Zaburzenie obsesyjno-kompulsyjne – Rokowania, prognozy i postęp choroby

Zaburzenie obsesyjno-kompulsyjne
Rokowania, prognozy i postęp choroby

Zaburzenie obsesyjno-kompulsyjne (OCD) charakteryzuje się przewlekłym przebiegiem z fluktuacjami nasilenia objawów, a całkowita remisja jest osiągana jedynie u około 20% dorosłych pacjentów (Y-BOCS ≤ 8). Poprawę kliniczną obserwuje się u 32-74% chorych, jednak 49% nadal doświadcza istotnych objawów. Kluczowe predyktory pozytywnej odpowiedzi na leczenie to wczesna odpowiedź na inhibitory wychwytu zwrotnego serotoniny (SRI), wysoki poziom wsparcia społecznego oraz podtyp OCD związany z myciem. Negatywne rokowniczo są natomiast wysokie nasilenie objawów, dominujące myśli obsesyjne, współwystępujące zaburzenia psychiczne (w tym bezsenność, napady paniki i objadania się) oraz późne skierowanie do terapii, zwłaszcza u dzieci i młodzieży. W badaniach nad terapią głębokiej stymulacji mózgu (DBS) u pacjentów z opornym OCD wykazano, że zmniejszenie przewidywalności sygnału neuronalnego 9 Hz koreluje z poprawą kliniczną, co może stanowić biomarker odpowiedzi na leczenie.

Prognoza w zaburzeniu obsesyjno-kompulsyjnym (OCD)

Długoterminowe wyniki leczenia
Czynniki prognostyczne odpowiedzi na leczenie
OCD u dzieci i młodzieży
Nowe podejścia do prognozowania
Skuteczność leczenia
Podsumowanie czynników rokowniczych
Kolejne rozdziały

Prognoza w zaburzeniu obsesyjno-kompulsyjnym (OCD)

Zaburzenie obsesyjno-kompulsyjne (OCD) jest zazwyczaj stanem przewlekłym, który często utrzymuje się przez całe życie, przy czym objawy mogą nasilać się i zmniejszać w czasie.¹ Przebieg OCD jest zróżnicowany, a prognozy dotyczące długoterminowych wyników leczenia wskazują, że tylko niewielki odsetek dorosłych pacjentów osiąga całkowitą remisję. Pomimo wprowadzenia i upowszechnienia różnych metod leczenia o udowodnionej skuteczności, u większości dorosłych pacjentów z OCD nie dochodzi do całkowitej remisji objawów.²

Długoterminowe wyniki leczenia

Badania długoterminowych wyników leczenia OCD (powyżej 5 lat) u dorosłych pacjentów sugerują, że około 32-74% pacjentów doświadcza poprawy klinicznej. Jednak szczegółowe analizy pokazują, że tylko około 20% badanych osiąga pełną remisję objawów OCD (definiowaną jako wynik Y-BOCS ≤ 8), podczas gdy 49% nadal doświadcza klinicznie istotnych objawów.³

Nieleczone OCD może stać się przewlekłe i znacząco wpływać na funkcjonowanie oraz jakość życia. W skrajnych przypadkach może prowadzić do sytuacji, gdy pacjent staje się osobą przywiązaną do domu i niezdolną do uczęszczania do pracy lub szkoły.⁴ Dlatego kluczowe znaczenie ma wczesne poszukiwanie pomocy medycznej w przypadku wystąpienia objawów u siebie lub dziecka.⁵

Czynniki prognostyczne odpowiedzi na leczenie

Identyfikacja predyktorów odpowiedzi na leczenie może pomóc w lepszym doborze terapii i optymalizacji wykorzystania zasobów.⁶ Badania wykazały kilka istotnych czynników wpływających na skuteczność leczenia:

Pozytywne czynniki prognostyczne

Początkowa odpowiedź na farmakoterapię – odpowiedź na pierwszą próbę leczenia inhibitorem wychwytu zwrotnego serotoniny (SRI) jest silnie związana z długoterminowymi wynikami. 31% pacjentów reagujących na początkową terapię SRI osiągnęło remisję w długoterminowej obserwacji, w porównaniu do 0% pacjentów niereagujących.⁷
Wsparcie społeczne – pacjenci z wyższym poziomem wsparcia społecznego odnoszą większe korzyści z leczenia. Negatywne wsparcie społeczne wiąże się z bardziej nasilonymi objawami, podczas gdy pozytywne wsparcie może być korzystne dla pacjentów z OCD.⁸
Podtyp OCD związany z myciem – co interesujące, pacjenci z OCD wykazujący więcej zachowań związanych z myciem/czyszczeniem odnoszą większe korzyści z leczenia niż inne podgrupy pacjentów z OCD.⁹¹⁰

