Article

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

ABSTRACT

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

Methods:
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.

Results:
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.

Conclusions:
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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    • "Developmentally , these findings suggest that OCD does not behave as a unitary disorder, but rather as a constellation of symptoms or dimensions that interact with additional psychopathology increasing the vulnerability for subsequent disorders. The relevance of psychiatric comorbidity in patients with OCD has been related to a number of clinical features, including treatment-seeking behaviors (Torres et al., 2006; Fineberg et al., 2013), clinical severity, chronicity and impairment (Tükel et al., 2002; Fineberg et al., 2013; Jakubovski et al., 2013; Hofmeijer‐Sevink et al., 2013),), suicidality (Torres et al., 2011), and treatment response (Ferrão et al., 2006; Raffin et al., 2009; Borges et al., 2011; Jakubovski et al., 2013). Nevertheless, very few studies have examined the specific associations between different OCD symptom dimensions and comorbid disorders (Hasler et al., 2005, 2007), except for the hoarding dimension (Fontenelle et al., 2004; Hartl et al., 2005; LaSalle-Ricci et al., 2006; Wheaton et al., 2008; Frost et al., 2011; Chakraborty et al., 2012; Hall et al., 2013; Samuels et al., 2014). "
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    ABSTRACT: Background: Obsessive-compulsive disorder (OCD) has a heterogeneous and complex phenomenological picture, characterized by different symptom dimensions and comorbid psychiatric disorders, which frequently co-occur or are replaced by others over the illness course. To date, very few studies have investigated the associations between specific OCD symptom dimensions and comorbid disorders. Methods: Cross-sectional, multicenter clinical study with 1001 well-characterized OCD patients recruited within the Brazilian Research Consortium on Obsessive-Compulsive and Related Disorders. The primary instruments were the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses between symptom dimensions and comorbidities were followed by logistic regression. Results: The most common comorbidities among participants (56.8% females) were major depression (56.4%), social phobia (34.6%), generalized anxiety disorder (34.3%), and specific phobia (31.4%). The aggressive dimension was independently associated with posttraumatic stress disorder (PTSD), separation anxiety disorder, any impulse-control disorder and skin picking; the sexual-religious dimension was associated with mood disorders, panic disorder/agoraphobia, social phobia, separation anxiety disorder, non-paraphilic sexual disorder, any somatoform disorder, body dysmorphic disorder and tic disorders; the contamination-cleaning dimension was related to hypochondriasis; and the hoarding dimension was associated with depressive disorders, specific phobia, PTSD, impulse control disorders (compulsive buying, skin picking, internet use), ADHD and tic disorders. The symmetry-ordering dimension was not independently associated with any comorbidity. Limitations: Cross-sectional design; participants from only tertiary mental health services; personality disorders not investigated. Conclusions: Different OCD dimensions presented some specific associations with comorbid disorders, which may influence treatment seeking behaviors and response, and be suggestive of different underlying pathogenic mechanisms.
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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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