Suicide in patients treated for obsessive–compulsive disorder: A prospective follow-up study

Alonso, Pino; Segalás, Cinto; Real, Eva; Pertusa, Alberto; Labad, Javier; Jiménez‐Murcia, Susana; Jaurrieta, Núria; Bueno, Blanca; Vallejo, Julio; Menchón, José M.

doi:10.1016/j.jad.2009.12.001

Cited by 73 publications

(79 citation statements)

References 40 publications

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“…There are few longitudinal studies that have reported suicidal behaviour. In a prospective clinical study in Spain, 82 218 outpatients with OCD were followed up for a mean duration of 4 years. Two patients (0.9%) committed suicide and 11 (5%) attempted suicide.…”

Section: Suicidalitymentioning

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

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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: Suicidalitymentioning

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

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“…7,8 In a prospective follow-up study of treated OCD patients, symmetry/ordering was the only symptom dimension from the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) that was more common among those who attempted or committed suicide, and it was independently associated with suicidal behaviors. 9 In humans, it has also been argued that symmetry or symmetry-related behaviors may have specific psychobiologic and evolutionary underpinnings. 10 Interestingly, familial OCD (compared to sporadic OCD) has also been found to be associated with increased compulsions, particularly ordering, i.e., one aspect of the symmetry symptom dimension.…”

Section: Introductionmentioning

confidence: 99%

Symmetry symptoms in obsessive-compulsive disorder: clinical and genetic correlates

Löchner

McGregor

Hemmings

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: In obsessive-compulsive disorder (OCD), symmetry-related symptoms may be important. Although clinical correlates of symmetry-related symptoms have been identified in OCD, few data exist on genetic associations. Animal studies indicate involvement of dopamine in symmetry-related behavior, suggesting this may be relevant to analogous symptoms in OCD. Alterations in dopamine may also reflect environmental influences. However, the association of symmetry-related symptomatology, early adversity, and polymorphisms in dopaminergic genes has not been investigated in OCD. Methods: Clinical information and polymorphisms in key dopaminergic genes were compared between OCD patients with primary symmetry symptoms and those without. Results: OCD patients with primary symmetry symptoms comprised 46.6% (n=210) of the sample (n=451), and were older (p o 0.01), had longer illness duration (p o 0.01), higher OCD severity scores (p = 0.01), and greater comorbidity (p o 0.01) than those without. In Caucasians (n=343), genotype frequency differed significantly between groups for ANKK1 rs1800497, with more OCD patients with symmetry symptoms being homozygous for the A2 (CC) genotype (w 2 = 7.296; p = 0.026). Conclusion: Symmetry symptoms have some distinct clinical features and may represent a marker of severity in OCD. However, clinical associations, in combination with the association found with the ANKK1 rs1800497 A2 variant, suggest that primary symmetry symptoms may represent a distinctive clinical and psychobiological profile.

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“…Considering that OCD is the 10th most common cause of disability, affecting 1 adult in 100 in the USA, this disease has a significant socioeconomic burden due to the costs entailed by the chronic nature of the illness and the impact on work, leisure activities and interaction with family and the social environment 2. Importantly, OCD is not only associated with suffering for the patients and a reduced quality of life but also with significant mortality3; recent studies suggest that 10%–27% of patients might attempt suicide during their lifetime.…”

Section: Introductionmentioning

confidence: 99%

Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up

D’Astous

Cottin

Roy

et al. 2013

J Neurol Neurosurg Psychiatry

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Suicide in patients treated for obsessive–compulsive disorder: A prospective follow-up study

Cited by 73 publications

References 40 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

Symmetry symptoms in obsessive-compulsive disorder: clinical and genetic correlates

Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up

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