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Chronic obsessive–compulsive disorder: prognostic factors

  • Lucas J. B. van Oudheusden (a1), Merijn Eikelenboom (a1), Harold J. G. M. van Megen (a2), Henny A. D. Visser (a2), Koen Schruers (a3), Gert-Jan Hendriks (a4), Nic van der Wee (a5), Adriaan W. Hoogendoorn (a1), Patricia van Oppen (a1) and Anton J. L. M. van Balkom (a1)...
Abstract
Background

The course of illness in obsessive–compulsive disorder (OCD) varies significantly between patients. Little is known about factors predicting a chronic course of illness. The aim of this study is to identify factors involved in inducing and in maintaining chronicity in OCD.

Methods

The present study is embedded within the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study, an ongoing multicenter naturalistic cohort study designed to identify predictors of long-term course and outcome in OCD. For this study, 270 subjects with a current diagnosis of OCD were included. Chronicity status at 2-year follow-up was regressed on a selection of baseline predictors related to OCD, to comorbidity and to stress and support.

Results

Psychotrauma [odds ratio (OR) 1.98, confidence interval (CI) 1.22–3.22, p = 0.006], recent negative life events (OR 1.42, CI 1.01–2.01, p = 0.043), and presence of a partner (OR 0.28, CI 0.09–0.85, p = 0.025) influenced the risk of becoming chronic. Longer illness duration (OR 1.46, CI 1.08–1.96, p = 0.013) and higher illness severity (OR 1.09, CI 1.03–1.16, p = 0.003) increased the risk of remaining chronic.

Conclusions

External influences increase the risk of becoming chronic, whereas the factors involved in maintaining chronicity are illness-related. As the latter are potentially difficult to modify, treatment should be devoted to prevent chronicity from occurring in the first place. Therapeutic strategies aimed at alleviating stress and at boosting social support might aid in achieving this goal.

