Self-Stigma and Treatment Effectiveness in Patients with SSRI Non-Responsive Obsessive-Compulsive Disorder
Status PubMed-not-MEDLINE Language English Country New Zealand Media electronic-ecollection
Document type Journal Article
PubMed
33574718
PubMed Central
PMC7873032
DOI
10.2147/prbm.s287419
PII: 287419
Knihovny.cz E-resources
- Keywords
- cognitive behavioral therapy, exposure and response prevention, non-response, obsessive compulsive disorder, self-stigma,
- Publication type
- Journal Article MeSH
PURPOSE: Obsessive compulsive disorder (OCD) is a debilitating mental disorder that often takes a chronic course. One of the factors influencing the treatment effectiveness in anxiety and depressive disorders is the self-stigma. This study focused on the relationship between the self-stigma, symptomatology, and therapeutic outcomes in patients with OCD. PATIENTS AND METHODS: Ninety-four inpatients with OCD, who did not sufficiently respond to at least one selective serotonin reuptake inhibitor trial, participated in the study. They attended a six-week therapeutic program consisting of exposure and response prevention, transdiagnostic group cognitive behavioral therapy, individual sessions, mental imagery, relaxation, sport, and ergotherapy. The participants completed several scales: the Internalized Stigma of Mental Illness Scale (ISMI), the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR), Beck Anxiety Scale (BAI), Beck Depression Scale-II (BDI-II), and Dissociative Experiences Scale (DES). A senior psychiatrist filled in the Clinical Global Impression (CGI-S). RESULTS: The average scales' scores considerably declined in all measurements except for DES. The self-stigma positively correlated with all psychopathology scales. It was also higher in patients with a comorbid personality disorder (PD). The higher self-stigma predicted a lower change in compulsion, anxiety, and depressive symptoms but not the change of obsessions or the overall psychopathology. CONCLUSION: The self-stigma presents an important factor connected to higher severity of OCD. It is also a minor predictor of a lower change in symptomatology after combined treatment.
Department of Psychiatry Hospital Liberec Prague The Czech Republic
Institute for Postgraduate Education in Health Care Prague The Czech Republic
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Huppert JD, Simpson HB, Nissenson KJ, Liebowitz MR, Foa EB. Quality of life and functional impairment in obsessive-compulsive disorder: A comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depress Anxiety. 2009;26(1):39–45. doi:10.1002/da.20506 PubMed DOI PMC
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: Author; 2013.
Weingarden H, Renshaw KD. Shame in the obsessive compulsive related disorders: a conceptual review. J Affect Disord. 2015;171:74–84. doi:10.1016/j.jad.2014.09.010 PubMed DOI PMC
Basile B, Mancini F, Macaluso E, Caltagirone C, Bozzali M. Abnormal processing of deontological guilt in obsessive–compulsive disorder. Brain Struct Funct. 2014;219(4):1321–1331. doi:10.1007/s00429-013-0570-2 PubMed DOI
Williams MT, Farris SG, Turkheimer E, et al. Myth of the pure obsessional type in obsessive-compulsive disorder. Depress Anxiety. 2011;28(6):495–500. doi:10.1002/da.20820 PubMed DOI PMC
Prasko J, Raszka M, Adamcova K, et al. Predicting the therapeutic response to cognitive behavioural therapy in patients with pharmacoresistant obsessive-compulsive disorder.. Neuro Endocrinol Lett. 2009;30(5):615–623. PubMed
Torres AR, Prince MJ. A importância de estudos epidemiológicos sobre o transtorno obsessivo-compulsivo. Rev Brasileira De Psiquiatria. 2004;26(3):141–142. doi:10.1590/s1516-44462004000300001 PubMed DOI
Simpson HB, Huppert JD, Petkova E, Foa EB, Liebowitz MR. Response versus remission in obsessive-compulsive disorder. J Clin Psychiatry. 2006;67(2):269–276. doi:10.4088/jcp.v67n0214 PubMed DOI
Fineberg NA, Gale TM. Evidence-based pharmacotherapy of obsessive–compulsive disorder. Int J Neuropsychopharmacology. 2005;8(1):107–129. doi:10.1017/S1461145704004675 PubMed DOI
