A Study of the Efficacy of Pharmacotherapy, rTMS and Cognitive Behavioral Therapy as a Multimodal Therapy Model in the Management of Obsessive Compulsive Disorder

SOURCE: Indian Journal of Psychiatry. Conference: 73rd Annual National Conference of Indian Psychiatric Society, ANCIPS 2022. Visakhapatnam India. 64(SUPPL 3) (pp S657), 2022.


AUTHORS: Unni A.; Gupta A.; Mittal S.; Srivastava M.

INTRODUCTION: Obsessive Compulsive Disorder can be a debilitating illness for many, and management and treatment modalities have been studied extensively to treat it. The effect of Cognitive Behavioral Therapy as a tool has been studied and proven to be efficacious in OCD. rTMS, though widely used to treat and manage depression and anxiety, has also been shown to be helpful in OCD. In real world settings at our institute, a combination of pharmacotherapy (comprising of antiobsessional drugs), psychotherapy and rTMS are used to treat OCD patients (moderate to severe). This study is to evaluate the efficacy of pharmacotherapy, psychotherapy and rTMS sessions concurrently as a multimodal treatment model.

METHOD(S): Retrospective review and analysis of records of 46 IPD and OPD patients (from January 2018 to January 2021) with OCD, all of whom received 20 sessions of rTMS as part of routine clinical care. Of 46 patients, 26 received rTMS over the Left DLPFC and 20 over both SMA and Left DLPFC. They were also undergoing CBT sessions on a weekly basis. These patients were on pharmacotherapy which involved anti obsessional drugs, dosage monitored on follow up, on a weekly basis. A minimum
reduction of 20% in Yale-Brown Obsessive Compulsive Scale (YBOCS) scores was used to classify outcome as partial (20% to 39% difference in YBOCS) or complete response (40% difference in YBOCS and above). Statistical analysis was done using SPSS and Microsoft Excel.

SELECTION CRITERIA: Male and Female patients with OCD above the age of 18 and below the age of 55 with one or more of the following: 1. Moderate to Severe OCD (Ybocs rating of 16 and above) 2. Treatment Resistant OCD 3. Intolerance to pharmacotherapy 4. Patient Preference.

OBJECTIVE(S): To assess, and evaluate the effectiveness of pharmacotherapy, rTMS in OCD patients undergoing weekly CBT sessions. rTMS sessions targeting the DLPFC (Dorsolateral Prefrontal Cortex) and SMA (Supplementary Motor Area) in patients with OCD in real world clinical practice settings. The present study explored the potential predictors of response to rTMS treatment as an adjuvant to CBT sessions, and pharmacotherapy. DESIGN: Retrospective and Comparative data study of patients of age group 18 to 55 of both genders rated with Y-BOCS rating scale, undergoing pharmacotherapy, rTMS and Cognitive Behavioral Therapy for OCD (moderate to severe) Results: Results showed that regular concurrent treatment of OCD with pharmacotherapy, 20 sessions of rTMs, and weekly Cognitive Behavioral Therapy in 46 patients showed a minimum YBOCS reduction of 20% in 82% of patients whereas 8 patients showed minimal or no change to the concurrent treatment. Out of 17 Female patients, 100% showed a minimum reduction of 20% in YBOCS Rating scale. Out of 29 males,
21 males i.e. 72% showed significant reduction in YBOCS Rating scale. 20 patients i.e. 43% patients showed complete response (minimum 40% change in YBOCS) and 39% showed partial response (20 to 39% change in YBOCS).

CONCLUSION(S): The concurrent role of pharmacotherapy in rTMS and CBT in OCD patients showed significant improvement in 82% of the patients, which showed the efficacy of a multimodal treatment model followed in our institute. Figures and charts will be utilised to provide a detailed and illustrative approach.