Copyright
Corresponding author
Author for correspondence: Lucas J. B. van Oudheusden, E-mail: l.oudheusden@ggzingeest.nl
References
Hide All
Anholt, GE, van Oppen, P, Emmelkamp, PMG, Cath, DC, Smit, JH, van Dyck, R et al. (2009). Measuring obsessive-compulsive symptoms: Padua Inventory-Revised vs. Yale-Brown Obsessive Compulsive Scale. Journal of Anxiety Disorders 23, 830835.
Ball, TM, Stein, MB and Paulus, MP (2014). Toward the application of functional neuroimaging to individualized treatment for anxiety and depression. Depression and Anxiety 31, 920933.
Baron-Cohen, S, Wheelwright, S, Skinner, R, Martin, J and Clubley, E (2001). The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders 31, 517.
Beck, AT, Epstein, N, Brown, G and Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893897.
Beck, AT, Ward, CH, Mendelson, M, Mock, J and Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.
Bernardini, F, Attademo, L, Cleary, SD, Luther, C, Shim, RS, Quartesan, R et al. (2016). Risk prediction models in psychiatry: toward a new frontier for the prevention of mental illnesses. The Journal of Clinical Psychiatry 78, 572583.
Boschen, MJ, Drummond, LM, Pillay, A and Morton, K (2010). Predicting outcome of treatment for severe, treatment resistant OCD in inpatient and community settings. Journal of Behavior Therapy and Experimental Psychiatry 41, 9095.
Brown, SD, Brady, T, Lent, RW, Wolfert, J and Hall, S (1987). Perceived social support among college-students – 3. Studies of the psychometric characteristics and counseling uses of the social support inventory. Journal of Counseling Psychology 34, 337354.
Catapano, F, Perris, F, Fabrazzo, M, Cioffi, V, Giacco, D, De Santis, V et al. (2010). Obsessive-compulsive disorder with poor insight: a three-year prospective study. Progress in Neuro-Psychopharmacology & Biological Psychiatry 34, 323330.
Catapano, F, Perris, F, Masella, M, Rossano, F, Cigliano, M, Magliano, L et al. (2006). Obsessive-compulsive disorder: a 3-year prospective follow-up study of patients treated with serotonin reuptake inhibitors OCD follow-up study. Journal of Psychiatric Research 40, 502510.
Cole, JD and Kazarian, SS (1988). The level of expressed emotion scale: a new measure of expressed emotion. Journal of Clinical Psychology 44, 392397.
Cromer, KR, Schmidt, NB and Murphy, DL (2007). An investigation of traumatic life events and obsessive-compulsive disorder. Behaviour Research and Therapy 45, 16831691.
Dell'Osso, B, Benatti, B, Buoli, M, Altamura, AC, Marazziti, D, Hollander, E et al. (2013). The influence of age at onset and duration of illness on long-term outcome in patients with obsessive-compulsive disorder: a report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS). European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology 23, 865871.
Draijer, N and Langeland, W (1999). Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. The American Journal of Psychiatry 156, 379385.
Eisen, JL, Pinto, A, Mancebo, MC, Dyck, IR, Orlando, ME and Rasmussen, SA (2010). A 2-year prospective follow-up study of the course of obsessive-compulsive disorder. The Journal of Clinical Psychiatry 71, 10331039.
Eisen, JL, Sibrava, NJ, Boisseau, CL, Mancebo, MC, Stout, RL, Pinto, A et al. (2013). Five-year course of obsessive-compulsive disorder: predictors of remission and relapse. The Journal of Clinical Psychiatry 74, 233239.
EuroQol Group (1990). EuroQol – a new facility for the measurement of health-related quality of life. Health Policy (Amsterdam, Netherlands) 16, 199208.
First, MB, Spitzer, RL, Gibbon, M and Williams, JBW (1999). Structured Clinical Interview for DSM-IV Axis I Disorders - Patient Edition (Scid-I/P, Version 2.0). Lisse: Swets & Zeitlinger.
Garnaat, SL, Boisseau, CL, Yip, A, Sibrava, NJ, Greenberg, BD, Mancebo, MC et al. (2015). Predicting course of illness in patients with severe obsessive-compulsive disorder. The Journal of Clinical Psychiatry 76, e1605e1610.
Goekoop, JG, Knoppert-Van der Klein, EA, Hoeksema, T, Klinkhamer, RA, Van Gaalen, HA and Van der Velde, EA (1991). The interrater reliability of a Dutch version of the Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica 83, 202205.
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RL, Hill, CL et al. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry 46, 10061011.
Göttlich, M, Krämer, UM, Kordon, A, Hohagen, F and Zurowski, B (2015). Resting-state connectivity of the amygdala predicts response to cognitive behavioral therapy in obsessive compulsive disorder. Biological Psychology 111, 100109.
De Graaf, R, Bijl, RV, Ravelli, A, Smit, F and Vollebergh, WAM (2002). Predictors of first incidence of DSM-III-R psychiatric disorders in the general population: findings from the Netherlands Mental Health Survey and Incidence Study. Acta Psychiatrica Scandinavica 106, 303313.
Grisham, JR, Fullana, MA, Mataix-Cols, D, Moffitt, TE, Caspi, A and Poulton, R (2011). Risk factors prospectively associated with adult obsessive–compulsive symptom dimensions and obsessive–compulsive disorder. Psychological Medicine 41, 24952506.
