Hostname: page-component-7c8c6479df-27gpq Total loading time: 0 Render date: 2024-03-27T03:43:02.174Z Has data issue: false hasContentIssue false

Clomipramine and Exposure for Obsessive-Compulsive Rituals: 1

Published online by Cambridge University Press:  29 January 2018

I. M. Marks
Affiliation:
Institute of Psychiatry, London, Honorary Consultant Psychiatrist, Maudsley and Bethlem Hospital
R. S. Stern
Affiliation:
Institute of Psychiatry and Bethlem–Maudsley Hospital, London; now Consultant Psychiatrist, St George's Hospital, London
D. Mawson
Affiliation:
Bethlem–Maudsley Hospital and Institute of Psychiatry, London
J. Cobb
Affiliation:
Institute of Psychiatry and Bethlem–Maudsley Hospital; Consultant Psychiatrist, Department of Psychiatry, St George's Hospital, London; Senior Lecturer in Psychotherapy, University of London
R. McDonald
Affiliation:
Institute of Psychiatry, London

Summary

Forty chronic obsessive-compulsive ritualizers were randomly assigned to treatment with oral clomipramine or placebo for 8 months. During weeks 4 to 7 these two groups were each randomly split into treatment by relaxation or by exposure in vivo, and during weeks 7 to 10 all patients had exposure in vivo. Double blind assessments were made at weeks 4, 7, 10, 18, 36, 62 and 114.

Results are reported to one year. Clomipramine produced significant improvement in rituals, mood and social adjustment, but only in those patients who initially had depressed mood. The clomipramine effect was maximum from weeks 10 to 18 and diminished thereafter. On stopping clomipramine patients often relapsed and improved again on restarting the drug. Relaxation produced little change. Exposure produced significant lasting improvement in rituals, but less change in mood; improvement generalized to social adjustment at follow-up. Clomipramine plus exposure had a slight additive but not interactional effect. Clomipramine enhanced compliance both with exposure and with relaxation.

Clomipramine is useful for compulsive ritualizers with depressed mood, but may need continuation for over a year and combination with exposure in vivo. Exposure in vivo remains the treatment of choice for rituals without depressed mood.

