Developing More Effective Treatments for Obsessive Compulsive Disorder across the Age-Span

Established: April 2006, first meeting June 2006

Convenor (Chair): Professor Derek Bolton, Professor of Philosophy & Psychopathology, Institute of Psychiatry, Kings College London. (e-mail: d.bolton@iop.kcl.ac.uk)

Members:
Derek Bolton (Convenor, Professor of Philosophy & Psychopathology, Institute of Psychiatry, Kings College London; Hon. Consultant Clinical Psychologist, South London and Maudsley Trust); Jo Derisley (Hon. Clinical Lecturer, University of East Anglia; Clinical Psychologist, Norfolk and Waveney Mental Health NHS Trust; Mark Freeston (Professor of Clinical Psychology, University of Newcastle, Honoraray Consultant Clinical Psychologist, Newcastle, Northumberland and North Tyneside Mental Health NHS Trust);
Isobel Heyman (Hon. Senior Lecturer, Institute of Psychiatry, Kings College London, Consultant Child and Adolescent Psychiatrist, South London and Maudsley Trust); Gillian Knight (Leading member of OCD Action and member of the NICE OCD and BDD clinical guidelines development group); Karina Lovell (Registered Mental Health Nurse, Professor of Mental Health, School of Nursing, Midwifery and Social Work. The University of Manchester); David Mataix-Cols (Senior Lecturer in Psychology, Institute of Psychiatry, Kings College London); Sean Perrin (Lecturer in Psychology, Institute of Psychiatry, Kings College London; Hon. Clinical Psychologist, South London and Maudsley Trust); Shirley Reynolds (Professor of Clinical Psychology, University of East Anglia); Paul Salkovskis (Professor of Psychology, Institute of Psychiatry, Kings College London; Hon. Consultant Clinical Psychologist, South London and Maudsley Trust); Cliff Snelling (Leading member of OCD Action and member of the NICE OCD and BDD clinical guidelines development group); Cynthia Turner (Hon. Tutor, Institute of Psychiatry, Kings College London; Clinical Psychologist, South London and Maudsley Trust); David Veale (Hon. Senior Lecturer, Institute of Psychiatry, Kings College London, Consultant Psychiatrist in Cognitive Behaviour Therapy, South London and Maudsley Trust); Tim Williams (Hon research fellow, psychologist, University of Reading, Consultant Clinical Psychologist, Berkshire Healthcare NHS Trust)

Remit and Aims:
OCD has relatively high life-time prevalence, up to 3%, with onset in a large proportion of cases by adolescence and is associated with significant impairment in social and occupational functioning and high national economic costs.

Developing more effective, accessible, and cost effective treatments will alleviate individual suffering and lower the burden of cost.

Clinical Guidelines have identified a stepped care model of interventions in OCD and sufficiently powered RCTs are not available for some elements of the model e.g. family involvement in therapy, brief or self-guided interventions. This research group aims to develop studies to inform the care pathway at both lower and higher stages.

Research methods will include RCTs and multimodal investigations of treatment refractory OCD (e.g. family history methods, experimental studies of cognitive processing). The MHRN concept would be particularly suited to this type of research both in bringing together complementary expertise and the scale that could be achieved.

Current Status & Future Plans:
The group will develop research proposals important in relation to the current treatment evidence-base and burden of care on the NHS and which are consistent with research recommendations of the recent NICE OCD guidelines.  The emphasis, on identifying and studying treatment refractory OCD, will combine basic science with clinical outcome.  Three areas identified by the group to date for focus are:

(1) Extending the evidence-base for treatments for Child and Adolescent OCD
(2) Extending the evidence-base for CBT for OCD in Adults
(3) Developing new approaches for treatment refractory OCD and OCD related problems

12 month update:

The group is very much on track to deliver its performance targets:

· Submitted two protocols for MHRN adoption and for external funding.
These are

(a) Treatment for paediatric Obsessive Compulsive Disorder (OCD): Randomised Controlled Trial comparing Cognitive Behaviour Therapy (CBT) combined with sertraline - v- CBT combined with placebo -v- CBT alone. This went to the MRC in Outline form, and was not invited to a full application.

(b) ROCKY: The acceptability, feasibility and effectiveness of individual versus parent enhanced cognitive behaviour therapy in young people with obsessive compulsive disorder (CI Shirley Reynolds). This was submitted to Research for Patient Benefit and was funded and is now running on MHRN.

· The group is now reviewing progress and planning for future work. The group has met twice in 2007 (in January & June).

Update March 08:

1. Protocol adopted by MHRN. Title: “The acceptability, feasibility and effectiveness of individual versus parent enhanced cognitive behaviour therapy in young people with obsessive compulsive disorder.” PI: Shirley Reynolds. This is funded by Research for Patient Benefit.

2. Submission to funding body. To HTA: “Self managed therapy packages for obsessive-compulsive disorder. Principal applicant: Karina Lovell; Applicants Penny Bee, Peter Bower, Shirley Reynolds, David Veale, Nicky Lidbetter, Michael Barkham, Gillian Hardy, Simon Gilbody, Paul Salkovskis, Chris Roberts, Sarah Byford, Mark Freeston – submitted Jan 08 – shortlisting July 08

3. The group is reviewing progress and planning for future work. The group has met twice since the previous report (in October 2007 and February 2008) and the minutes are attached.