Inpatient hospital admissions for people with obsessive-compulsive disorder (OCD). A position statement by the international college of obsessive-compulsive spectrum disorders

The hospitalization of patients with obsessive-compulsive disorder (OCD) is less common in comparison to other mental disorders, and often a significant and distressing event. This paper presents a position statement, developed by the International College of Obsessive-Compulsive Spectrum Disorders, on the indications for hospital admission for people with OCD, the treatment that is offered within hospital, the complications that may occur in this setting, and principles for best practice. Current literature was critically reviewed and narratively synthesized by a group of international experts in the field of OCD. An inpatient hospital admission may be required for people with severe OCD who are unable to accept or tolerate pharmacological or psychological treatment as an outpatient or where there would be significant risks to the individual or those around them. Admissions have been associated with significant reductions in OCD severity. Inpatient treatment often involves psychoeducation of staff, patients and family members, pharmacotherapy, exposure and response prevention psychological work, addressing comorbidity as well as psychosocial issues such as family-relational issues, homelessness, grief or loss. Admissions can be distressing, and intensive inpatient-based therapy programs require the comprehensive assessment of risk. The inpatient treatment of people with OCD is an important management option that needs to be well considered and managed. Admissions often require close monitoring of risks, additional support to staff who may be unfamiliar with OCD, addressing comorbidity, pharmacotherapy and exposure and response prevention therapy. • Admissions for OCD have been associated with significant reductions in symptom severity. • An admission may lead to acute distress secondary to exposure to a different environment. • Admissions may provide the support required to commence exposure tasks and/or pharmacotherapy. • Education and training of staff working on wards with limited expertise in OCD is required.