Clinical Predictors of Long-Term Outcome in Obsessive-Compulsive Disorder

Jakubovski, Ewgeni; Diniz, Juliana Belo; Valério, Carolina; Fossaluza, Victor; Belotto-Silva, Cristina; Gorenstein, Clarice; Miguel, Eurí­pedes Constantino; Shavitt, Roseli Gedanke

doi:10.1002/da.22013

Cited by 77 publications

(58 citation statements)

References 52 publications

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“…In patients with OCD treated with CBT, earlier onset of symptoms and longer duration of illness were correlated with poor long-term prognosis. 22 However, others have stated that the effect size of CBT in OCD did not alter with duration of symptoms or with age difference in adults. Interestingly, the effect size of treatment with CBT was greater in children than in adults.…”

Section: Patient Age At Surgerymentioning

confidence: 93%

“…Conversely, of the 19 patients who underwent AC for OCD in Quebec, no difference was found in the number of comorbidities between the socalled responders and nonresponders. 8 In this review a significant number of patients who underwent AC suffered from moderate OCD (YBOCS score of [16][17][18][19][20][21][22][23]; on the other hand, all patients who received DBS belonged to the severe and extreme groups (Fig. 2).…”

Section: Severity Of Ocdmentioning

confidence: 97%

“…11 Patients with OCD who have comorbid psychiatric disorders are more likely to have impaired long-term outcome. 22 Thus, it may not be symptom severity that partly determines treatment response but other associated factors, particularly the number of comorbidities. Conversely, of the 19 patients who underwent AC for OCD in Quebec, no difference was found in the number of comorbidities between the socalled responders and nonresponders.…”

Section: Severity Of Ocdmentioning

confidence: 99%

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Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Pepper

Hariz

Zrinzo

2015

JNS

101

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Obsessive-compulsive disorder (OCD) is a chronic and debilitating psychiatric condition. Traditionally, anterior capsulotomy (AC) was an established procedure for treatment of patients with refractory OCD. Over recent decades, deep brain stimulation (DBS) has gained popularity. In this paper the authors review the published literature and compare the outcome of AC and DBS targeting of the area of the ventral capsule/ventral striatum (VC/VS) and nucleus accumbens (NAcc). Patients in published cases were grouped according to whether they received AC or DBS and according to their preoperative scores on the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and then separated according to outcome measures: remission (YBOCS score < 8); response (≥ 35% improvement in YBOCS score); nonresponse (< 35% improvement in YBOCS score); and unfavorable (i.e., worsening of the baseline YBOCS score). Twenty studies were identified reporting on 170 patients; 62 patients underwent DBS of the VC/VS or the NAcc (mean age 38 years, follow-up 19 months, baseline YBOCS score of 33), and 108 patients underwent AC (mean age 36 years, follow-up 61 months, baseline YBOCS score of 30). In patients treated with DBS there was a 40% decrease in YBOCS score, compared with a 51% decrease for those who underwent AC (p = 0.004). Patients who underwent AC were 9% more likely to go into remission than patients treated with DBS (p = 0.02). No difference in complication rates was noted. Anterior capsulotomy is an efficient procedure for refractory OCD. Deep brain stimulation in the VC/VS and NAcc area is an emerging and promising therapy. The current popularity of DBS over ablative surgery for OCD is not due to nonefficacy of AC, but possibly because DBS is perceived as more acceptable by clinicians and patients.

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Section: Patient Age At Surgerymentioning

confidence: 93%

Section: Severity Of Ocdmentioning

confidence: 97%

Section: Severity Of Ocdmentioning

confidence: 99%

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Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Pepper

Hariz

Zrinzo

2015

JNS

101

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“…89,[92][93][94][95] In the Brown cohort, 91 patients with primary hoarding obsessions/ compulsions had a worse prognosis with very low remission rates, whereas patients with primary obsessions regarding an inflated sense of responsibility for harm had a better prognosis. In the Yale cohort, 90 an initial good response to SSRIs was a good prognostic factor.…”

Section: Natural History: Prognosismentioning

confidence: 99%

A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive–compulsive disorder in children/adolescents and adults

