A 40-year follow-up of patients with obsessive-compulsive disorder [see commetns].
ABSTRACT The long-term course of obsessive-compulsive disorder is insufficiently known. We studied the course of this disorder in patients who were followed up for 40 years.
Patients admitted with a diagnosis of obsessive-compulsive disorder to the Department of Psychiatry, Sahlgrenska University Hospital, Göteborg, Sweden, between 1947 and 1953 were examined by an experienced psychiatrist using a semistructured interview between 1954 and 1956 (n=251). The diagnosis was made according to the criteria of Schneider. A reexamination was performed by the same psychiatrist between 1989 and 1993 (n=122). In another 22 patients, the necessary information was obtained from close informants and medical records. The response rate in surviving patients was 82%. The mean length of follow-up from onset was 47 years.
Improvement was observed in 83%, including recovery in 48% (complete recovery, 20%; recovery with subclinical symptoms, 28%). Among those who recovered, 38% had done so already in the 1950s. Forty-eight percent had obsessive-compulsive disorder for more than 30 years. Early age of onset, having both obsessive and compulsive symptoms, low social functioning at baseline, and a chronic course at the examination between 1954 and 1956 were correlated with a worse outcome. Magical obsessions and compulsive rituals were correlated with a worse course. Qualitative symptom changes within the obsessive-compulsive disorder occurred in 58% of the patients.
After several decades, most individuals with obsessive-compulsive disorder improve, although most patients continue to have clinical or subclinical symptoms.
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ABSTRACT: : Obsessive-compulsive disorder (OCD) is one of the most common and disabling psychiatric disorders. Treatment with selective serotonin reuptake inhibitors (SSRIs) shows significant improvement; however, residual symptoms remain in most patients despite continued treatment. For partial or nonresponding patients to multiple SSRIs, augmentation strategies are usually recommended. Here we present a consecutive sample of patients with resistant OCD treated with amisulpride augmentation to SSRIs. We present 10 patients (5 males, 5 females) experiencing resistant OCD. Subjects were treated openly for 6 weeks with amisulpride 200 mg/d as add-on, excluding 1 patient who was treated with only 100 mg/d due to acute extrapyramidal adverse effect on a larger dose. Efficacy was assessed at baseline and after 6 weeks of treatment using the Yale-Brown Obsessive-Compulsive Scale, Clinical Global Impression-Severity, and Clinical Global Impression-Improvement. The treatment was generally well tolerated without serious events. In all patients, average Yale-Brown Obsessive-Compulsive Scale scores diminished from 25.3 ± 5.96 points at baseline to 12.2 ± 5.98 at the sixth week (P < 0.0005). Of 10 patients, 7 had significant and partial improvement, and 3 patients did not demonstrate any improvement. Treatment-resistant OCD patients positively responded and well tolerated amisulpride add-on to their ongoing regular pharmacotherapy. This case series demonstrates that amisulpride could be a promising optional therapy for patients who have resistant OCD. Further randomized controlled studies are necessary.Clinical Neuropharmacology 01/2015; DOI:10.1097/WNF.0000000000000065 · 1.84 Impact Factor
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ABSTRACT: The aim of this prospective follow-up study is to describe the long-term outcome of obsessive-compulsive disorders (OCD) with onset in childhood or adolescence as well as psychiatric comorbidity. A cohort of 30 former patients who had been treated for OCD in the Clinic for Child and Adolescent Psychiatry of the University of Würzburg were assessed by means of standardized measures in a personal examination at the beginning of their treatment and again after a follow-up period of 6 years. At follow-up, 46.7% of the participants still fulfilled the DSM-IV criteria for OCD. Some 23.3% of the former patients showed subclinical OCD symptoms. 70% met the criteria for any Axis I disorder. Predominantly anxiety and affective disorders, but also obsessive-compulsive and anxious-avoidant personality disorders were found. Six persons showed a complete remission. The rate of 46.7% persistent OCD matches the outcomes found in a meta-analysis (41%); however, lower persistence rates were expected in view of improved treatment options. An extension of the sample planned. FActors maintaining preservation of OCD should be analyzed,Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 06/2009; 37(3):173-82. · 0.99 Impact Factor
Article: Obsessive-Compulsive Disorder[Show abstract] [Hide abstract]
ABSTRACT: A 19-year-old man is brought to his primary physician by his father, who explains that his son washes his hands a hundred times a day, will not touch anything that has been touched by someone else without scrubbing it first, and has a fear of germs that has left him isolated in his bedroom, unable to eat, and wishing he were dead. Although the father reports that his son has always been finicky, this problem started approximately 2 years ago and has gradually become completely disabling. How should this patient be evaluated and treated?New England Journal of Medicine 08/2014; 371(7):646-53. DOI:10.1056/NEJMcp1402176 · 54.42 Impact Factor