A 40-Year Follow-up of Patients With Obsessive-compulsive Disorder

Skoog, Gunnar; Skoog, Ingmar

doi:10.1001/archpsyc.56.2.121

Cited by 522 publications

(241 citation statements)

References 31 publications

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“…In another study from Italy, which included 55 outpatients with OCD treated with SSRIs, the rates for complete and partial remission at 3 years' follow-up were 22% and 34%, respectively. 92 The main conclusion that can be drawn from the above discussion is that remission rates in the modern era have not improved compared with those reported in earlier studies 88,89 despite the wide availability of effective treatments. It is difficult, however, to interpret this finding, as changes in diagnostic preferences or criteria may have resulted in non-comparable groups of patients being selected for inclusion in these studies.…”

Section: Natural History: Prognosismentioning

confidence: 86%

“…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%

“…60% of the patients had a benign course). A study conducted in Sweden by Skoog and Skoog 89 included 144 patients with OCD who were examined by one of the authors between 1954 and 1956 by means of a semistructured clinical interview. The patients were re-examined by the same researcher after 40 years using the same methodology.…”

Section: Natural History: Prognosismentioning

confidence: 99%

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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

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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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Section: Natural History: Prognosismentioning

confidence: 86%

Section: Natural History: Prognosismentioning

confidence: 99%

Section: Natural History: Prognosismentioning

confidence: 99%

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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

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“…However, we know that the rate of improvement in OCD is limited. A naturalistic study [30]found that over a follow-up of 40 years, only 20% of 144 OCD patients had recovered. Our study showed at post-test (week 16) that about 16% of our sample had recovered and 20% at week 52.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Cognitive Therapy versus Intensive Behavior Therapy in Obsessive Compulsive Disorder

Cottraux

Note²,

Yao

et al. 2001

Psychother Psychosom

238

105

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Background: The study was designed to compare cognitive therapy (CT) with intensive behavior therapy (BT) in obsessive-compulsive disorder (OCD) and to study their change process. Methods: Sixty-five outpatients with DSM-4 OCD were randomized into 2 groups for 16 weeks of individual treatment in 3 centers. Group 1 received 20 sessions of CT. Group 2 received a BT program of 20 h in two phases: 4 weeks of intensive treatment (16 h), and 12 weeks of maintenance sessions (4 h). No medication was prescribed. Results: Sixty-two patients were evaluated at week 4, 60 at week 16 (post-test), 53 at week 26 and 48 at week 52 (follow-up). The response rate was similar in the 2 groups. The Beck Depression Inventory (BDI) was significantly more improved by CT (p = 0.001) at week 16. The baseline BDI and Obsessive Thoughts Checklist scores predicted a therapeutic response in CT, while the baseline BDI score predicted a response in BT. At week 16, only the changes in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and a scale measuring the interpretation of intrusive thoughts correlated in CT, while the changes in Y-BOCS, BDI, and interpretation of intrusive thoughts correlated in BT. Improvement was retained at follow-up without a between-group difference. The intent-to-treat analysis (last observation carried forward) found no between-group differences on obsessions, rituals and depression. Conclusions: CT and BT were equally effective on OCD, but at post-test CT had specific effects on depression which were stronger than those of BT. Pathways to improvement may be different in CT and BT. The outcomes are discussed in the light of an effect size analysis.

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“…Symptom exacerbations are frequent and only some patients achieve durable complete remission [9, 10, 11]. …”

Section: Introductionmentioning

confidence: 99%

Increased Maintenance of Obsessive-Compulsive Disorder Remission after Integrated Serotonergic Treatment and Cognitive Psychotherapy Compared with Medication Alone

Biondi¹,

Picardi²

2005

Psychother Psychosom

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Background: Both medication and psychotherapy are effective in obsessive-compulsive disorder (OCD). However, they both have disadvantages. We aimed at studying the long-term effectiveness of integrated treatment compared with medication alone. Methods: A private practice sample of 20 consecutive patients with OCD (DSM-III-R) who achieved remission or marked improvement [Yale-Brown Obsessive-Compulsive Scale (YBOCS) score ≤10 and Global Assessment of Functioning (GAF) scale score ≧70] after drug treatment (clomipramine or selective serotonin reuptake inhibitors for 12–24 months) with or without concurrent cognitive psychotherapy were followed up. In the integrated treatment group, psychotherapy was started on the second or third visit and was timed to end after medication. Efforts were applied to integrate treatments within a biopsychosocial theoretical framework. As randomisation was not feasible in the study setting, treatment allocation was based on patients’ preference. Patients were assessed before treatment, after treatment and at each follow-up contact with the YBOCS, the Hamilton Depression Rating Scale, and the GAF scale. Kaplan-Meier survival analysis was performed on the time to OCD relapse. Results: Of the factors studied (gender, age, duration of disorder, severity of OCD symptoms at baseline), only treatment was associated with outcome. Of 10 patients treated with medication alone, 8 relapsed. Of 10 patients who received integrated treatment, only 1 relapsed. The estimated mean survival time was significantly higher (p < 0.001) in the integrated treatment group (132 months, 95% CI 107–157) than in the medication group (25 months, 95% CI 12–38). Conclusions: Although our results need confirmation by further, more robust studies, the long-term superiority of integrated treatment over medication alone was large. Patients with OCD might have viable options other than long-term drug treatment.

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A 40-Year Follow-up of Patients With Obsessive-compulsive Disorder

Abstract: Background:The long-term course of obsessivecompulsive disorder is insufficiently known. We studied the course of this disorder in patients who were followed up for 40 years.

Cited by 522 publications

References 31 publications

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 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 Randomized Controlled Trial of Cognitive Therapy versus Intensive Behavior Therapy in Obsessive Compulsive Disorder

Increased Maintenance of Obsessive-Compulsive Disorder Remission after Integrated Serotonergic Treatment and Cognitive Psychotherapy Compared with Medication Alone

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