Öst L-G, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clin Psychol Rev. 2015;40:156–169. doi:10.1016/j.cpr.2015.06.003 PubMed DOI
Pallanti S, Hollander E, Bienstock C, Koran L, Leckman J, Marazziti D. International Treatment Refractory OCD Consortium. Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacology. 2002;5(2):181–191. doi:10.1017/S1461145702002900 PubMed DOI
Eisen JL, Sibrava NJ, Boisseau CL, et al. Five-year course of obsessive-compulsive disorder: predictors of remission and relapse. J Clin Psychiatry. 2013;74(3):233–239. doi:10.4088/JCP.12m07657 PubMed DOI PMC
Jakubovski E, Diniz JB, Valerio C, et al. Clinical predictors of long-term outcome in obsessive-compulsive disorder. Depress Anxiety. 2013;30(8):763–772. doi:10.1002/da.22013 PubMed DOI
Semiz UB, Inanc L, Bezgin CH. Are trauma and dissociation related to treatment resistance in patients with obsessive–compulsive disorder? Soc Psychiatry Psychiatr Epidemiol. 2014;49(8):1287–1296. doi:10.1007/s00127-013-0787-7 PubMed DOI
Knopp J, Knowles S, Bee P, Lovell K, Bower P. A systematic review of predictors and moderators of response to psychological therapies in OCD: do we have enough empirical evidence to target treatment? Clin Psychol Rev. 2013;33(8):1067–1081. doi:10.1016/j.cpr.2013.08.008 PubMed DOI
Goffman E. Stigma: Notes on the Management of Spoiled Identity. New York: Touchstone; 1986.
Corrigan PW, Nieweglowski K, Sayer J. Self-stigma and the mediating impact of the “why try” effect on depression. J Community Psychol. 2019;47(3):698–705. doi:10.1002/jcop.22144 PubMed DOI
Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Soc Sci Med. 2010;71(12):2150–2161. doi:10.1016/j.socscimed.2010.09.030 PubMed DOI
Prasko J, Ociskova M, Grambal A, Sigmundova Z. Slepecky M. Personality features, dissociation, self-stigma, hope, and the complex treatment of depressive disorder. Neuropsychiatric Dis Treat. 2016;12:2539–2552. doi:10.2147/NDT.S117037 PubMed DOI PMC
Ansari E, Mishra S, Tripathi A, Kar SK, Dalal PK. Cross-sectional study of internalised stigma and medication adherence in patients with obsessive compulsive disorder. General Psychiatry. 2020;33(2):e100180. doi:10.1136/gpsych-2019-100180 PubMed DOI PMC
Grambal A, Prasko J, Kamaradova D, et al. Self-stigma in borderline personality disorder - Cross-sectional comparison with schizophrenia spectrum disorder, major depressive disorder, and anxiety disorders. Neuropsychiatr Dis Treat. 2016;(2016(12):2439–2448. doi:10.2147/NDT.S114671 PubMed DOI PMC
Ociskova M, Prasko J, Kamaradova D, Grambal A, Sigmundova Z. Individual correlates of self-stigma in patients with anxiety disorders with and without comorbidities. Neuropsych Dis Treat. 2015;11:1767–1779. doi:10.2147/NDT.S87737 PubMed DOI PMC
Ociskova M, Prasko J, Vrbova K, Kasalova P, Holubova M. Self-stigma and treatment effectiveness in patients with anxiety disorders – a mediation analysis. Neuropsychiatric Dis Treat. 2018;14:383–392. doi:10.2147/NDT.S152208 PubMed DOI PMC
Deres AT, Bürkner P-C, Klauke B, Buhlmann U. The role of stigma during the course of inpatient psychotherapeutic treatment in a German sample. Clin Psychol Psychother. 2020;27(2):239–248. doi:10.1002/cpp.2423 PubMed DOI
Prasko J, Ociskova M, Latalova K, Kamaradova D, Grambal A. Psychological factors and treatment effectiveness in resistant anxiety disorders in highly comorbid inpatients. Neuropsychiatric Dis Treat. 2016;12:1539–1551. doi:10.2147/NDT.S104301 PubMed DOI PMC
Picco L, Lau YW, Pang S, et al. Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: findings from a cross-sectional survey in Singapore. BMJ Open. 2017;7(8):e018228. doi:10.1136/bmjopen-2017-018228 PubMed DOI PMC
Glazier K, Wetterneck C, Singh S, Williams M. Stigma and shame as barriers to treatment for obsessive-compulsive and related disorders. J Depression Anxiety. 2015;4(3):191. doi:10.4191/2167-1044.1000191 DOI
Stengler-Wenzke K, Trosbach J, Dietrich S, Angermeyer MC. Experience of stigmatization by relatives of patients with obsessive compulsive disorder. Arch Psychiatr Nurs. 2004;18(3):88–96. doi:10.1016/j.apnu.2004.03.004 PubMed DOI
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: Author; 1992.