Höhn, P, Menne-Lothmann, C, Peeters, F, Nicolson, NA, Jacobs, N, Derom, C et al. (2013). Moment-to-moment transfer of positive emotions in daily life predicts future course of depression in both general population and patient samples. PLoS ONE 8, e75655.
Hollander, E, Doernberg, E, Shavitt, R, Waterman, RJ, Soreni, N, Veltman, DJ et al. (2016). The cost and impact of compulsivity: a research perspective. European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology 26, 800809.
Kempe, PT, van Oppen, P, de Haan, E, Twisk, JWR, Sluis, A, Smit, JH et al. (2007). Predictors of course in obsessive-compulsive disorder: logistic regression versus Cox regression for recurrent events. Acta Psychiatrica Scandinavica 116, 201210.
Kooij, JJS, Buitelaar, JK, van den Oord, EJ, Furer, JW, Rijnders, CAT and Hodiamont, PPG (2005). Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological Medicine 35, 817827.
Lafleur, DL, Petty, C, Mancuso, E, McCarthy, K, Biederman, J, Faro, A et al. (2011). Traumatic events and obsessive compulsive disorder in children and adolescents: is there a link? Journal of Anxiety Disorders 25, 513519.
LaSalle, VH, Cromer, KR, Nelson, KN, Kazuba, D, Justement, L and Murphy, DL (2004). Diagnostic interview assessed neuropsychiatric disorder comorbidity in 334 individuals with obsessive-compulsive disorder. Depression and Anxiety 19, 163173.
Leckman, JF, Riddle, MA, Hardin, MT, Ort, SI, Swartz, KL, Stevenson, J et al. (1989). The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry 28, 566573.
Lyketsos, C, Nestadt, G, Cwi, J, Heithoff, K and Eaton, W (1994). The life chart interview: a standardized method to describe the course of psychopathology. International Journal of Methods in Psychiatric Research 4, 143155.
Mancebo, MC, Boisseau, CL, Garnaat, SL, Eisen, JL, Greenberg, BD, Sibrava, NJ et al. (2014). Long-term course of pediatric obsessive-compulsive disorder: 3 years of prospective follow-up. Comprehensive Psychiatry 55, 14981504.
Marcks, BA, Weisberg, RB, Dyck, IR and Keller, MB (2011). Longitudinal course of obsessive-compulsive disorder in patients with anxiety disorders: a 15-year prospective follow-up study. Comprehensive Psychiatry 52, 670677.
Mathews, CA, Kaur, N and Stein, MB (2008). Childhood trauma and obsessive-compulsive symptoms. Depression and Anxiety 25, 742751.
Obsessive Compulsive Cognitions Working Group. (2003). Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: part I. Behaviour Research and Therapy 41, 863878.
Pinto, A, Mancebo, MC, Eisen, JL, Pagano, ME and Rasmussen, SA (2006). The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. The Journal of Clinical Psychiatry 67, 703711.
Ravizza, L, Maina, G and Bogetto, F (1997). Episodic and chronic obsessive-compulsive disorder. Depression and Anxiety 6, 154158.
Samuels, JF, Riddle, MA, Greenberg, BD, Fyer, AJ, McCracken, JT, Rauch, SL et al. (2006). The OCD collaborative genetics study: methods and sample description. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics 141B, 201207.
Schuurmans, J, van Balkom, AJLM, van Megen, HJGM, Smit, JH, Eikelenboom, M, Cath, DC et al. (2012). The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study: design and rationale of a longitudinal naturalistic study of the course of OCD and clinical characteristics of the sample at baseline. International Journal of Methods in Psychiatric Research 21, 273285.
Skoog, G and Skoog, I (1999). A 40-year follow-up of patients with obsessive-compulsive disorder [see comments]. Archives of General Psychiatry 56, 121127.
Spitzer, RL, Williams, JB, Gibbon, M and First, MB (1992). The Structured Clinical Interview for DSM-III-R (SCID). I: history, rationale, and description. Archives of General Psychiatry 49, 624629.
Steketee, G, Eisen, JL, Dyck, I, Warshaw, M and Rasmussen, SA (1999). Predictors of course in obsessive-compulsive disorder. Psychiatry Research 89, 229238.
Tükel, R, Oflaz, SB, Ozyildirim, I, Aslantaş, B, Ertekin, E, Sözen, A et al. (2007). Comparison of clinical characteristics in episodic and chronic obsessive-compulsive disorder. Depression and Anxiety 24, 251255.
Vidal-Ribas, P, Stringaris, A, Rück, C, Serlachius, E, Lichtenstein, P and Mataix-Cols, D (2015). Are stressful life events causally related to the severity of obsessive-compulsive symptoms? A monozygotic twin difference study. European Psychiatry 30, 309316.
Visser, HA, van Oppen, P, van Megen, HJGM, Eikelenboom, M and van Balkom, AJLM (2014). Obsessive-compulsive disorder; chronic versus non-chronic symptoms. Journal of Affective Disorders 152–154, 169–74.
von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC and Vandenbroucke, JP (2008). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Journal of Clinical Epidemiology 61, 344349.
Warshaw, MG, Keller, MB and Stout, RL (1994). Reliability and validity of the longitudinal interval follow-up evaluation for assessing outcome of anxiety disorders. Journal of Psychiatric Research 28, 531545.
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