Clinical characteristics and treatment response in poor and good insight obsessive–compulsive disorder

Abstract

The DSM-IV criteria recognize the existence of obsessive-compulsive disorder (OCD) with poor insight. However, there is paucity of literature on the clinical correlates and treatment response in poor and good insight OCD. In this study, insight is measured by using the Brown Assessment of Beliefs Scale (BABS) developed specifically to assess insight. One hundred subjects with DSM-IV OCD were ascertained from the OCD clinic of a large psychiatric hospital in India. All subjects were evaluated extensively by using structured instruments and established measures of psychopathology. The subjects were treated with adequate doses of drugs for adequate period. The results showed that 25% of the subjects had poor insight. Poor insight was associated with earlier age-at-onset, longer duration of illness, more number of obsessive-compulsive symptoms, more severe illness and higher comorbidity rate, particularly major depression. Of the subjects who were treated adequately (N = 73), 44 (60%) were treatment responders. Poor insight was associated with poor response to drug treatment. In the step-wise logistic regression analysis, baseline BABS score was highly predictive of poor treatment response. Poor insight appears to be associated with specific clinical correlates and poor response to drug treatment. Further studies are needed in larger samples to replicate our findings.

Obsessive Compulsive Disorder with Poor Insight

“…[26] İçgörüsü az olan hastaların içgörüsü iyi olanlara göre hastalık başlangıç yaşları daha erken, hastalık süreleri daha uzun, obsesif kompulsif belirtileri daha fazla, OKB'leri daha ağır, komorbid ruhsal bozuklukları ve değerlendirme sırasındaki major depresyon oranları daha fazladır. İçgörüsü az olanlarda biriktirme belirtisine daha fazla rastlanmıştır.…”

O conceito do insight em pacientes com transtorno obsessivo-compulsivo

“…Em termos clínicos, pacientes com TOC e pouco insight caracterizaram-se por idade de início mais precoce 16 , duração mais longa da doença 16 e maior número de sintomas obsessivocompulsivos 16,19 . Indivíduos com TOC e pouco insight também apresentaram maior gravidade de sintomas obsessivocompulsivos 8,15,19 , depressivos 8,17,19 e ansiosos 8 , prevalência mais elevada da lentidão obsessiva 20 , de depressão maior 8,16 e de transtornos de personalidade borderline 8 , narcisista 8 e esquizotípico 17 , e menor prevalência de transtorno de personalidade dependente 8 .…”

“…Indivíduos com TOC e pouco insight também apresentaram maior gravidade de sintomas obsessivocompulsivos 8,15,19 , depressivos 8,17,19 e ansiosos 8 , prevalência mais elevada da lentidão obsessiva 20 , de depressão maior 8,16 e de transtornos de personalidade borderline 8 , narcisista 8 e esquizotípico 17 , e menor prevalência de transtorno de personalidade dependente 8 . Em um estudo 10 , adultos com TOC e pouco insight manifestaram um comprometimento funcional semelhante ao de pacientes com esquizofrenia e TOC.…”

“…Apesar destes achados relativamente desanimadores, no estudo de Matsunaga et al 10 , 14 em 25 pacientes com TOC e pouco insight não foram mais classificados como tal após seis meses de tratamento combinado e melhora dos sintomas obsessivo-compulsivos e depressivos associados. 16 , e à terapia cognitivo-comportamental em grupo 44 . Este mesmo fenômeno foi constatado em crianças refratárias a diversas formas de tratamento 18 .…”

Aripiprazole augmentation of clomipramine therapy in treatment-resistant obsessive-compulsive disorder: case series

“…Resistance to OCD therapy is defined as; a decrease less than 35% in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score after at least 10 weeks' treatment, and after two different SSRIs or clomipramine trials, with or without cognitivebehavioral therapy (CBT) (2)(3)(4). Treatment period, dose of medicine, treatment compliance, presence of insight, social support and personal features may play important roles in treatment resistance (5)(6)(7)(8). Antipsychotic augmentation, especially with risperidone, haloperidol, aripiprazole, and CBT have shown the best evidence.…”