Storch EA, De Nadai AS, Conceição Do Rosário M. Defining clinical severity in adults with obsessive–compulsive disorder. Compr Psychiatry. 2015;63:30–35. doi:10.1016/j.comppsych.2015.08.007 PubMed DOI PMC
Julian LJ. Measures of anxiety: state-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken). 2011;63(S11):S467–S472. doi:10.1002/acr.20561 PubMed DOI PMC
Ociskova M, Prasko J, Kamarádová D, et al. Self-stigma in psychiatric patients--standardization of the ISMI scale.. Neuro Endocrinol Lett. 2014;35(7):624–632. PubMed
Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121(1):31–49. doi:10.1016/j.psychres.2003.08.008 PubMed DOI
Guy W. ECDEU Assessment Manual for Psychopharmacology. Rockville: DHEW; 1976.
Zaider TI, Heimberg RG, Fresco DM, Schneier FR, Liebowitz MR. Evaluation of the clinical global impression scale among individuals with social anxiety disorder. Psychol Med. 2003;33(4):611–622. doi:10.1017/s0033291703007414 PubMed DOI
Goodman WK. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006–1011. doi:10.1001/archpsyc.1989.01810110048007 PubMed DOI
Baer L, Brown-Beasley MW, Sorce J, Henriques AI. Computer-assisted telephone administration of a structured interview for obsessive-compulsive disorder. Am J Psychiatry. 1993;150(11):1737–1738. doi:10.1176/ajp.150.11.1737 PubMed DOI
Rapp AM, Bergman RL, Piacentini J, McGuire J. Evidence-Based Assessment of Obsessive–Compulsive Disorder. J Cent Nerv Syst Dis. 2016;8:13–29. doi:10.4137/JCNSD.S38359 PubMed DOI PMC
Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties.. J Consult Clin Psychol. 1988;56(6):893–897. doi:10.1037/0022-006X.56.6.893 PubMed DOI
Kamaradova D, Prasko J, Latalova K, et al. Psychometric properties of the Czech version of the Beck Anxiety Inventory - comparison between diagnostic groups.. Neuro Endocrinol Lett. 2015;36(7):706–712. PubMed
Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients. J Pers Assess. 1996;67(3):588–597. doi:10.1207/s15327752jpa6703_13 PubMed DOI
Ociskova M, Prasko J, Kupka M, et al. Psychometric evaluation of the Czech Beck Depression Inventory-II in a sample of depressed patients and healthy controls.. Neuro Endocrinol Lett. 2017;38(2):98–106. PubMed
Carlson EB, Putnam FW. An update on the Dissociative Experience Scale: an update on the Dissociative. Dissociation. 1993;6:16–27. doi:10.1177/1073191116645904 DOI
Ptacek R, Bob P, Paclt I. Skala disociativnich zkusenosti – ceska verze [Dissociative Experiences Scale – A Czech Version]. Cesk Psychol. 2006;50(3):262–272.
Prasko J, Kamaradova D, Cakirpaloglu S, et al. Predicting the therapeutic response to intensive psychotherapeutic programs in patients with neurotic spectrum disorders. Act Nervosa Superior Rediviva. 2015;57(1–2):30–39.
Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–191. doi:10.3758/bf03193146 PubMed DOI
Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988.
