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Psychologische interventies OCS

Beoordeeld: 01-02-2010

Bij de behandeling van obsessief-compulsieve stoornis (OCS) zijn verschillende psychotherapeutische interventies onderzocht. Uit het onderzoek komt naar voren dat met name twee behandelmethoden effectief zijn:

a. exposure in vivo met respons-preventie en

b. cognitieve therapie.

Hierbij is exposure in vivo met responspreventie eerste keus behandeling, vanwege de grote hoeveelheid positieve onderzoeksresultaten en de positieve lange termijn effecten. Bij cognitieve therapie zijn deze lange termijn effecten nog niet onderzocht. Andere psychotherapeutische behandelmethoden blijken niet of minder effectief, of zijn onvoldoende onderzocht. Er zijn geen randomized controlled trials waarin de effectiviteit van andere psychotherapeutische methoden is geëvalueerd.

Onderbouwing

Bij deze module zijn geen conclusies geformuleerd.

Voor onderstaande tekst is gebruik gemaakt van literatuur die gevonden is door middel van een gecomputeriseerd literatuuronderzoek in MedLine en PsycINFO met de volgende trefwoorden: obsessive compulsive disorder, behavior therapy, cognitive therapy en psychotherapeutic techniques. Gezien de grote hoeveelheid literatuur werd in eerste instantie gebruik gemaakt van meta-analyses en reviews, in tweede instantie van randomized controlled trials. Waar nodig is gebruik gemaakt van aanvullende niet systematisch gezochte literatuur.

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Autorisatiedatum en geldigheid

Laatst beoordeeld  : 01-02-2010

Laatst geautoriseerd  : 01-02-2010

Geplande herbeoordeling  :

De Multidisciplinaire Richtlijn Angststoornissen wordt op dit moment ge-update. Naar de revisie van de MDR Angststoornissen kan op de volgende wijze verwezen worden: Richtlijnherziening van de Multidisciplinaire richtlijn Angststoornissen (eerste revisie). Richtlijn voor de diagnostiek, behandeling en begeleiding van volwassen patiënten met een angststoornis.

Initiatief en autorisatie

Initiatief:
  • Nederlandse Vereniging voor Psychiatrie
Geautoriseerd door:
  • Nederlandse Vereniging voor Psychiatrie

Algemene gegevens

De digitale versie van deze richtlijn is ontwikkeld vanuit het Landelijk Actieprogramma Kwaliteit geestelijke gezondheidszorg en verslavingszorg (LAK GGZ/VZ). Dit programma is een initiatief van het ministerie van VWS en wordt gecoördineerd en gefinancierd door ZonMw.

 

Kwaliteitsinstituut voor de Gezondheidszorg CBO

Het Kwaliteitsinstituut voor de Gezondheidszorg CBO, gevestigd in Utrecht, heeft tot doel individuele beroepsbeoefenaren, hun beroepsverenigingen en zorginstellingen te ondersteunen bij het verbeteren van de patiëntenzorg. Sinds zijn oprichting in 1979 heeft het CBO zich ontwikkeld tot een toonaangevend en ook internationaal erkend instituut dat via programma's en projecten ondersteuning en begeleiding biedt bij systematisch en gestructureerd meten, verbeteren, herontwerpen en borgen van kwaliteit van de patiëntenzorg.

 

Trimbos-instituut

Het Trimbos-instituut is het landelijk kennisinstituut voor de geestelijke gezondheidszorg, de verslavingszorg en de maatschappelijke zorg.

De missie van het Trimbos-instituut is kennis over geestelijke gezondheid creëren en doen toepassen in beleid en praktijk van de geestelijke gezondheidszorg, de verslavingszorg en de maatschappelijke zorg.

Samenstelling werkgroep

De multidisciplinaire richtlijn Angststoornissen is op initiatief en onder auspiciën van de Landelijke Stuurgroep Multidisciplinaire Richtlijnontwikkeling in de GGZ en de daaronder ressorterende Commissie Cliëntenparticipatie tot stand gebracht door de werkgroep Angststoornissen waarin de deelnemende verenigingen en organisaties hebben samengewerkt.

Methodologische en organisatorische ondersteuning en begeleiding werden verzorgd door het Kwaliteitsinstituut voor de Gezondheidszorg CBO en het Trimbos-instituut.