Negatywne czynniki prognostyczne

Nasilenie objawów przed leczeniem – wyższe nasilenie objawów OCD i ogólnego dystresu psychopatologicznego przy przyjęciu przewiduje wyższe nasilenie objawów po leczeniu.¹¹¹²
Nasilone myśli obsesyjne – pacjenci z wyższymi wynikami w zakresie obsesyjnych myśli wydają się odnosić mniejsze korzyści z leczenia szpitalnego w zakresie redukcji obsesji.¹³¹⁴
Współwystępujące zaburzenia psychiczne – badania wykazały, że współwystępowanie zaburzeń psychicznych jest znacznie wyższe u pacjentów opornych na leczenie niż u pacjentów odpowiadających na leczenie.¹⁵
Bezsenność – została zidentyfikowana jako najważniejszy predyktor kategoryzacji pacjentów jako opornych na leczenie, szczególnie w podtypie związanym z zanieczyszczeniem/czyszczeniem.¹⁶¹⁷
Atak paniki i napady objadania się – w podtypie OCD związanym z niebezpieczeństwem/sprawdzaniem są istotnymi predyktorami oporności na leczenie.¹⁸

OCD u dzieci i młodzieży

Zaburzenie obsesyjno-kompulsyjne dotyka ponad 500 000 osób w Australii i zwykle rozpoczyna się w późnym dzieciństwie lub wczesnym okresie nastoletnim.¹⁹ Badania dotyczące długoterminowej obserwacji OCD u dzieci i młodzieży wykazały, że znaczna część pacjentów doświadcza remisji. Rokowanie u dzieci i młodzieży wydaje się być lepsze niż u dorosłych, jednak większość badań pokazuje, że 40-60% może nadal mieć objawy o różnym stopniu nasilenia, co wskazuje, że OCD może być stanem przewlekłym u niektórych pacjentów.²⁰

W badaniu prospektywnym z 7-letnim okresem obserwacji dzieci i młodzieży z OCD zidentyfikowano następujące niekorzystne czynniki prognostyczne:²¹

Fenotypowa prezentacja obsesji magicznych i kompulsji powtarzania
Pozytywny wywiad rodzinny w kierunku OCD
Objawy depresyjne i zaburzenia hiperkinetyczne
Skierowanie do leczenia po 10. roku życia

Nowe podejścia do prognozowania

Neuronalne predyktory odpowiedzi na leczenie

Rozwój neuromodulacji chirurgicznej umożliwił monitorowanie wewnątrzczaszkowe u osób z opornym na leczenie OCD, które otrzymują terapię głębokiej stymulacji mózgu (DBS). Badania wykazały, że:²²²³

Przed aktywacją DBS, w stanie najbardziej objawowym, moc theta/alfa (9Hz) wykazuje wyraźny wzorzec dobowy i wysoki stopień przewidywalności
U pacjentów z utrzymującymi się objawami (niereagujących) przewidywalność danych neuronalnych pozostaje konsekwentnie wysoka
U pacjentów, którzy uzyskali poprawę objawową (reagujących), przewidywalność danych neuronalnych jest znacznie zmniejszona

Zmniejszona okresowość i przewidywalność sygnału 9 Hz po rozpoczęciu DBS charakteryzowała odpowiedź kliniczną, podczas gdy utrzymywanie się tych cech wskazywało na brak odpowiedzi.²⁴²⁵ Ta cecha neuronalna dokładnie klasyfikowała stan kliniczny nawet u pacjentów z ograniczonym czasem rejestracji, wskazując na uniwersalność, która mogłaby ułatwić podejmowanie decyzji terapeutycznych.²⁶

Perfekcjonizm jako predyktor wyników leczenia

Perfekcjonizm jest uważany za ważny czynnik w OCD, jednak jego wpływ na powodzenie leczenia wymaga dalszych badań. Dotyczy to zarówno klasycznej terapii poznawczo-behawioralnej (CBT), jak i nowszych podejść terapeutycznych wprowadzonych w ostatnich latach.²⁷

Badania nad perfekcjonizmem jako predyktorem wyników objawowych w terapiach grupowych trzeciej fali (konkretnie MBCT i MCT-OCD) dla OCD wykazały, że:²⁸²⁹

Wbrew oczekiwaniom, tylko zmniejszenie perfekcjonizmu klinicznego (mierzonego CPQ) przewidywało ustąpienie objawów OCD (mierzonych Y-BOCS), ale nie zmniejszenie obaw dotyczących pomyłek (mierzonych FMPS-CM)
Zmiana w perfekcjonizmie klinicznym poprzedzała zmianę objawów
Obawy dotyczące pomyłek (FMPS-CM) nie przewidywały objawów OCD, ale przewidywały objawy depresyjne (BDI-II) w czasie

