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Integrating Videoconferencing Into Treatment for Obsessive-Compulsive Disorder: Practical Strategies With Case Examples.

ABSTRACT: Obsessive-compulsive disorder (OCD), a disabling psychiatric illness, creates substantial societal burden. Evidence-based treatments, including psychopharmacology and exposure with response/ritual prevention (EX/RP), are often inaccessible. Digital health technologies, including videoconferencing, may increase access, but the best way to integrate them with current treatments remains unclear. This column describes the experiences of faculty at the Center for OCD and Related Disorders with videoconferencing-assisted treatment. Through a case series, the authors describe five ways to incorporate videoconferencing into OCD treatment: hybrid in-person/remote EX/RP; fully remote EX/RP; and videoconferencing-assisted psychopharmacology, support groups, and clinical supervision. For each strategy, the authors highlight advantages, challenges, clinical considerations, and avenues needing further research.

SUBMITTER: Kayser RR

PROVIDER: S-EPMC8249317 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Integrating Videoconferencing Into Treatment for Obsessive-Compulsive Disorder: Practical Strategies With Case Examples.

Kayser Reilly R RR Gershkovich Marina M Patel Sapana S Simpson H Blair HB

Psychiatric services (Washington, D.C.) 20210326 7

Obsessive-compulsive disorder (OCD), a disabling psychiatric illness, creates substantial societal burden. Evidence-based treatments, including psychopharmacology and exposure with response/ritual prevention (EX/RP), are often inaccessible. Digital health technologies, including videoconferencing, may increase access, but the best way to integrate them with current treatments remains unclear. This column describes the experiences of faculty at the Center for OCD and Related Disorders with videoc ...[more]

PMID: 33765864

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Project description:Introduction: Attention deficit hyperactivity disorder (ADHD) is a common disease in childhood and adolescence. In about 60% of pediatric patients, the symptoms persist into adulthood. Treatment guidelines for adult ADHD patients suggest multimodal therapy consisting of psychostimulants and psychotherapy. Many adult ADHD patients also suffer from psychiatric comorbidities, among others obsessive-compulsive disorder (OCD). The treatment of the comorbidity of ADHD and OCD remains challenging as the literature is sparse. Moreover, the impact of psychostimulants on obsessive-compulsive symptoms is still unclear. Case Presentation: Here, we report on a 33-year-old patient with an OCD who was unable to achieve sufficient remission under long-term guideline-based treatment for OCD. The re-examination of the psychological symptoms revealed the presence of adult ADHD as a comorbid disorder. The patient has already been treated with paroxetine and quetiapine for the OCD. Due to the newly established diagnosis of ADHD, extended-release methylphenidate (ER MPH) was administered in addition to a serotonin reuptake inhibitor. After a dose of 30 mg ER MPH, the patient reported an improvement in both the ADHD and the obsessive-compulsive symptoms. After discharge, the patient reduced ER MPH without consultation with a physician due to subjectively described side effects. The discontinuation of medication led to a renewed increase in ADHD and obsessive-compulsive symptoms. The readjustment to ER MPH in combination with sertraline and quetiapine thereafter led to a significant improvement in the compulsive symptoms again. Conclusion: The present case shows that in ADHD and comorbid obsessive-compulsive disorder, treatment with psychostimulants can improve the obsessive-compulsive symptoms in addition to the ADHD-specific symptoms. To our knowledge, this is only the second case report describing a treatment with ER MPH for an adult patient with OCD and ADHD comorbidity in the literature. Further research, especially randomized controlled trials, is needed to standardize treatment options.

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Integrating Videoconferencing Into Treatment for Obsessive-Compulsive Disorder: Practical Strategies With Case Examples.

Publications

Integrating Videoconferencing Into Treatment for Obsessive-Compulsive Disorder: Practical Strategies With Case Examples.

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