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.
SourceAvailable from: Eric Hollander[Show abstract] [Hide abstract]
ABSTRACT: Obsessive-compulsive disorder (OCD) is a common, often debilitating disorder characterized by the presence of obsessions and compulsions. Obsessions are repetitive thoughts or images which are experienced as intrusive and unwanted; they cause marked anxiety and distress. Compulsions (also known as rituals) are repetitive behaviors or mental acts that individuals with OCD perform in an attempt to decrease their anxiety. Patients tend to hide their symptoms due to shame; the amount of time between onset of symptoms and appropriate treatment is often many years. The disorder likely results from several etiological variables; functional imaging studies have consistently shown hyperactivity in the orbitofrontal cortex, anterior cingulate, thalamus, and striatum. The mainstays of treatment include cognitive-behavioral therapy in the form of exposure and response prevention (ERP) and serotonin reuptake inhibiting medications. Several pharmacological augmentation strategies exist for treatment-resistant OCD, with addition of antipsychotics being most commonly employed. Radio and neurosurgical procedures, including gamma knife radiation and deep brain stimulation, are reserved for severe, treatment-refractory disease that has not responded to multiple treatments, and some patients may benefit from transcranial magnetic stimulation.08/2014; 6:68. DOI:10.12703/P6-68
[Show abstract] [Hide abstract]
ABSTRACT: Background Quality of life (QoL) is a well-established outcome measure. However, in contrast to adult obsessive-compulsive disorder (OCD), little is known about QoL in children with OCD. This study aimed to assess QoL, social competence and school functioning of paediatric patients with OCD by comparing them with the general population and assessing the relations between comorbidity, duration and severity of symptoms, family accommodation and QoL.Methods Children and adolescents (n =135), aged 7¿17 (mean 13 [SD 2.7] years; 48.1% female) were assessed at baseline for treatment. QoL was assessed by self-report and caregiver¿s proxy report on the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R) and compared with an age- and sex-matched sample from the general population. Social competence and school functioning were assessed with the Child Behavior Checklist, comorbidity with the Kiddie Schedule for Affective Disorders and Schizophrenia (Present and Lifetime Version), severity of OCD with the Children¿s Yale-Brown Obsessive Compulsive Scale and the families¿ involvement with the child¿s OCD symptoms with the Family Accommodation Scale.ResultsQoL and social competence were reduced (p¿<¿.001) in patients with OCD compared with controls (KINDL-R mean score 62.40 [SD 13.00] versus 69.72 [12.38] in self-reports and 61.63 [SD 13.27] versus 74.68 [9.97] in parent reports). Patients with comorbidity had lower QoL (p¿=¿.001) in proxy ratings than those with OCD only (mean score 56.26 [SD 12.47] versus 64.30 [SD 12.75]). In parent proxy reports, severity of OCD (r¿=¿¿.28) and family accommodation (r¿=¿¿.40) correlated moderately negatively with QoL.Conclusions To our knowledge, this is the largest QoL study of paediatric OCD. QoL was markedly reduced in children with OCD, especially in those with comorbid psychiatric disorders. Based on our findings, we suggest employing QoL assessment in order to have a more comprehensive understanding of childhood OCD.Clinical trials registration informationThis study was registered in Current Controlled Trials; Nordic Long-term Obsessive Compulsive disorder (OCD) Treatment Study (www.controlled-trials.com ISRCTN66385119).Health and Quality of Life Outcomes 10/2014; 12(1):152. DOI:10.1186/s12955-014-0152-x · 2.10 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Many children and adults with Obsessive-Compulsive Disorder experience incomplete symptom relief despite treatment with several evidence-based interventions for OCD. Converging lines of evidence from genetic, neuroimaging, biochemical and pharmacological studies implicate the importance of abnormalities in the glutamate symptoms in the pathogenesis of OCD. Strong evidence suggests that oxidative stress may be important in the progression of several psychiatric disorders, especially psychotic and affective disorders. N-acetylcysteine (NAC) is a cheap, relatively safe over-the-counter supplement that crosses the blood-brain barrier and acts potentially as a glutamate modulating agent and antioxidant. NAC has demonstrated efficacy in the treatment of a wide variety of psychiatric conditions in individual randomized, controlled trials including psychosis, autism, bipolar depression, trichotillomania. A recent double-blind placebo-controlled in adults with SRI-refractory OCD demonstrated the efficacy of NAC compared to placebo. In this review we summarize the preclinical and clinical data demonstrating NAC is a potentially promising new pharmacological agent in the treatment of OCD.Journal of Applied Statistics 11/2014; 10(4). DOI:10.2174/1573400510666140807005327 · 0.45 Impact Factor