Wyniki te sugerują, że początkowy poziom obaw dotyczących pomyłek może nie mieć tak silnego obstrukcyjnego wpływu na wyniki leczenia w terapiach trzeciej fali (np. MBCT i MCT-OCD), jak ma to miejsce w klasycznej CBT.³⁰

Skuteczność leczenia

Pomimo wyzwań związanych z przewlekłym charakterem OCD, badania wskazują na skuteczność leczenia w warunkach rutynowej opieki. Badanie naturalnej skuteczności rutynowego leczenia szpitalnego pacjentów z OCD wykazało:³¹³²

Wielkości efektów dla różnych zmiennych wynikowych można sklasyfikować jako duże (g=1,34 dla zmiany objawów OCD)
Predyktorami zmian w objawach OCD i depresyjnych były nasilenie objawów przy przyjęciu i ogólny dystres psychopatologiczny
Pacjenci z wyższym wsparciem społecznym i większą liczbą kompulsji związanych z myciem odnosili większe korzyści z leczenia

Wyniki wskazują, że program psychoterapii opartej na dowodach dla OCD może być skutecznie wdrożony w rutynowej opiece szpitalnej.³³³⁴ Osoby z OCD, które otrzymują odpowiednie leczenie, często doświadczają zwiększonej jakości życia i poprawy funkcjonowania społecznego, szkolnego i/lub zawodowego.³⁵

Podsumowanie czynników rokowniczych

Badania nad rokowaniem w OCD wskazują na kilka kluczowych czynników, które mogą przewidywać odpowiedź na leczenie:³⁶³⁷³⁸³⁹

Pozytywne czynniki rokownicze:
- Wczesna odpowiedź na farmakoterapię SRI
- Silne wsparcie społeczne
- Podtyp OCD związany z myciem/czyszczeniem
- Młodszy wiek zachorowania (dla dzieci i młodzieży)
Negatywne czynniki rokownicze:
- Wysokie początkowe nasilenie objawów
- Wysoki poziom ogólnego dystresu psychopatologicznego
- Dominujące myśli obsesyjne
- Współwystępujące zaburzenia psychiczne (szczególnie bezsenność, napady paniki, napady objadania się)
- Pozytywny wywiad rodzinny w kierunku OCD
- Późniejszy wiek skierowania do leczenia (dla dzieci i młodzieży)

Zrozumienie tych czynników może pomóc w identyfikacji pacjentów zagrożonych brakiem odpowiedzi na leczenie i dostosowaniu strategii terapeutycznych w celu poprawy długoterminowych wyników.⁴⁰⁴¹