Type
Papers
Copyright
Copyright © The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ananth, J., Pecknold, J. C., Van den Steen, & Engelsmann, F. (1978) Double blind comparative study of chlorimipramine in obsessive-neurosis. Paper to CINP, Vienna, July.Google Scholar
Beaumont, G. (1973) Clomipramine (Anafranil) in the treatment of obsessive-compulsive disorders—a review of the work of Dr G. H. Collins. Journal of International Medical Research, 1, 423–4.Google Scholar
Black, A. (1974) The natural history of obsessional neurosis. Chapter 2. In Obsessional States. (Ed. Beech, H. R.). London: Methuen.Google Scholar
Boersma, K., Den Hengst, S., Dekker, J. & Emmelkamp, P. M. G. (1976) Exposure and response prevention in the natural environment. A comparison with obsessive-compulsive patients. Behaviour, Research and Therapy, 14, 1924.CrossRefGoogle ScholarPubMed
Boulougouris, J. C. (1977) Variables affecting the behaviour of obsessive-compulsive patients treated by flooding. Paper to European Association for Behaviour Therapy, Spetsae, Greece, September, 1976. In Studies in Phobic and Obsessive-Compulsive Disorders. (Eds. J. C. Boulougouris and Rabavilas, A.). Oxford: Pergamon.Google Scholar
Boulougouris, J. C. & Rabavilas, A. (1977) The Treatment of Phobic and Obsessive-Compulsive Disorders. Oxford: Pergamon.Google Scholar
Capstick, N. (1975) Clomipramine in the treatment of the true obsessional state—a report on four patients. Psychosomatics, 16, 1, 21–5.CrossRefGoogle ScholarPubMed
Capstick, N. & Seldrup, J. (1973) Phenomenological aspects of obsessional patients treated with clomipramine. British Journal of Psychiatry, 122, 719–20.CrossRefGoogle ScholarPubMed
Fernandez, J. & Lopez-Ibor, J. J. (1967) Monochlorimipramine in the treatment of psychiatric patients resistant to other therapies. Actas Luso-Espanolas de Neurologia y Psiquatria, 26, 119–47.Google Scholar
Foa, E. B. & Goldstein, A. (1980) Continuous exposure and complete response prevention treatment of obsessive-compulsive neurosis. Behavior Therapy. (In press).Google Scholar
Foa, E. B. & Steketee, G. (1979) In Progress in Behavior Modification. (Eds. R. M. Hersen et al). London: Academic Press.Google Scholar
Francis, A. D., Williams, P., Williams, R., Link, G., Zole, E. N. & Hughes, D. (1976) The effect of clomipramine on prolactin levels—pilot studies. Post-Graduate Medical Journal, Supplement 3, 52, 8792.Google Scholar
Gelder, M. G. & Marks, I. M. (1966) Severe agoraphobia: a controlled prospective trial of behaviour therapy. British Journal of Psychiatry, 112, 309–19.CrossRefGoogle ScholarPubMed
Gittleson, N. L. (1966) The effect of obsessions on depressive psychosis. British Journal of Psychiatry, 112, 253–9, 261, 705, 883, 889.Google ScholarPubMed
Goodwin, D. W., Guze, S. B. & Robins, E. (1969) Follow-up studies in obsessional neurosis. Archives of General Psychiatry, 20, 182–7.Google Scholar
Hamilton, M. (1969) Standardized assessment and recording of depressive symptoms. Psychiatrica Neurologia Neurochirurgia., 72, 201–5.Google Scholar
Hodgson, R., Rachman, S. & Marks, I. M. (1972) The treatment of obsessive-compulsive neurosis: follow-up and further findings. Behaviour Research and Therapy, 10, 181–9.Google Scholar
Horn, A. S. (1976) The interaction of tricyclic antidepressants with the biogenic amine uptake systems of the central nervous system. Postgraduate Medical Journal, Supplement 3, 52, 2531.Google Scholar
Jefferson, J. W. (1976) A review of the cardiovascular effects and toxicity of tricyclic antidepressants. Psychosomatic Medicine, 37, 160–79.Google Scholar
Jones, R. B. & Luscombe, D. K. (1976) Plasma levels of clomipramine and its N-desmethylmetabolite following oral administration of clomipramine in man. British Journal of Pharmacology, 57, 4308.Google Scholar
Karabanow, O. (1977) Double blind controlled study in phobias and obsessions complicated by depression. International Journal of Medical Research, 5, Supplement 5, 42–8.Google Scholar
Kendell, R. E. & DiScipio, W. J. (1970) Obsessional symptoms and obsessional personality traits in patients with depressive illnesses. Psychological Medicine, 1, 6572.CrossRefGoogle ScholarPubMed
Knesevitch, J. W., Biggs, J. T., Clayton, P. J. & Ziegler, V. E. (1977) Validity of the Hamilton rating scale for depression. British Journal of Psychiatry, 131, 4952.Google Scholar
Kringlen, E. (1965) Obsessional neurotics: a long term follow-up. British Journal of Psychiatry, 111, 709–22.Google Scholar
Lewis, A. J. (1934) Melancholia: a clinical survey of depressive states. Journal of Mental Science, 80, 277378.CrossRefGoogle Scholar
Lipsedge, M., Hajioff, J., Huggings, P., Napier, L., Pearce, J., Pike, D. J. & Rich, M. (1973) The management of severe agoraphobia: a comparison of iproniazid and systematic desensitization. Psychopharmacologia, 32, 67.CrossRefGoogle ScholarPubMed
Marks, I. M. (1965) Patterns of Meaning in Psychiatric Patients. Maudsley Monograph No. 13. Oxford University Press.Google Scholar
