Section - Quick Takes

05. Efficacy and Clinical Predictors of Response to rTMS Treatment in Pharmacoresistant Obsessive-Compulsive Disorder (OCD): A Retrospective Study

Published on February 1, 2021 Expired on April 1, 2024

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

Reminder: The starting point for treating OCD is the variation of CBT, known as exposure and response prevention (ERP). - Transcranial magnetic stimulation for treatment-resistant OCD has multiple studies showing efficacy greater than sham TMS. However, the brain location, pulse frequency, and treatment duration are all still under investigation. - One randomized trial supports the use of “deep” TMS, but it had heavy financial support from the device’s manufacturer. Active treatment was superior to sham TMS in reducing the Yale-Brown Obsessive Compulsive Scale (YBOCS) score by a 3-point margin on the 40-point scale.

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Text version

What options should you and your patient discuss for serious obsessive-compulsive disorder which has not responded to multiple treatments? Should you consider referring the patient for transcranial magnetic stimulation or treating them yourself if you have a TMS machine?

Hi! Jim Phelps here for the Psychopharmacology Institute. First, let’s look at updated guidelines on the treatment of OCD to make sure you know what to try before turning to TMS perhaps. We will look at a meta-analysis of TMS as a treatment for OCD and an article that describes results obtained by a team of clinicians looking back at 65 of their most recent cases with TMS. Finally, we’ll look at a single randomized trial of deep TMS for OCD.

First, the guidelines: The American Psychiatric Association and the National Institute for Clinical Excellence of the UK National Health Service both agree that the OCD-specific version of CBT known as

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Learning Objectives:

After completing this activity, the learner will be able to:

Review the current understanding of Alzheimer's dementia risk and protective factors using a new meta-analysis, which rank-orders factors by relative risk.
Assess the evidence for claims of superior efficacy of selected antidepressants for the treatment of cognitive impairment in the context of major depressive disorder.
Review the evidence for treatment options for severe neuroleptic malignant syndrome.
Analyze a recent review and meta-analysis of depression relapse rates upon antidepressant discontinuation during pregnancy.
Assess the value of transcranial magnetic stimulation for patients with treatment-resistant obsessive-compulsive disorder.

Original Release Date: 02/01/2021

Review Date: 03/01/2024

Expiration Date: 04/01/2024

Relevant Financial Disclosures:

The following planners, faculty, and reviewers have the following relevant financial relationships with commercial interests to disclose:

Dr. Phelps has disclosed the following relationships:

McGraw-Hill: book on bipolar disorder
W.W. Norton & Co.: books on bipolar disorder

All of the relevant financial relationships listed for these individuals have been mitigated.

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