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Materiały źródłowe

#1 OCD (Obsessive-Compulsive Disorder): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/9490-ocd-obsessive-compulsive-disorder
Obsessive-compulsive disorder (OCD) is usually a life-long (chronic) condition, but symptoms can come and go over time. […] The prognosis (outlook) of OCD can vary. OCD is often a lifelong condition that can wax and wane. […] People with OCD who receive appropriate treatment often experience increased quality of life and improved social, school and/or work functioning. […] If you dont receive treatment, the cycle of obsessions and compulsions is more difficult to break and treat, as structural changes in your brain take place. Because of this, its key to seek medical care as soon as possible if you or your child experience symptoms.
#2 LONG-TERM OUTCOME IN ADULTS WITH OBSESSIVE-COMPULSIVE DISORDER – PMC Lock
https://pmc.ncbi.nlm.nih.gov/articles/PMC3932438/
Obsessive-compulsive disorder (OCD) is a chronic condition that often produces lifelong morbidity, but few studies have examined long-term outcome (greater than 5 years) in adult patients. Available studies suggest that 32â74% of adult OCD patients will experience clinical improvement over the long term. […] Only 20% (17 of 83) of subjects had experienced a remission of their OCD symptoms at follow-up (Y-BOCS â¤ 8). Forty-nine percent (41 of 83) of subjects were still experiencing clinically significant OCD symptoms. […] Despite the introduction and dissemination of several evidence-based treatments for OCD, most adult OCD patients do not achieve remission. Initial response to pharmacotherapy was strongly associated with long-term outcome. […] This study examined long-term clinical outcomes in OCD patients since the introduction of modern pharmacological and psychotherapeutic interventions with demonstrated efficacy. Unfortunately, our results confirm that, despite the availability of such treatments, a very small proportion of adults with OCD achieve clinical remission over the long term. We found that initial response to SRI pharmacotherapy was strongly predictive of long-term outcome. Thirty-one percent of responders to their initial SRI trial achieved remission at follow-up (defined as Y-BOCS â¤ 8), compared to 0% of nonresponders.
#3 LONG-TERM OUTCOME IN ADULTS WITH OBSESSIVE-COMPULSIVE DISORDER – PMC Lock
https://pmc.ncbi.nlm.nih.gov/articles/PMC3932438/
Obsessive-compulsive disorder (OCD) is a chronic condition that often produces lifelong morbidity, but few studies have examined long-term outcome (greater than 5 years) in adult patients. Available studies suggest that 32â74% of adult OCD patients will experience clinical improvement over the long term. […] Only 20% (17 of 83) of subjects had experienced a remission of their OCD symptoms at follow-up (Y-BOCS â¤ 8). Forty-nine percent (41 of 83) of subjects were still experiencing clinically significant OCD symptoms. […] Despite the introduction and dissemination of several evidence-based treatments for OCD, most adult OCD patients do not achieve remission. Initial response to pharmacotherapy was strongly associated with long-term outcome. […] This study examined long-term clinical outcomes in OCD patients since the introduction of modern pharmacological and psychotherapeutic interventions with demonstrated efficacy. Unfortunately, our results confirm that, despite the availability of such treatments, a very small proportion of adults with OCD achieve clinical remission over the long term. We found that initial response to SRI pharmacotherapy was strongly predictive of long-term outcome. Thirty-one percent of responders to their initial SRI trial achieved remission at follow-up (defined as Y-BOCS â¤ 8), compared to 0% of nonresponders.
#4 Obsessive-compulsive disorder (OCD) â symptoms and treatment | healthdirect
https://www.healthdirect.gov.au/obsessive-compulsive-disorder-ocd
Obsessive-compulsive disorder (OCD) is a treatable anxiety disorder. It affects more than 500,000 people in Australia. It usually starts in late childhood or the early teenage years. […] OCD can be a lifelong condition. But, there are treatments that can help you manage intrusive symptoms and significant distress, and stop them controlling your life. […] If not treated, OCD can become chronic and cause significant impact to your functioning and quality of life. This may mean that you become housebound and cant attend work or school.
#5 OCD (Obsessive-Compulsive Disorder): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/9490-ocd-obsessive-compulsive-disorder
Obsessive-compulsive disorder (OCD) is usually a life-long (chronic) condition, but symptoms can come and go over time. […] The prognosis (outlook) of OCD can vary. OCD is often a lifelong condition that can wax and wane. […] People with OCD who receive appropriate treatment often experience increased quality of life and improved social, school and/or work functioning. […] If you dont receive treatment, the cycle of obsessions and compulsions is more difficult to break and treat, as structural changes in your brain take place. Because of this, its key to seek medical care as soon as possible if you or your child experience symptoms.
#6
https://link.springer.com/article/10.1007/s10608-023-10361-0
Identifying predictors of treatment outcome can guide treatment selection and optimize use of resources. In patients affected by obsessive-compulsive disorder (OCD), perfectionism has emerged as one possible predictor, with some data suggesting that cognitive-behavioral therapy outcomes are poorer for more perfectionistic patients. Findings so far are inconsistent, however, and research has yet to be extended to newer treatment approaches. […] Neither concern over mistakes nor clinical perfectionism at baseline predicted OCD symptoms across time points. However, concern over mistakes at baseline did significantly predict comorbid depressive symptoms. Furthermore, exploratory analysis revealed change in clinical perfectionism during treatment as a predictor of OCD symptoms at follow-up. […] These results suggest that initial concern over mistakes may not prevent patients with OCD from benefitting from third-wave treatments. Change in clinical perfectionism may present a putative process of therapeutic change.
