The Brown Longitudinal Obsessive Compulsive Study: Treatments Received and Patient Impressions of Improvement. [CME]
J Clin Psychiatry 2006;67(11):1713-1720
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: The primary aim of this study
was to assess the extent to which individuals with
obsessive-compulsive disorder (OCD) received recommended doses of treatment and perceived
a response to these treatments.
Method: Participants were 293 adults
with primary OCD (DSM-IV) who were enrolled in the Brown Longitudinal Obsessive
Compulsive Study, a naturalistic, prospective study of
course in OCD. Data were collected at intake
interviews between June 2001 and October 2004.
Patient impressions of response to treatments
received were assessed using the Clinical Global
Impressions-Improvement Scale-patient version.
Results: Of the 182 participants taking
recommended doses of serotonin reuptake inhibitors (SRIs) at intake, 112 (62%) rated themselves
as being very much or much improved. The remaining participants rated themselves as
minimally improved, unchanged, or worse while taking
recommended doses of SRIs. These participants (N = 70) reported receiving their current SRI for
a mean (SD) of 2.7 (3.2) years. Twelve (29%) of the 42 participants receiving neuroleptic
augmentation of SRIs reported a response.
Thirty-eight percent of the sample received the
recommended number of 13 sessions of
cognitive-behavioral therapy (CBT) lifetime. Only 24% reported
completing a continuous course of 13 weekly sessions. Eighteen (67%) of the 27 participants
who received a course of CBT in the past year
rated themselves as very much or much improved.
Conclusions: In this large, naturalistic
study of OCD, over one third of participants
receiving recommended doses of SRIs did not perceive
substantial long-term benefit from
pharmacotherapy. Relatively few participants received
recommended doses of CBT. Clinical implications