Ty Drake, Nabil Malik*
Background: The prevalence of Obsessive-Compulsive Disorder (OCD) following Traumatic Brain Injury (TBI) ranges from 2-15%. OCD in patients with TBI can be distressing, difficult to manage, and hinder the rehabilitation process. Compared to non-TBI patients who have OCD, those with TBI and OCD present unique diagnostic and treatment challenges. The aim of this literature review was to identify treatments for OCD following TBI, and to evaluate the quality of evidence to explore recommendations for clinical practice and future research.
Methods: The following databases were searched for treatments of OCD in patients with TBI using Medical Subject Headings (MeSH) and key index terms: MEDLINE, Embase, CINAHL, PsycINFO, Cochrane, Scopus, Web of Science, and Google Scholar. The search criteria included studies on humans from 16-years-old to 65-years-old from database inception to November 2020. Grey literature was also searched.
Results: After deduplication, the literature search identified 232 results. The title, abstract, and key index terms were then screened against inclusion and exclusion criteria; leaving 30 results for further review. These 30 results were screened at full-text level against the criteria, ending with 13 results for the final analysis. In total, there were 10 case reports and three case series; a total of 19 patients with TBI treated for OCD. All results were NHMRC Level IV evidence and descriptive; therefore, a narrative analysis was performed. Pharmacological treatments included several antidepressant classes and stimulants.
Conclusion: Pharmacological, psychological, combination treatments and ECT have been utilised to treat OCD in patients with TBI. Treatments not immediately described in guidelines for treating OCD in the general population appeared to have achieved some success in treating OCD in a TBI population. However, there is currently not enough high quality evidence to support an evidence-based clinical guideline or recommendation. There is a paucity of high-level research, and further research would assist future clinical practice.