#7 LONG-TERM OUTCOME IN ADULTS WITH OBSESSIVE-COMPULSIVE DISORDER – PMC Lock
https://pmc.ncbi.nlm.nih.gov/articles/PMC3932438/
Obsessive-compulsive disorder (OCD) is a chronic condition that often produces lifelong morbidity, but few studies have examined long-term outcome (greater than 5 years) in adult patients. Available studies suggest that 32â74% of adult OCD patients will experience clinical improvement over the long term. […] Only 20% (17 of 83) of subjects had experienced a remission of their OCD symptoms at follow-up (Y-BOCS â¤ 8). Forty-nine percent (41 of 83) of subjects were still experiencing clinically significant OCD symptoms. […] Despite the introduction and dissemination of several evidence-based treatments for OCD, most adult OCD patients do not achieve remission. Initial response to pharmacotherapy was strongly associated with long-term outcome. […] This study examined long-term clinical outcomes in OCD patients since the introduction of modern pharmacological and psychotherapeutic interventions with demonstrated efficacy. Unfortunately, our results confirm that, despite the availability of such treatments, a very small proportion of adults with OCD achieve clinical remission over the long term. We found that initial response to SRI pharmacotherapy was strongly predictive of long-term outcome. Thirty-one percent of responders to their initial SRI trial achieved remission at follow-up (defined as Y-BOCS â¤ 8), compared to 0% of nonresponders.
#8 Determining prognostic variables of treatment outcome in obsessiveâcompulsive disorder: effectiveness and its predictors in routine clinical care
https://pmc.ncbi.nlm.nih.gov/articles/PMC8866294/
Therefore, in addition to the above-mentioned effectiveness question, it would seem promising to identify stable predictors of treatment outcome (i.e., prognostic variables) to determine patients at risk for nonresponse. […] Overall, and in line with the previous studies, pretreatment OCD symptom severity and general distress appear to predict post-treatment symptom severity. In general, for symptom-specific change, OCD patients with lower general distress, higher social support, and higher scores on washing behavior appear to benefit most from the treatment. […] This finding is in line with the results of a recent systematic review in which the authors concluded that negative social support appeared to be associated with more severe symptoms whereas positive social support could be beneficial for OCD patients.
#9 Determining prognostic variables of treatment outcome in obsessiveâcompulsive disorder: effectiveness and its predictors in routine clinical care
https://pmc.ncbi.nlm.nih.gov/articles/PMC8866294/
Our analyses indicate that, surprisingly, OCD patients who exhibit more washing behavior benefit more from treatment than do other subgroups of OCD patients. […] Subanalyses revealed distinct predictor profiles for each of the symptom-specific reductions (obsessions and compulsions): interestingly, the results suggest that OCD patients with higher scores on obsessing thoughts appear to benefit less from inpatient treatment in terms of a reduction in obsessions. […] This result adds to the evidence base for CBT in treating OCD patients with high levels of washing behavior, and stresses the crucial role of changing debilitating obsessions in such patients.
#10
https://link.springer.com/article/10.1007/s00406-021-01284-6
Overall, and in line with the previous studies, pretreatment OCD symptom severity and general distress appear to predict post-treatment symptom severity. In general, for symptom-specific change, OCD patients with lower general distress, higher social support, and higher scores on washing behavior appear to benefit most from the treatment. […] Our analyses indicate that, surprisingly, OCD patients who exhibit more washing behavior benefit more from treatment than do other subgroups of OCD patients. […] Subanalyses revealed distinct predictor profiles for each of the symptom-specific reductions (obsessions and compulsions): interestingly, the results suggest that OCD patients with higher scores on obsessing thoughts appear to benefit less from inpatient treatment in terms of a reduction in obsessions. […] Overall, the findings of the Y-BOCS-SR were supported by the results of the OCI-R.
#11 Determining prognostic variables of treatment outcome in obsessiveâcompulsive disorder: effectiveness and its predictors in routine clinical care
https://pmc.ncbi.nlm.nih.gov/articles/PMC8866294/
Therefore, in addition to the above-mentioned effectiveness question, it would seem promising to identify stable predictors of treatment outcome (i.e., prognostic variables) to determine patients at risk for nonresponse. […] Overall, and in line with the previous studies, pretreatment OCD symptom severity and general distress appear to predict post-treatment symptom severity. In general, for symptom-specific change, OCD patients with lower general distress, higher social support, and higher scores on washing behavior appear to benefit most from the treatment. […] This finding is in line with the results of a recent systematic review in which the authors concluded that negative social support appeared to be associated with more severe symptoms whereas positive social support could be beneficial for OCD patients.
#12
https://link.springer.com/article/10.1007/s00406-021-01284-6
