Clinical predictors of long-term outcome in obsessive-compulsive disorder

Department of Psychology, University of Heidelberg, Heidelberg, Germany.
Depression and Anxiety (Impact Factor: 4.41). 08/2013; 30(8). DOI: 10.1002/da.22013
Source: PubMed


The purpose of this study was to investigate demographic and clinical factors associated with the long-term outcome of obsessive-compulsive disorder (OCD).

A hundred ninety-six previously untreated patients with DSM-IV criteria OCD completed a 12-week randomized open trial of group cognitive-behavioral therapy (GCBT) or fluoxetine, followed by 21 months of individualized, uncontrolled treatment, according to international guidelines for OCD treatment. OCD severity was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at different times over the follow-up period. Demographics and several clinical variables were assessed at baseline.

Fifty percent of subjects improved at least 35% from baseline, and 21.3% responded fully (final Y-BOCS score < or = 8). Worse prognosis was associated with earlier age at onset of OCD (P = 0.045), longer duration of illness (P = 0.001) presence of at least one comorbid psychiatric disorder (P = 0.001), comorbidity with a mood disorder (P = 0.002), higher baseline Beck-Depression scores (P = 0.011), positive family history of tics (P = 0.008), and positive family history of anxiety disorders (P = 0.008). Type of initial treatment was not associated with long-term outcome. After correction for multiple testing, the presence of at least one comorbid disorder, the presence of a depressive disorder, and duration of OCD remained significant.

Patients under cognitive-behavioral or pharmacological treatment improved continuously in the long run, regardless of initial treatment modality or degree of early response, suggesting that OCD patients benefit from continuous treatment. Psychiatric comorbidity, especially depressive disorders, may impair the long-term outcome of OCD patients.