 

Landelijke Stuurgroep Multidisciplinaire Richtlijnontwikkeling in de GGZ

Voorzitter          

R.M.W. Smeets, Raad van Bestuur GGZ Friesland

Vice-voorzitter 

Prof.dr. G. Hutschemaekers, De Gelderse Roos, Arnhem

Secretaris           

Mw. dr. A. Eland (tot januari 2002) en dr. A.L.C.M. Henkelman, Trimbos-instituut

Leden   

Ir. T.A. van Barneveld, Kwaliteitsinstituut voor de Gezondheidszorg CBO

Mw. H. Blankman, Federatie Verpleegkunde in de GGZ (FVGGZ)

Mw. dr. J.H. Dekker, Nederlands Huisartsen Genootschap (NHG)

Dr. P.M.A.J. Dingemans, Nederlands Instituut van Psychologen (NIP)

Dr. P.A. de Groot t, Nederlandse Vereniging voor Psychiatrie (NVvP)

Prof.dr. R.W. Trijsburg, Nederlandse Vereniging voor Psychotherapie (NVP)

Agendaleden   

Prof. Dr. W.J.J. Assendelft, Nederlands Huisartsen Genootschap (NHG)

Dr. dr. G.A. van Essen, Nederlands Huisartsen Genootschap (NHG)

Mw. dr. G.H.M.M. ten Horn     

Drs. J. Penninga, Ministerie van Volksgezondheid, Welzijn en Sport

Adviseur             

Prof. dr. J.A. Swinkels, AMC De Meren, Amsterdam/Trimbos-instituut

 

Commissie Cliëntenparticipatie

Voorzitter          

Mw. dr. G.H.M.M. ten Horn     

Secretaris           

Mw. drs. C. van der Veen, Trimbos-instituut

Leden   

Mw H. Boumans, Ypsilon

Mw. E. Dangerman, Stichting Borderline

Mw. T. de Vent, Stichting Labyrint/ In Perspectief

Mw. drs. A.M. Dijkman, Vereniging voor Manisch Depressieve en Betrokkenen (VMDB)

T. Festen            

Mw. H. van ’t Kooten, Vereniging voor Manisch Depressieve en Betrokkenen (VMDB)

B.H. Kraaijenbrink, Stichting Anorexia en Boulimia Nervosa

Mw. I. Lüneburg, Landelijke Vereniging Balans

Mw. M. Mannak-Bouman, Stichting Labyrint/In Perspectief

Mw. I. Poort, Nederlandse Vereniging voor Autisme (NVA)

Mw. drs. M.K. Taams, Stichting FobieVrienden

Mw. M. Van der Linden, Angst, Dwang en Fobiestichting

Mw. L. van ’t Veen, Cliëntenbond in de GGZ

M. Vermeulen, Anoiksis

T. Vriens, Stichting Pandora

Mw. drs. J. Zwanikken-Leenders, GGZ Den Bosch

 

Werkgroep Angststoornissen

Voorzitter

Prof. dr. Ph. Spinhoven, hoogleraar Universiteit Leiden

Leden

Prof. dr. A.J.L.M. van Balkom, psychiater, Vrije Universiteit Medisch Centrum, Amsterdam

Mw. M. Boon, creatief therapeut, Sinai Centrum, Amersfoort

Mw. drs. C.A.M. Bouwmans, gezondheidswetenschapper, iMTA, Rotterdam

F.E. ten Broeke, psycholoog

Prof. dr. R. van Dyck, hoogleraar psychiatrie, Vrije Universiteit Medisch Centrum, Amsterdam

Prof. dr. P.M.G. Emmelkamp, psycholoog

Mw. dr. M.H. Grol, huisarts

Mw. dr. L. Hakkaart-van Roijen, gezondheidseconoom, iMTA, Rotterdam

Mw. drs. H. de Kam, verpleegkundig stafmedewerker, Symforagroep Zon en Schild, Amersfoort

Dr. C.W. Korrelboom, psychotherapeut, Parnassia Psycho-medisch Centrum, Den Haag

Drs. J.C.G.J. Oomen, psychotherapeut, Vincent van Gogh Instituut, Venray

G.J.M. Roodbol MScN, verpleegkundig specialist, Universitair Medisch Centrum St. Radboud, Nijmegen

Mw. drs. E.M.A.A. Rozenbroek, apotheker, Apotheek Koek, Amsterdam

Mw. drs. M. Scholte, onderzoeker, Nederlands Instituut voor Zorg en Welzijn, Utrecht