Overall, and in line with the previous studies, pretreatment OCD symptom severity and general distress appear to predict post-treatment symptom severity. In general, for symptom-specific change, OCD patients with lower general distress, higher social support, and higher scores on washing behavior appear to benefit most from the treatment. […] Our analyses indicate that, surprisingly, OCD patients who exhibit more washing behavior benefit more from treatment than do other subgroups of OCD patients. […] Subanalyses revealed distinct predictor profiles for each of the symptom-specific reductions (obsessions and compulsions): interestingly, the results suggest that OCD patients with higher scores on obsessing thoughts appear to benefit less from inpatient treatment in terms of a reduction in obsessions. […] Overall, the findings of the Y-BOCS-SR were supported by the results of the OCI-R.
#13 Determining prognostic variables of treatment outcome in obsessiveâcompulsive disorder: effectiveness and its predictors in routine clinical care
https://pmc.ncbi.nlm.nih.gov/articles/PMC8866294/
Our analyses indicate that, surprisingly, OCD patients who exhibit more washing behavior benefit more from treatment than do other subgroups of OCD patients. […] Subanalyses revealed distinct predictor profiles for each of the symptom-specific reductions (obsessions and compulsions): interestingly, the results suggest that OCD patients with higher scores on obsessing thoughts appear to benefit less from inpatient treatment in terms of a reduction in obsessions. […] This result adds to the evidence base for CBT in treating OCD patients with high levels of washing behavior, and stresses the crucial role of changing debilitating obsessions in such patients.
#14
https://link.springer.com/article/10.1007/s00406-021-01284-6
Overall, and in line with the previous studies, pretreatment OCD symptom severity and general distress appear to predict post-treatment symptom severity. In general, for symptom-specific change, OCD patients with lower general distress, higher social support, and higher scores on washing behavior appear to benefit most from the treatment. […] Our analyses indicate that, surprisingly, OCD patients who exhibit more washing behavior benefit more from treatment than do other subgroups of OCD patients. […] Subanalyses revealed distinct predictor profiles for each of the symptom-specific reductions (obsessions and compulsions): interestingly, the results suggest that OCD patients with higher scores on obsessing thoughts appear to benefit less from inpatient treatment in terms of a reduction in obsessions. […] Overall, the findings of the Y-BOCS-SR were supported by the results of the OCI-R.
#15 Network Analysis for Predicting Treatment Response in Patients with Obsessive-Compulsive Disorder
https://brieflands.com/articles/ijpbs-137119
High resistance-to-treatment rates in obsessive-compulsive disorder (OCD) and various treatments remain significant obstacles to psychiatric disorder treatments. […] The current study used network analysis to predict treatment response by psychiatric symptoms in the contamination/cleaning and danger/checking OCD subtypes. […] Psychiatric symptoms can predict treatment responses in OCD subtypes. So, it is necessary to consider psychiatric comorbidities regarding OCD subtypes. […] Due to the limitations of available treatments, researchers are trying to identify predictors of treatment response or resistance in patients with OCD. […] Recent studies showed that psychiatric comorbidities are significantly higher in treatment-resistant patients than in responders. […] Insomnia was the most significant predictor for categorizing patients as resistant at the post-test.
#16 Network Analysis for Predicting Treatment Response in Patients with Obsessive-Compulsive Disorder
https://brieflands.com/articles/ijpbs-137119
High resistance-to-treatment rates in obsessive-compulsive disorder (OCD) and various treatments remain significant obstacles to psychiatric disorder treatments. […] The current study used network analysis to predict treatment response by psychiatric symptoms in the contamination/cleaning and danger/checking OCD subtypes. […] Psychiatric symptoms can predict treatment responses in OCD subtypes. So, it is necessary to consider psychiatric comorbidities regarding OCD subtypes. […] Due to the limitations of available treatments, researchers are trying to identify predictors of treatment response or resistance in patients with OCD. […] Recent studies showed that psychiatric comorbidities are significantly higher in treatment-resistant patients than in responders. […] Insomnia was the most significant predictor for categorizing patients as resistant at the post-test.
#17 Network Analysis for Predicting Treatment Response in Patients with Obsessive-Compulsive Disorder
https://brieflands.com/articles/ijpbs-137119
For contamination/cleaning, panic and binge eating played similar roles in treatment outcomes. […] This study is the first to examine the difference between the network structure of psychiatric symptoms in OCD subtypes. […] According to the Y-BOCS scores, patients are categorized as responders and resistant in both subtypes. […] Results showed that insomnia was the most significant predictor for response type in contamination/cleaning according to centrality measures. […] In the danger/checking subtype, panic and binge eating were significant predictors of treatment-resistant outcomes. […] The results showed that each subtype of OCD has a unique network structure. Therefore, it is necessary to develop a particular protocol for each of these subtypes. […] It is also possible to predict treatment response in each subtype of OCD based on their network of psychiatric symptoms.
#18 Network Analysis for Predicting Treatment Response in Patients with Obsessive-Compulsive Disorder
https://brieflands.com/articles/ijpbs-137119