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    • "One major study found a familial relationship between OCD and BDD, as well as between OCD and " compulsive grooming behaviors, " suggesting that these disorders are part of the " familial OCD spectrum " (Bienvenu et al., 2000). Patients with OCD or BDD have a high chance of presenting a chronic course of symptoms, with low rates of full remission, even when adequately treated (Eisen et al., 2010; Jakubovski et al., 2012; Phillips et al., 2013), a poor quality of life, and impaired occupational and social functioning (Ishak et al., 2012; Rosa et al., 2012). These disorders generally require long-term treatment and share serotonin reuptake inhibitors (SRI) and cognitive behavior therapy (CBT) as their first-line treatment options (Bandelow et al., 2012; Neziroglu and Khemlani-Patel, 2002; Phillips and Hollander, 2008). "
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    ABSTRACT: Our aim was to investigate the impact of comorbid body dysmorphic disorder (BDD) on the response to sequential pharmacological trials in adult obsessive-compulsive disorder (OCD) patients. The sequential trial initially involved fluoxetine monotherapy followed by one of three randomized, add-on strategies: placebo, clomipramine or quetiapine. We included 138 patients in the initial phase of fluoxetine, up to 80 mg or the maximum tolerated dosage, for 12 weeks. We invited 70 non-responders to participate in the add-on trial; as 54 accepted, we allocated 18 to each treatment group and followed them for an additional 12 weeks. To evaluate the combined effects of sex, age, age at onset, initial severity, type of augmentation and BDD on the response to sequential treatments, we constructed a model using generalized estimating equations (GEE). Of the 39 patients who completed the study (OCD-BDD, n = 13; OCD-non-BDD, n = 26), the OCD-BDD patients were less likely to be classified as responders than the OCD-non-BDD patients (Pearson Chi-Square = 4.4; p = 0.036). In the GEE model, BDD was not significantly associated with a worse response to sequential treatments (z-robust = 1.77; p = 0.07). The predictive potential of BDD regarding sequential treatment strategies for OCD did not survive when the analyses were controlled for other clinical characteristics.
    Journal of Psychopharmacology 11/2013; 28(6). DOI:10.1177/0269881113512042 · 3.59 Impact Factor
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    • "The worst prognosis for the disorder is associated with an earlier age of onset and a longer duration of illness. It has been suggested that patients with OCD may benefit from prolonged continuous treatment.6 "
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    ABSTRACT: The Internet is increasingly used as a source of information for mental health issues. The burden of obsessive compulsive disorder (OCD) may lead persons with diagnosed or undiagnosed OCD, and their relatives, to search for good quality information on the Web. This study aimed to evaluate the quality of Web-based information on English-language sites dealing with OCD and to compare the quality of websites found through a general and a medically specialized search engine. Keywords related to OCD were entered into Google and OmniMedicalSearch. Websites were assessed on the basis of accountability, interactivity, readability, and content quality. The "Health on the Net" (HON) quality label and the Brief DISCERN scale score were used as possible content quality indicators. Of the 235 links identified, 53 websites were analyzed. The content quality of the OCD websites examined was relatively good. The use of a specialized search engine did not offer an advantage in finding websites with better content quality. A score ≥16 on the Brief DISCERN scale is associated with better content quality. This study shows the acceptability of the content quality of OCD websites. There is no advantage in searching for information with a specialized search engine rather than a general one. Practical implications: The Internet offers a number of high quality OCD websites. It remains critical, however, to have a provider-patient talk about the information found on the Web.
    Neuropsychiatric Disease and Treatment 11/2013; 9:1717-23. DOI:10.2147/NDT.S49645 · 1.74 Impact Factor
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    • "Prediction of response to treatment in OCD individuals is an extensive area of research. However, to date, pharmacotherapy studies have focused mainly on demographic and clinical features present at baseline as potential predictors, such as age at OCD onset (Ackerman et al., 1994; Erzegovesi et al., 2001), marital status (Shavitt et al., 2006), type of symptoms content (Alarcon et al., 1993; Ferrão et al., 2006; Mataix-Cols et al., 1999), presence of sensory phenomena (Shavitt et al., 2006), specific axis I or II comorbidities (Baer et al., 1992; Carrasco et al., 1992; Jakubovski et al., 2012; Jenike et al., 1986; Shavitt et al., 2010), family history of OCD (Erzegovesi et al., 2001), illness duration (Alarcon et al., 1993; Ravizza et al., 1995; Stein et al., 2001), level of insight (Erzegovesi et al., 2001), socioeconomic status (Ferrão et al., 2006; Tükel et al., 2006) and family functioning (Ferrão et al., 2006; Tükel et al., 2006). "
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    ABSTRACT: Unlabelled: In major depression, early response to treatment has been strongly associated with final outcome. We aimed to investigate the ability of early improvement (4 weeks) to predict treatment response at 12 weeks in DSM-IV-defined obsessive-compulsive disorder (OCD) patients treated with serotonin reuptake inhibitors (SRI). We conducted an SRI practical trial with 128 subjects. Inclusion criteria: age range 18-65 years-old, baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score ≥ 16, and absence of previous adequate pharmacological treatment. Systematic assessments were performed at baseline, 4 and 12 weeks of treatment. Treatment response at 12 weeks was defined as a 35% or greater reduction in baseline Y-BOCS score. Stepwise logistic regression was used to test the relationship between early improvement and treatment response at 12 weeks, taking into account additional potential predictive factors. Different thresholds of early improvement were tested and their predictive power was calculated. Early improvement, defined as a 20% or greater reduction from baseline Y-BOCS score at 4 weeks, predicted response at 12 weeks with 75.6% sensitivity and 61.9% specificity. According to a logistic regression including demographic and clinical features as explaining variables, early improvement was the best predictor of treatment response (OR = 1.05, p < 0.0001). Only 19.8% of patients who did not improve at 4 weeks were responders after 12 weeks. In contrast, 55.3% of the individuals who showed early improvement were responders at 12 weeks (Pearson Chi-Square = 17.06, p < 0.001). Early improvement predicted OCD treatment response with relatively good sensitivity and specificity, such that its role in early decision-making warrants further investigation in wider samples. Trial registration: Identifier NCT00680602.
    Journal of Psychiatric Research 08/2013; 47(11). DOI:10.1016/j.jpsychires.2013.07.006 · 3.96 Impact Factor
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