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Depress Anxiety. 2013 Aug;30(8):716-22. doi: 10.1002/da.22103. Epub 2013 Mar 26.

Long-term outcome in adults with obsessive-compulsive disorder.

Author information

  • 1Child Study Center, Yale University, New Haven, CT, USA. michael.bloch@yale.edu

Abstract

BACKGROUND:

Obsessive-compulsive disorder (OCD) is a chronic condition that often produces lifelong morbidity, but few studies have examined long-term outcome (greater than 5 years) in adult patients. Available studies suggest that 32-74% of adult OCD patients will experience clinical improvement over the long term. However, these studies were conducted before validated OCD rating scales were established and the development of evidence-based treatments for OCD.

METHODS:

We investigated the 10-20 year outcome of 83 of 165 eligible subjects previously enrolled after participation in placebo-controlled trials of serotonin reuptake inhibitor (SRI) medications for OCD. We examined the association between clinical characteristics at initial assessment and OCD symptom severity at follow-up. We hypothesized that primary OCD symptom dimension and initial response to pharmacotherapy with serotonin reuptake inhibitors would be associated with later symptom severity.

RESULTS:

Only 20% (17 of 83) of subjects had experienced a remission of their OCD symptoms at follow-up (Y-BOCS ≤ 8). Forty-nine percent (41 of 83) of subjects were still experiencing clinically significant OCD symptoms. Response to initial SRI pharmacotherapy was significantly associated with long-term outcome: 31% (13 of 42) of subjects who responded (CGI < 3) to initial SRI pharmacotherapy were remitted at follow-up, compared to 12% (3 of 25) of partial responders and none of the 16 subjects who had no response to initial SRI pharmacotherapy. We did not find a significant association between long-term clinical outcome and any of the OCD symptom dimensions.

CONCLUSION:

Despite the introduction and dissemination of several evidence-based treatments for OCD, most adult OCD patients do not achieve remission. Initial response to pharmacotherapy was strongly associated with long-term outcome.

© 2013 Wiley Periodicals, Inc.

KEYWORDS:

OCD/obsessive compulsive disorder; anxiety/anxiety disorders; pharmacotherapy; treatment; treatment resistance

PMID:
23532944
[PubMed - indexed for MEDLINE]
PMCID:
PMC3932438
Free PMC Article
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