For contamination/cleaning, panic and binge eating played similar roles in treatment outcomes. […] This study is the first to examine the difference between the network structure of psychiatric symptoms in OCD subtypes. […] According to the Y-BOCS scores, patients are categorized as responders and resistant in both subtypes. […] Results showed that insomnia was the most significant predictor for response type in contamination/cleaning according to centrality measures. […] In the danger/checking subtype, panic and binge eating were significant predictors of treatment-resistant outcomes. […] The results showed that each subtype of OCD has a unique network structure. Therefore, it is necessary to develop a particular protocol for each of these subtypes. […] It is also possible to predict treatment response in each subtype of OCD based on their network of psychiatric symptoms.
#19 Obsessive-compulsive disorder (OCD) â symptoms and treatment | healthdirect
https://www.healthdirect.gov.au/obsessive-compulsive-disorder-ocd
Obsessive-compulsive disorder (OCD) is a treatable anxiety disorder. It affects more than 500,000 people in Australia. It usually starts in late childhood or the early teenage years. […] OCD can be a lifelong condition. But, there are treatments that can help you manage intrusive symptoms and significant distress, and stop them controlling your life. […] If not treated, OCD can become chronic and cause significant impact to your functioning and quality of life. This may mean that you become housebound and cant attend work or school.
#20 A 7 year follow-up of children and adolescents with obsessive-compulsive disorder: an analysis of predictive factors in a clinical prospective study
http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632014000300006
A 7 year follow-up of children and adolescents with obsessive-compulsive disorder. An analysis of predictive factors in a clinical prospective study […] Background and Objectives: Obsessive compulsive disorder (OCD) is a frequent psychiatric disorder. Despite its significant influence on personal development, little is known about its long-term course in children and adolescents. The aim was to follow children and adolescents with OCD for 7 years and to compare patients gaining remission with patients experiencing symptoms. […] Important predictive factors included predisposition to OCD, the occurrence of comorbid disorders and older referral age. The occurrence of magic obsessions and repetitive compulsions increased the risk of OC symptoms at follow-up. […] Overall, studies on long-term follow-up of OCD in children and adolescent have shown that a substantial portion of patients experience remission at follow-up. As such, the prognosis in children and adolescents seems to be better than in adults. However, most studies show that 40-60% may continue having symptoms of varying degrees of severity, which indicates that OCD may be a chronic condition in some patients. […] Poor prognostic factors included the phenotypic presentation of magic obsessions and repeating compulsions, a positive family occurrence of OCD, depressive symptoms and hyperkinetic disorder, and referral after the 10th year of age. […] The present study showed that, for some patients, OCD may be a persistent disorder demanding close follow-up. The study confirmed several previous findings. In addition, the study has added new knowledge concerning the importance of phenotypic presentation, personality traits and quality of life. Furthermore, the late responder group has been described in relation to the group with persistent symptoms.
#21 A 7 year follow-up of children and adolescents with obsessive-compulsive disorder: an analysis of predictive factors in a clinical prospective study
http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632014000300006
A 7 year follow-up of children and adolescents with obsessive-compulsive disorder. An analysis of predictive factors in a clinical prospective study […] Background and Objectives: Obsessive compulsive disorder (OCD) is a frequent psychiatric disorder. Despite its significant influence on personal development, little is known about its long-term course in children and adolescents. The aim was to follow children and adolescents with OCD for 7 years and to compare patients gaining remission with patients experiencing symptoms. […] Important predictive factors included predisposition to OCD, the occurrence of comorbid disorders and older referral age. The occurrence of magic obsessions and repetitive compulsions increased the risk of OC symptoms at follow-up. […] Overall, studies on long-term follow-up of OCD in children and adolescent have shown that a substantial portion of patients experience remission at follow-up. As such, the prognosis in children and adolescents seems to be better than in adults. However, most studies show that 40-60% may continue having symptoms of varying degrees of severity, which indicates that OCD may be a chronic condition in some patients. […] Poor prognostic factors included the phenotypic presentation of magic obsessions and repeating compulsions, a positive family occurrence of OCD, depressive symptoms and hyperkinetic disorder, and referral after the 10th year of age. […] The present study showed that, for some patients, OCD may be a persistent disorder demanding close follow-up. The study confirmed several previous findings. In addition, the study has added new knowledge concerning the importance of phenotypic presentation, personality traits and quality of life. Furthermore, the late responder group has been described in relation to the group with persistent symptoms.
#22 Disruption of neural periodicity predicts clinical response after deep brain stimulation for obsessive-compulsive disorder | Nature Medicine
https://www.nature.com/articles/s41591-024-03125-0
Recent advances in surgical neuromodulation have enabled chronic and continuous intracranial monitoring during everyday life. […] We used this opportunity to identify neural predictors of clinical state in 12 individuals with treatment-resistant obsessive-compulsive disorder (OCD) receiving deep brain stimulation (DBS) therapy (NCT05915741). […] Before DBS activation, in the most symptomatic state, theta/alpha (9Hz) power evidenced a prominent circadian pattern and a high degree of predictability. […] In patients with persistent symptoms (non-responders), predictability of the neural data remained consistently high. […] On the other hand, in patients who improved symptomatically (responders), predictability of the neural data was significantly diminished. […] This neural feature accurately classified clinical status even in patients with limited duration recordings, indicating generalizability that could facilitate therapeutic decision-making.