Marks, I. M. (1978) Exposure treatments: Chapter 7: Conceptual Issues, Chapter 8: Clinical Applications. In Behavior Modification. (Ed. Agras, W. S.). Boston: Little Brown.Google Scholar
Marks, I. M., Hodgson, R. & Rachman, S. (1975) Treatment of chronic obsessive-compulsive neurosis by in vivo exposure: a two year follow-up and issues in treatment. British Journal of Psychiatry, 127, 349–64.CrossRefGoogle ScholarPubMed
Marks, I. M., Hallam, R. S., Philpott, R. & Connolly, J. (1977) Nursing in Behavioural Psychotherapy. Research Series of Royal College of Nursing, Cavendish Square, Henrietta Street, London, W.C.I. Google Scholar
Marks, I. M., Bird, J. & Lindley, P. (1978) Behavioural nurse therapists. Behavioural Psychotherapy, 6, 2535.Google Scholar
Mawson, D., Marks, I. M. & Stern, R. S. (1979) Two year follow-up of obsessive-compulsive rituals. In preparation.Google Scholar
Meyer, V., Levy, R. & Schnurer, A. (1974) The behavioural treatment of obsessive-compulsive disorders. Chapter 10, p. 233258. In Obsessional States. (Ed. Beech, H. R.). London: Methuen.Google Scholar
Oswald, I. (1973) Sleep studies with clomipramine and related drugs. Journal of International Medical Research, 1, 296–8.Google Scholar
Philpott, R. (1975) Recent advances in the behavioural measurement of obsessional illness. Scottish Medical Journal, 20, 3340.Google Scholar
Rabavilas, A. D., Boulougouris, J. C. & Stefand, D. (1976) Duration of flooding session in the treatment of obsessive-compulsive patients. Behaviour, Research and Therapy, 14, 349–55.Google Scholar
Rachman, S., Hodgson, R. & Marks, I. M. (1971) Treatment of chronic obsessive-compulsive neurosis. Behaviour, Research and Therapy, 9, 237–47.Google Scholar
Rachman, S., Marks, I. M. & Hodgson, R. (1973) The treatment of obsessive-compulsive neurotics by modelling and flooding in vivo. Behaviour, Research and Therapy, 11, 463.Google Scholar
Rachman, S. & Hodgson, R. (1979) Obsessions and Compulsions. Hemel Hempstead: Prentice-Hall.Google Scholar
Rack, P. H. (1973) Clomipramine in the treatment of obsessional states with special reference to the Leyton Obsessional Inventory. Journal of International Medical Research, 1, (5) 332 and 397–402.CrossRefGoogle Scholar
Roper, G., Rachman, S. & Marks, I. (1976) Passive and participant modelling in exposure treatment of obsessive-compulsive neurotics. Behaviour, Research and Therapy, 13, 271–9.Google Scholar
Rosenberg, C. M. (1968) Complications of obsessional neurosis. British Journal of Psychiatry, 114, 477–8.CrossRefGoogle ScholarPubMed
Singh, A. N., Saxena, B. & Gent, M. (1977) Clomipramine in depressive patients with obsessive neurosis. International Journal of Medical Research, Supplement 5, 2532.Google Scholar
Snaith, R. P., Ahmed, S. N., Mehta, S. & Hamilton, M. (1971) Assessment of the severity of primary depressive illness. Wakefield Self-Assessment Depression Inventory. Psychological Medicine, February, 1, 143–9.CrossRefGoogle ScholarPubMed
Solyom, L., Lapierre, Y. D., Solyom, C. & Smyth, D. (1974) The interaction of phenelzine and exposure to the phobic situation in the treatment of phobias. Paper to Canadian Psychiatric Association Meeting, Ottawa.Google Scholar
Stern, R. S., Marks, I. M., Mawson, D. & Luscombe, D. K. (1979) Clomipramine and exposure for compulsive rituals—II. Plasma levels, side effects and outcome. British Journal of Psychiatry. (In press).CrossRefGoogle Scholar
Symes, M. H. (1967) Monochlorimipramine: a controlled trial of a new antidepressant. British Journal of Psychiatry, 113, 671–5.Google Scholar
Thoren, P., Asberg, M., Cronholm, B., Jornestedt, L. & Traskman, L. (1979) Clomipramine treatment of obsessive-compulsive disorder. I: a controlled clinical trial. Archives of General Psychiatry. (Submitted for publication.) CrossRefGoogle Scholar
Tyrer, P. J., Candy, J. & Kelly, D. H. S. (1973) Phenelzine in phobic anxiety: a controlled trial. Psychological Medicine, 3, 120–4.Google Scholar
Tyrer, P. J. & Steinberg, D. (1975) Symptomatic treatment of agoraphobia and social phobias: a follow-up study. British Journal of Psychiatry, 127, 163–8.Google Scholar
Vaughan, M. (1976) Relationships between obsessional personality, obsessions in depression and symptoms of depression. British Journal of Psychiatry, 129, 36–9.Google Scholar
Videbech, T. (1975) The psychopathology of endogenous depression. Acta Psychiatrica Scand., 52, 336–73.Google Scholar
Weissman, M. M., Kasl, S. V. & Klerman, G. L. (1975) Depressed women one year after maintenance therapy. Paper 96 in Proceedings Summary, American Psychiatric Association annual meeting, Anaheim, p. 88–9.Google Scholar
Zitrin, C. M., Klein, D. F. & Woerner, M. G. (1978) Behavior therapy, supportive psychotherapy, imipramine and phobias. Archives of General Psychiatry, 35, 307–16.CrossRefGoogle ScholarPubMed
Zung, W. W. K. (1965) A self-rating depression scale. Archives of General Psychiatry, 12, 6370.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.