Skapinakis

Caldwell

Hollingworth

et al. 2016

Health Technol Assess

100

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BackgroundObsessive–compulsive disorder (OCD) is a relatively common and disabling condition.ObjectivesTo determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents and adults.Data sourcesWe searched the Cochrane Collaboration Depression, Anxiety and Neurosis Trials Registers, which includes trials from routine searches of all the major databases. Searches were conducted from inception to 31 December 2014.Review methodsWe undertook a systematic review and network meta-analysis (NMA) of the clinical effectiveness and acceptability of available treatments. Outcomes for effectiveness included mean differences in the total scores of the Yale–Brown Obsessive–Compulsive Scale or its children’s version and total dropouts for acceptability. For the cost-effectiveness analysis, we developed a probabilistic model informed by the results of the NMA. All analyses were performed using OpenBUGS version 3.2.3 (members of OpenBUGS Project Management Group; seewww.openbugs.net).ResultsWe included 86 randomised controlled trials (RCTs) in our systematic review. In the NMA we included 71 RCTs (54 in adults and 17 in children and adolescents) for effectiveness and 71 for acceptability (53 in adults and 18 in children and adolescents), comprising 7643 and 7942 randomised patients available for analysis, respectively. In general, the studies were of medium quality. The results of the NMA showed that in adults all selective serotonin reuptake inhibitors (SSRIs) and clomipramine had greater effects than drug placebo. There were no differences between SSRIs, and a trend for clomipramine to be more effective did not reach statistical significance. All active psychological therapies had greater effects than drug placebo. Behavioural therapy (BT) and cognitive therapy (CT) had greater effects than psychological placebo, but cognitive–behavioural therapy (CBT) did not. BT and CT, but not CBT, had greater effects than medications, but there are considerable uncertainty and methodological limitations that should be taken into account. In children and adolescents, CBT and BT had greater effects than drug placebo, but differences compared with psychological placebo did not reach statistical significance. SSRIs as a class showed a trend for superiority over drug placebo, but the difference did not reach statistical significance. However, the superiority of some individual drugs (fluoxetine, sertraline) was marginally statistically significant. Regarding acceptability, all interventions except clomipramine had good tolerability. In adults, CT and BT had the highest probability of being most cost-effective at conventional National Institute for Health and Care Excellence thresholds. In children and adolescents, CBT or CBT combined with a SSRI were more likely to be cost-effective. The results are uncertain and sensitive to assumptions about treatment effect and the exclusion of trials at high risk of bias.LimitationsThe majority of psychological trials included patients who were taking medications. There were few studies in children and adolescents.ConclusionsIn adults, psychological interventions, clomipramine, SSRIs or combinations of these are all effective, whereas in children and adolescents, psychological interventions, either as monotherapy or combined with specific SSRIs, were more likely to be effective. Future RCTs should improve their design, in particular for psychotherapy or combined interventions.Study registrationThe study is registered as PROSPERO CRD42012002441.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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“…The phenotypic presentation of magic obsessions and repeating compulsions as negative prognostic factors are in accordance with the findings of Leckman et al 13 . Leckman et al 13 shows that the symmetry/ordering dimension including obsession with symmetry, repeating rituals, counting compulsions and ordering/arranging, often is seen in relation to an early-onset OCD, and that it is associated with concomitant tic disorder, both of which have been associated with a poor outcome 17 . Thus, the findings of the present study may represent the effects of several factors.…”

Section: Discussionmentioning

confidence: 99%

A 7 year follow-up of children and adolescents with obsessive-compulsive disorder: an analysis of predictive factors in a clinical prospective study

2014

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-Background and Objectives: Obsessive compulsive disorder (OCD) is a frequent psychiatric disorder. Despite its significant influence on personal development, little is known about its long-term course in children and adolescents. The aim was to follow children and adolescents with OCD for 7 years and to compare patients gaining remission with patients experiencing symptoms.Methods: The study was a prospective follow-up study in which the patients were interviewed 7 years after their initial contact with the healthcare system. The patients had been described at baseline.Results: Among the 95 participants, 53 participants described symptoms at follow-up and 44 participants described remission. More patients with persistent symptoms described an anxious personality trait. The schizoid/compulsive personality traits were represented at a higher rate in the group with persistent symptoms than in the group with remission symptoms. Important predictive factors included predisposition to OCD, the occurrence of comorbid disorders and older referral age. The occurrence of magic obsessions and repetitive compulsions increased the risk of OC symptoms at follow-up. The group "late responders" differed from the non-responder group by predisposition to depression.Conclusions: The present clinical study is one of the longest follow-up studies conducted in children and adolescents with OCD. In addition to confirming several previous findings, the study added new knowledge about the importance of phenotypic presentation, personality traits and quality of life. Furthermore, the late responder group has been described in relation to the remission group and to the group with persistent symptoms.

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Clinical Predictors of Long-Term Outcome in Obsessive-Compulsive Disorder

Cited by 77 publications

References 52 publications

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive–compulsive disorder in children/adolescents and adults

A 7 year follow-up of children and adolescents with obsessive-compulsive disorder: an analysis of predictive factors in a clinical prospective study

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