Long-Term Follow-Up and Predictors of Clinical Outcome in Obsessive-Compulsive Patients Treated With Serotonin Reuptake Inhibitors and Behavioral Therapy. [CME]
J Clin Psychiatry 2001;62(7):535-540
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Background: The objective of this study was to
examine the long-term course of obsessive-compulsive disorder
(OCD) in patients treated with serotonin reuptake inhibitors
(SRIs) and behavioral therapy and to identify predictors of
Method: Sixty outpatients meeting DSM-III-R or
DSM-IV criteria for OCD were followed up for 1 to 5 years (mean =
2.5 years). All of them received prolonged pharmacologic therapy
with an SRI.
Results: Thirty-seven patients (61.7%) completed
an adequate behavioral treatment. At long-term assessment, 22
patients (36.7%) exhibited a global Yale-Brown Obsessive
Compulsive Scale (Y-BOCS) score greater than 16 or a final
reduction in Y-BOCS global score of less than 35% and were
considered nonresponders. Patients who completed behavioral
therapy showed a significant decrease in Y-BOCS compulsions
subscale score (p = .01), whereas no significant differences in
either Y-BOCS global or obsessions subscale scores between those
who did and those who did not undergo behavioral therapy were
detected. Obsessions of sexual/religious content were the unique
factor related to a poorer long-term outcome.
Conclusion: A substantial number of OCD patients
showed persistent disabling symptoms at the long-term follow-up
in spite of combined pharmacologic and behavioral treatment.
Major benefits from behavioral therapy appeared to be the
improvement of ritualistic behaviors. Sexual/religious obsessions
predicted poorer long-term outcome, whereas short-term response
to SRI treatment failed to achieve predictive value in the
long-term course of OCD.