Psychotherapy Unit, Springfield University Hospital

Declaration of interest

None. All authors work in the service described.

See original paper, pp. 333-336, this issue.

AIMS AND METHOD

In November 2005, the National Institute for Health and Clinical Excellence published guidelines for the treatment of obsessive-compulsive disorder (OCD) and body dysmorphic disorder. These guidelines incorporated a stepped care approach with different interventions advised throughout the patient pathway. South West London and St George’s Mental Health NHS Trust devised a system of expert clinicians with special expertise in OCD/body dysmorphic disorder to help deliver this model of care. To aid the delivery of service it was decided to operationalise the definitions of severity of OCD/body dysmorphic disorder at each of the stepped-care levels. Examples are given as to how this has been applied in practice. Outcome is presented in terms of clinical hours in the first year of operation.

RESULTS

In total, 108 patients were referred to the service in the first year. Many of these patients were treated by offering advice and support and joint working with the community mental health team and psychotherapy in primary care teams who had referred. Sixty-eight patients were treated by a member of the specialist service alone and 57 of these suffered from severe OCD. Outcome data from these 57 patients is presented using an intention-to-treat paradigm. They showed a clinically and statistically significant reduction in OCD symptoms after 24 weeks of cognitive-behavioural therapy comprising graded exposure and self-imposed response prevention. The mean Yale-Brown Obsessive Compulsive Scale score dropped from 28 (severe OCD) to 19 (considerable OCD). Depressive symptoms on the Beck Depression Inventory also decreased by an average 24% over the same period.

CLINICAL IMPLICATIONS

The feasibility of extending this model of service organisation to other areas and other diagnoses is discussed.

Related articles in PB:

National service for adolescents and adults with severe obsessive-compulsive and body dysmorphic disorders

L. M. Drummond, N. A. Fineberg, I. Heyman, P. J. Kolb, A. Pillay, S. Rani, P. Salkovskis, and D. Veale
PB 2008 32: 333-336. [Abstract] [Full Text]  

This article has been cited by other articles:

				L. M. Drummond, N. A. Fineberg, I. Heyman, P. J. Kolb, A. Pillay, S. Rani, P. Salkovskis, and D. Veale National service for adolescents and adults with severe obsessive-compulsive and body dysmorphic disorders Psychiatr. Bull., September 1, 2008; 32(9): 333 - 336. [Abstract] [Full Text] [PDF]