European Medicines Agency. Guideline for good clinical practice E6 (R2) (2018). http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500002874.pdf. Accessed 3August 2020..
Lochner C, Stein DJ. Gender in obsessive-compulsive disorder and obsessive-compulsive spectrum disorders. Arch Women’s Mental Health. 2001;4(1):19–26. doi:10.1007/s007370170004 DOI
Brakoulias V, Starcevic V, Belloch A, et al. Comorbidity, age of onset and suicidality in obsessive–compulsive disorder (OCD): an international collaboration. Compr Psychiatry. 2017;76:79–86. doi:10.1016/j.comppsych.2017.04.002 PubMed DOI
Melca IA, Yücel M, Mendlowicz MV, de Oliveira-souza R, Fontenelle LF. The correlates of obsessive–compulsive, schizotypal, and borderline personality disorders in obsessive–compulsive disorder. J Anxiety Disord. 2015;33:15–24. doi:10.1016/j.janxdis.2015.04.004 PubMed DOI
Jónsson H, Hougaard E. Group cognitive behavioural therapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Acta Psychiatr Scand. 2009;119(2):98–106. doi:10.1111/j.1600-0447.2008.01270.x PubMed DOI
Sunde T, Walseth LT, Himle JA, et al. A long-term follow-up of group behavioral therapy for obsessive-compulsive disorder in a general outpatient clinic in Norway. J Obsessive Compuls Relat Disord. 2017;14:59–64. doi:10.1016/j.jocrd.2017.06.002 DOI
Prasko J, Grambal A, Kasalova P, et al. Impact of dissociation on treatment of depressive and anxiety spectrum disorders with and without personality disorders. Neuropsychiatric Dis Treat. 2016;12:2659–2676. doi:10.2147/NDT.S118058 PubMed DOI PMC
Tatlı M, Cetinkaya O, Maner F. Evaluation of relationship between obsessive-compulsive disorder and dissociative experiences. Clin Psychopharmacol Neurosci. 2018;16(2):161–167. doi:10.9758/cpn.2018.16.2.161 PubMed DOI PMC
Belli H. Dissociative symptoms and dissociative disorders comorbidity in obsessive compulsive disorder: symptom screening, diagnostic tools and reflections on treatment. World J Clin Cases. 2014;2(8):327–331. doi:10.12998/wjcc.v2.i8.327 PubMed DOI PMC
Taylor S, Cox BJ. An expanded Anxiety Sensitivity Index: evidence for a hierarchic structure in a clinical sample. J Anxiety Disord. 1998;12(5):463–483. doi:10.1016/s0887-6185(98)00028-0 PubMed DOI
Robinson LJ, Freeston MH. Emotion and internal experience in Obsessive Compulsive Disorder: reviewing the role of alexithymia, anxiety sensitivity and distress tolerance. Clin Psychol Rev. 2014;34(3):256–271. doi:10.1016/j.cpr.2014.03.003 PubMed DOI
Rüsch N, Lieb K, Göttler I, et al. Shame and implicit self-concept in women with borderline personality disorder. Am J Psychiatry. 2007;164(3):500–508. doi:10.1176/ajp.2007.164.3.500 PubMed DOI
Thiese MS, Ronna B, Ott U. P value interpretations and considerations. J Thorac Dis. 2016;8(9):E928–E931. doi:10.21037/jtd.2016.08.16 PubMed DOI PMC
Perez V, Barrachina J, Soler J, et al. The clinical global impression scale for borderline personality disorder patients (CGI-BPD): a scale sensible to detect changes.. Actas Esp Psiquiatr. 2007;35(4):229–235. PubMed
Alreja S, Sengar S, Singh A, Mishra D. Insight and its relationship with stigma in psychiatric patients. Industrial Psychiatry J. 2009;18(1):39–42. doi:10.4103/0972-6748.57858 PubMed DOI PMC
Lien Y-J, Chang H-A, Kao Y-C, Tzeng N-S, Lu C-W, Loh C-H. Insight, self-stigma and psychosocial outcomes in Schizophrenia: a structural equation modelling approach. Epidemiol Psychiatr Sci. 2018;27(2):176–185. doi:10.1017/S2045796016000950 PubMed DOI PMC