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Asian J Psychiatr. 2019 Nov 9;47:101878. doi: 10.1016/j.ajp.2019.101878. [Epub ahead of print]

Clinical remission of a treatment-refractory individual with severe repetitive rituals and rumination.

Author information

1
The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang City, 453002, Henan Province, PR China.
2
The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang City, 453002, Henan Province, PR China; Workstation of Henan Province for Psychiatry Experts, Kaifeng City, 475003, Henan Province, PR China. Electronic address: huxianzhang@xxmu.edu.cn.

Abstract

BACKGROUND:

Obsessive-compulsive disorder (OCD) is a severe chronic mental disorder and tends to be refractory to pharmacotherapy or psychotherapy. For treatment-refractory patients, neurosurgical interventions are options. 64 % of OCD patients who undergo neurosurgery still have greater than 16 in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) after a long-term follow-up. Here, we reported a patient living with long-term OCD (20 years) who was refractory to pharmacotherapy, mindfulness-based psychotherapy, and neurosurgery that injured his bilateral anterior cingulates (AC) and caudate nucleus.

METHODS:

The patient accepted a novel psychotherapy named cognitive-coping therapy (CCT) and completed Y-BOCS, Hamilton depression rating scale, the Hamilton anxiety rating scale, social and occupational function assessment, and resting-state function magnetic resonance imaging scans (rs-fMRI) before and after 4-week CCT.

RESULTS:

His Y-BOCS score was reduced from 25 to 4. His depression score and anxiety score were reduced from 19 to 3 and from 12 to 3, respectively. The global assessment of functioning score increased from 32 to 88.

CONCLUSIONS:

The remission of the patient suggested that CCT could be an alternative intervention for treatment-refractory OCD and those with severe OCD could be cured in short-term.

KEYWORDS:

Cognitive-coping therapy; Neurosurgery; Obsessive-compulsive disorder; Pharmacotherapy; Treatment

PMID:
31756555
DOI:
10.1016/j.ajp.2019.101878

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