Comparison of medication treatment versus cognitive behavior therapy of hoarding behaviors in obsessive-compulsive disorder

A project presented to the Department of Physician Assistant of Wichita State University in partial fulfillment of the requirements for the degree of Master of Physician Assistant.Obsessive-compulsive disorder (OCD) can be difficult to treat due to patient non-compliance and treatment efficacy. This anxiety disorder presents in behaviors such as checking, washing, repeating/counting, ordering/symmetry, harming obsessions, religious/sexual obsessions, obsessional slowness, pure obsessions and hoarding. Of these behaviors, hoarding is the most difficult to treat. Hoarding is defined as the inability to throw away items that are useless. Objective: To determine the best possible therapy for individuals with hoarding behaviors comparing the use of psychotropic medications, cognitive behavioral therapy (CBT) or both. Method: A comprehensive evidence-based medicine (EBM) literature review was conducted using Medline, PubMed, and FirstSearch databases. Included articles were published in English between 1995 and the present. Studies were then ranked Level 1, 2 or 4 based on the quality of the study design. Level 3 articles were not available for this topic of study. Results: Of the 17 studies that met the inclusion criteria in this comprehensive EBM analysis, five were used primarily as background information, one supported the use of medication along with CBT, two supported the use of CBT alone, one did not support the use of medications, two did not support the use of CBT, one did not support either the use of medications or CBT, and five were inconclusive. Conclusion: This analysis warrants a Level C recommendation (inadequate number of Level 1, 2 or 3 studies) for use of medications with CBT, medication treatment alone or CBT alone. This patient population often does not recognize the seriousness of their illness and are non-compliant. Due to this dilemma more research must be performed and data obtained from Level 1 and 2 studies to search for the most effective treatment of hoarding