Mw. drs. M.K. Taams, cliëntvertegenwoordiger, Stichting Fobie Vrienden, Hillegom

Dr. B. Terluin, huisarts, senior onderzoeker, Emgo-instituut, Amsterdam

Mw. S.C.D. Timmer, maatschappelijk werk

Mw. M. Ulrich, cliëntvertegenwoordiger

Drs. D.W.F. Veldhorst, bedrijfsarts, ‘Arboreijn' Arbo en reïntegratiebedrijf, Ede

Dr. S. Visser, klinisch psycholoog/psychotherapeut, Angstpolikliniek GGZ Buitenamstel, Amsterdam

Mw. dr. I.M. van Vliet, psychiater, Leids Universitair Medisch Centrum, Leiden

 

Met dank aan:

Mw.drs. M. Scholte, NIZW, leverde de werkgroep belangrijke bijdragen voor het hoofdstuk "Ondersteunende interventies".

 

Adviseurs

Mw. drs. M.M. Kroeze, adviseur Kwaliteitsinstituut voor de Gezondheidszorg CBO, Utrecht, adviseur (tot mei 2002)

Mw. drs. A. Hagemeijer               , adviseur Kwaliteitsinstituut voor de Gezondheidszorg CBO, Utrecht, adviseur (vanaf mei 2002)

Mw. dr. M.J.C. van Hattum, wetenschappelijk medewerker, Trimbos instituut, Utrecht secretaris (tot september 2002)

Methode ontwikkeling

Evidence based

Werkwijze

Voor artikelen betreffende preventie of therapie:

A1

systematische reviews die ten minste enkele onderzoeken van A2-niveau betreffen, waarbij de resultaten van afzonderlijke onderzoeken consistent zijn

A2

gerandomiseerd vergelijkend klinisch onderzoek van goede kwaliteit (gerandomiseerde, dubbelblind gecontroleerde trials) en van voldoende omvang en consistentie

B

gerandomiseerde klinische trials van matige kwaliteit of onvoldoende omvang of ander vergelijkend onderzoek (niet-gerandomiseerd, vergelijkend cohortonderzoek, patiëntcontroleonderzoek)

C

niet-vergelijkend onderzoek

D

mening van deskundigen, bijvoorbeeld de werkgroepleden

 

Voor artikelen betreffende diagnostiek:

A1 onderzoek naar de effecten van diagnostiek op klinische uitkomsten bij een prospectief gevolgde goed gedefinieerde patiëntengroep met een tevoren gedefinieerd beleid op grond van de te onderzoeken testuitslagen, of besliskundig onderzoek naar de effecten van diagnostiek op klinische uitkomsten, waarbij resultaten van onderzoek van A2-niveau als basis worden gebruikt en voldoende rekening wordt gehouden met onderlinge afhankelijkheid van diagnostische tests

A2 onderzoek ten opzichte van een referentietest, waarbij van tevoren criteria zijn gedefinieerd voor de te onderzoeken test en voor een referentietest, met een goede beschrijving van de test en de onderzochte klinische populatie; het moet een voldoende grote serie van opeenvolgende patiënten betreffen, er moet gebruikgemaakt zijn van tevoren gedefinieerde afkapwaarden en de resultaten van de test en de 'gouden standaard' moeten onafhankelijk zijn beoordeeld. Bij situaties waarbij multipele, diagnostische tests een rol spelen, is er in principe een onderlinge afhankelijkheid en dient de analyse hierop te zijn aangepast, bijvoorbeeld met logistische regressie

B vergelijking met een referentietest, beschrijving van de onderzochte test en populatie, maar niet de kenmerken die verder onder niveau A staan genoemd

C niet-vergelijkend onderzoek

D mening van deskundigen, bijvoorbeeld de werkgroepleden

 

Niveau van de conclusie op basis van de literatuuranalyse:

1

gebaseerd op minimaal één systematische review (A1) of ten minste twee onafhankelijk van elkaar uitgevoerde onderzoeken van niveau A1 of A2

2

gebaseerd op ten minste twee onafhankelijk van elkaar uitgevoerde onderzoeken van niveau B

3

gebaseerd op één onderzoek van niveau A2 of B, of op onderzoek(en) van niveau C

4

gebaseerd op (gepubliceerde) mening van deskundigen, bijvoorbeeld de werkgroepleden

 

Volgende:
Gegeneraliseerde angststoornis (GAS)