Conflict of interest: The authors have no conflicts of interest to disclose.
LONG-TERM OUTCOME IN ADULTS WITH OBSESSIVE-COMPULSIVE DISORDER
Article first published online: 26 MAR 2013
© 2013 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 30, Issue 8, pages 716–722, August 2013
How to Cite
Bloch, M. H., Green, C., Kichuk, S. A., Dombrowski, P. A., Wasylink, S., Billingslea, E., Landeros-Weisenberger, A., Kelmendi, B., Goodman, W. K., Leckman, J. F., Coric, V. and Pittenger, C. (2013), LONG-TERM OUTCOME IN ADULTS WITH OBSESSIVE-COMPULSIVE DISORDER. Depress. Anxiety, 30: 716–722. doi: 10.1002/da.22103
Contract grant sponsor: National Institute of Mental Health.
- Issue published online: 1 AUG 2013
- Article first published online: 26 MAR 2013
- Manuscript Accepted: 1 MAR 2013
- Manuscript Revised: 26 FEB 2013
- Manuscript Received: 5 SEP 2012
- National Institute of Mental Health
- OCD/obsessive compulsive disorder;
- anxiety/anxiety disorders;
- treatment resistance
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.
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.
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.
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.