A 40 year follow-up of patients with obsessive-compulsive disorder. Arch Gen Psychiatry
Institute of Clinical Neuroscience, Department of Psychiatry, Sahlgrenska University Hospital, Göteborg University, Sweden. Archives of General Psychiatry
(Impact Factor: 14.48).
03/1999; 56(2):121-7. DOI: 10.1001/archpsyc.56.2.121
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.
Available from: Bernhard Weidle
- "The studies of psychosocial, symptomatic, and genetic factors on the treatment study will increase our understanding of OCD. In view of the high risk of chronic impairment and suffering in paediatric OCD these aspects need to be highlighted [73,74]. "
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ABSTRACT: This paper describes and discusses the methodology of the Nordic long-term OCD-treatment study (NordLOTS). The purpose of this effectiveness study was to study treatment outcome of CBT, to identify CBT non- or partial responders and to investigate whether an increased number of CBT-sessions or sertraline treatment gives the best outcome; to identify treatment refractory patients and to investigate the outcome of aripiprazole augmentation; to study the outcome over a three year period for each responder including the risk of relapse, and finally to study predictors, moderators and mediators of treatment response.
Step 1 was an open and uncontrolled clinical trial with CBT, step 2 was a controlled, randomised non-blinded study of CBT non-responders from step 1. Patients were randomized to receive either sertraline plus CBT-support or continued and modified CBT. In step 3 patients who did not respond to either CBT or sertraline were treated with aripiprazole augmentation to sertraline.
This multicenter trial covering three Scandinavian countries is going to be the largest CBT-study for paediatric OCD to date. It is not funded by industry and tries in the short and long-term to answer the question whether further CBT or SSRI is better in CBT non-responders.
Available from: PubMed Central
- "Patients with OCD suffer from recurrent, unwanted thoughts (obsessions) and repetitive, ritualized behaviour (compulsions), which are often intended to neutralize anxiety induced by the obsessions. OCD often evolves as a chronic illness  with severe occupational and social impairment. In the last two decades, various efficacious pharmacological and psychotherapeutic treatments for OCD have been extensively studied and well established . "
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ABSTRACT: Patient satisfaction is an important outcome variable that is increasingly used in mental health service evaluation. There are no results available for patients with obsessive-compulsive disorder (OCD) yet.
Using the Verona Service Satisfaction Scale, patient satisfaction with a specialized mental health service was examined in patients with OCD.
OCD patients were overall satisfied with the professional help provided, whereas satisfaction with the professional involvement of relatives within the treatment and health care process was found to be quite low. Patients with more severe OCD, as measured by the Yale-Brown Obsessive-Compulsive Scale, as well as chronically ill and more disabled patients were more likely to be dissatisfied with the overall care they received. Patient satisfaction plays an important role in the long-term course of an illness such OCD. This seems to be decreased so longer illness is not or badly treated. There is a stronger need for involvement of family members in the treatment and health care of patients with OCD.
More OCD-specific treatment offers have to be established for patients with this long-term illness such as psychotherapy in groups.
Available from: Elisabeth Hertenstein
- "Thus, conclusions about potential causal relationships between the administration of inpatient CBT and subsequent outpatient treatment, QoL improvements, and symptomatic changes cannot be drawn. We can nevertheless draw on solid data demonstrating that OCD is a chronic disorder which does not show considerable improvement over time without treatment [33,34]. Third, the current analysis is based on quality management data from our clinic that, within the period of observation, did not routinely include measures of OCD severity. "
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ABSTRACT: Quality of life (QoL) is increasingly recognized as a critical outcome parameter in mental health studies. The aim of this study was to investigate different domains of the QoL in persons with obsessive-compulsive disorder (OCD) before and after a multimodal, disorder-specific in- and outpatient treatment.
Data of 73 persons with OCD treated in an inpatient setting followed by outpatient treatment were analyzed. The World Health Organization Quality of Life abbreviated (a multidimensional measure of the QoL) and the Beck Depression Inventory were administered prior to (baseline) and 12 months after the inpatient treatment (follow-up).
At baseline, participants reported a significantly diminished psychological, social, physical, and global QoL compared to the German general population. Environmental QoL was not impaired in the present sample. The QoL was significantly improved at follow-up, except for social QoL, but remained below norm values. The QoL improvement was predicted by improvements of depressive symptoms.
The results indicate that persons with OCD suffer from a very low QoL. The QoL was significantly improved after 12 months of intensive state-of-the-art treatment. However, the QoL indices remained considerably lower than population norm values, indicating the need for additional research into novel treatment options for persons with OCD.
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