MHM Magazine

30 | MENTAL HEALTH MATTERS | Issu3 2 | 2022 MHM SCREENING/ASSESSMENT FOR OCPD Structured or semi-structured interviews are often used in screening for OCPD. The psychometrically sound instruments used to evaluate personality disorders, including OCPD, are the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), the International Personality Disorder Examination (IPDE), the Structured Interview for DSM-IV Personality (SIDP), and the Diagnostic Interview for Personality Disorders (DIPD). The Compulsive Personality Assessment Scale (CPAS) was developed as an observer-rated semi-structured interview to measure the presence and severity of OCPD specifically, mapping directly on each of the DSM-5 criteria for OCPD. Each of the 8 criteria is rated from 0 to 4, and the maximum total score of the CPAS is 32. To meet a diagnosis of DSM-5 OCPD, a score of three (severe) or four (very severe) on at least four of the CPAS items should be presented. In addition, valid self- report measures such as Pathological Obsessive Compulsive Personality Scale (POPS) may also be used to assess the severity of OCPD traits in clinical practice. CAN OCPD BE TREATED? The scientific evidence for pharmacological treatment in case of OCPD is still limited. Until now, only two randomised controlled trials are available that evaluate the efficacy of pharmacological treatment for OCPD. Unfortunately, they provide very preliminary evidence on the efficacy of selective serotonin reuptake inhibitors (SSRIs; i.e., citalopram and fluvoxamine), with low levels of certainty. In terms of non-pharmacological treatment, there are currently four randomised clinical trials available in the literature. In one of the most promising high quality multicenter randomised controlled trials by Bamelis and colleagues (2014), Schema therapy was found to be highly effective for treating personality disorder including OCPD. Schema therapy is one of the third generation CBT therapies, based on integrative approach that combines the elements of CBT, psychodynamic, psychodrama, and other therapeutic approaches. In addition, in three of the earlier studies, short-term psychodynamic therapy and cognitive therapy were found to be effective in treating DSM cluster C personality disorders, including OCPD. However, the number of patients was relatively small, and the evidence rather limited. When drawing comparisons between treatment strategies for OCPD and OCD, accurate diagnosis is probably most important. Some data suggests that if OCPD is present as a comorbid diagnosis in OCD, the established treatment for OCD (i.e., SSRIs with CBT) will be less effective. Therefore, in the case of comorbid OCPD and OCD, greater emphasis should be placed on long-term evidence-based psychotherapy, like schema therapy, in order to target the egosyntonic nature of OCPD, as the presence of this personality disorder may interfere with the well- established short-term psychotherapy manuals and pharmacotherapy for OCD, as mentioned earlier. CONCLUDING REMARKS OCPD is a mental disorder that causes distress and significantly impairs functioning in several life domains. Despite a similar sounding name and some overlapping features, it differs significantly fromOCD. These differences need to be taken into account during diagnosis as it has treatment implications. As yet however, there is still a relative paucity of studies on the possible pharmacological and psychological treatment for OCPD. References available upon request Table 1. Thompson score and biochemical markers for end organ dysfunction OCPD criteria (DSM-5) OCD criteria (DSM-5) A persistent pattern of following criteria (at least four) that starts in early adulthood and are manifested in a various context: 1.Preoccupation with details including rules, list, order, organizational matters at the cost of major point of the activity; 2.Perfectionism that directly interferes with task completion due to overly strict standards; 3.Workaholism including excessive devotion to work, effectiveness and productivity at the expense of friendships and leisure time even when financially or economically not necessary; 4.Over-conscientiousness that is directly manifested by high scrupulosity and inflexibility in the matters of morality, ethic, and values (except for cultural/religious identification); 5.Hoarding including inability to discard worn-out and worthless objects with no sentimental meaning; 6.Need for control that is usually manifested by inability to delegate tasks and work with other unless they submit to his/her style of doing things; 7.Miserliness that includes stingy spending style towards self and others, while the money are seen as something to be hoarded for future catastrophes; 8.Rigidity and stubbornnes. A.A presence of obsessions (i.e. repetitive and persistent thoughts), compulsions (i.e. repetitive [ritualistic] behaviors), or both; B.Obsessions/compulsions are time consuming (at least 1 hour/day) or cause a significant distress or impairment in daily functioning; C.Obsessive-compulsive symptoms are not caused by substance use or other medical condition; D.The disturbances are not better explained by other mental disorder.