Long-term Outcomes of Intensive Inpatient Care for Severe, Resistant Obsessive-Compulsive Disorder: Résultats à long terme de soins intensifs à des patients hospitalisés pour un trouble obsessionnel-compulsif grave et résistant

Abstract

Objective: A substantial proportion of severely ill patients with obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) and are unable to practice cognitive behavioral therapy (CBT) on an out-patient basis. We report the short-term (at discharge) and long-term (up to 2 years) outcome of a multimodal inpatient treatment program that included therapist-assisted intensive CBT with adjunctive pharmacotherapy for severely ill OCD patients who are often resistant to SRIs and are either unresponsive or unable to practice outpatient CBT. Methods: A total of 420 patients, admitted between January 2012 and December 2017 were eligible for the analysis. They were evaluated using the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Clinical Global Impression (CGI) scale. All patients received 4 to 5 therapist-assisted CBT sessions per week along with standard pharmacotherapy. Naturalistic follow-up information at 3, 6, 12, and 24 months were recorded. Results: At baseline, patients were mostly severely ill (YBOCS = 29.9 ± 4.5) and nonresponsive to ≥2 SRIs (83%). Mean duration of inpatient stay was 42.7 ± 25.3 days. At discharge, there was a significant decline in the mean YBOCS score (29.9 ± 4.5 vs. 18.1 ± 7.7, P < .001, Cohen’s d = 1.64); 211/420 (50%) were responders (≥35% YBOCS reduction and CGI-I≤2) and an additional 86/420 (21%) were partial responders (25% to 35% YBOCS reduction and CGI-I≤3). Using latent class growth modeling of the follow-up data, 4 distinct classes were identified, which include “remitters” (14.5%), “responders” (36.5%), “minimal responders” (34.7%), and “nonresponders” (14.6%). Shorter duration of illness, better insight, and lesser contamination/washing symptoms predicted better response in both short- and long-term follow-up. Conclusion: Intensive, inpatient-based care for OCD may be an effective option for patients with severe OCD and should be considered routinely in those who do not respond with outpatient treatment.

Are There Familial Patterns of Symptom Dimensions in Obsessive-Compulsive Disorder?

“…Previous factor analysis studies in OCD have shown discrepant findings with respect to aggressive/harm & checkingrelated symptoms. While some studies have shown checking compulsions to load with aggressive obsessions (60,61), many others (32,62,63) including several from our center (12,64,65) found doubts & checking to load separately from aggressive obsessions (which loads with forbidden/taboo thoughts). In the current study "doubts" were coded separately from aggressive obsessions, which could have resulted in a factor structure different from the OCGS study.…”

Responsiveness and other psychometric properties of the Yale–Brown Obsessive–Compulsive Scale Severity Scale—Second Edition in a Dutch clinical sample

“…The finding that, especially in the group of OCD patients with more severe symptoms, the Y‐BOCS‐II appeared to be more responsive is of clinical importance: It suggests that mental health care professionals can more accurately assess the effects of treatment of patients with severe OCD than was possible with the Y‐BOCS‐I. This is a noteworthy improvement because recent studies estimate that only 50% to 60% of patients with severe OCD benefit from intensive residential treatment, the currently available effective treatment option usually consisting of CBT with daily therapist guided exposure with response prevention (EX/RP), cognitive (group) therapy, additional pharmacotherapy and treatment modules (Balachander et al, 2020; Brennan et al, 2014; Siwiec et al, 2019; Veale et al, 2016). It is therefore important to be able to assess accurately and timely whether patients benefit from treatment or not.…”

Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore?

“…Such programs deliver CBT with ERP and other therapies on a daily schedule with treatments lasting cumulatively for hours each day, often across 12 or more weeks. Intensive residential treatment programs appear particularly suited for treatment of severe OCD [ 110 ] and may help to achieve improvement in those who did not respond to outpatient therapy [ 111 ].…”