#23 Disruption of neural periodicity predicts clinical response after deep brain stimulation for obsessive-compulsive disorder | Nature Medicine
https://www.nature.com/articles/s41591-024-03125-0
For the 10-20% of individuals with OCD who are treatment resistant, deep brain stimulation (DBS) of the ventral striatum (VS) and adjacent capsular white matter (ventral capsule (VC)) is an effective therapy, with response rates in the 66% range and regulatory approval in the form of a humanitarian device exemption from the US Food Drug Administration. […] The early appearance of these behaviors is a possible predictor of eventual clinical response, although notable counter-examples exist. […] We, thus, focused on the approach-avoidance axis as one of the critical neurobehavioral axes underlying the pathophysiology of OCD. […] Our results demonstrate that 9-Hz (theta/alpha border) VS neural activity is highly periodic in the symptomatic state. […] Decreased periodicity and predictability of this signal after DBS initiation characterized clinical response, whereas persistence of these features marked non-response.
#24 Disruption of neural periodicity predicts clinical response after deep brain stimulation for obsessive-compulsive disorder | Nature Medicine
https://www.nature.com/articles/s41591-024-03125-0
For the 10-20% of individuals with OCD who are treatment resistant, deep brain stimulation (DBS) of the ventral striatum (VS) and adjacent capsular white matter (ventral capsule (VC)) is an effective therapy, with response rates in the 66% range and regulatory approval in the form of a humanitarian device exemption from the US Food Drug Administration. […] The early appearance of these behaviors is a possible predictor of eventual clinical response, although notable counter-examples exist. […] We, thus, focused on the approach-avoidance axis as one of the critical neurobehavioral axes underlying the pathophysiology of OCD. […] Our results demonstrate that 9-Hz (theta/alpha border) VS neural activity is highly periodic in the symptomatic state. […] Decreased periodicity and predictability of this signal after DBS initiation characterized clinical response, whereas persistence of these features marked non-response.
#25 Disruption of neural periodicity predicts clinical response after deep brain stimulation for obsessive-compulsive disorder | Nature Medicine
https://www.nature.com/articles/s41591-024-03125-0
We focused our efforts on identifying neural predictors of long-term clinical state (that is, responder versus non-responder status). […] The heatmaps of 9-Hz power demonstrated a marked reduction in circadian periodicity during periods of clinical response relative to the pre-DBS symptomatic state. […] Clinical response was associated with decreased predictability of neural activity, whereas non-response was associated with persistent neural predictability. […] Our results identify a neurophysiological biomarker in the VS that enables prediction of clinical state from neural data. […] Chronically, retention versus loss of this predictability distinguishes clinical non-responders from responders, respectively.
#26 Disruption of neural periodicity predicts clinical response after deep brain stimulation for obsessive-compulsive disorder | Nature Medicine
https://www.nature.com/articles/s41591-024-03125-0
Recent advances in surgical neuromodulation have enabled chronic and continuous intracranial monitoring during everyday life. […] We used this opportunity to identify neural predictors of clinical state in 12 individuals with treatment-resistant obsessive-compulsive disorder (OCD) receiving deep brain stimulation (DBS) therapy (NCT05915741). […] Before DBS activation, in the most symptomatic state, theta/alpha (9Hz) power evidenced a prominent circadian pattern and a high degree of predictability. […] In patients with persistent symptoms (non-responders), predictability of the neural data remained consistently high. […] On the other hand, in patients who improved symptomatically (responders), predictability of the neural data was significantly diminished. […] This neural feature accurately classified clinical status even in patients with limited duration recordings, indicating generalizability that could facilitate therapeutic decision-making.
#27
https://link.springer.com/article/10.1007/s10608-023-10361-0
In sum, perfectionism is assumed to be an important factor in OCD, yet its impact on treatment success requires further investigation. This is the case for both classic CBT treatment as well as younger treatment approaches which have been introduced in recent years. […] The aim of the current study was to investigate perfectionism as a predictor of symptom outcome in third-wave group treatments (namely MBCT and MCT-OCD) for OCD. […] We hypothesized that greater perfectionism at baseline would predict greater OCD symptom severity at post treatment and follow-up (H1), controlling for symptom severity at baseline. […] Contrary to our expectations, only reductions in clinical perfectionism (CPQ) predicted recovery from OCD symptoms (Y-BOCS), but not reduction in concern over mistakes (FMPS-CM). Change in clinical perfectionism preceded symptom change.
#28
https://link.springer.com/article/10.1007/s10608-023-10361-0
In sum, perfectionism is assumed to be an important factor in OCD, yet its impact on treatment success requires further investigation. This is the case for both classic CBT treatment as well as younger treatment approaches which have been introduced in recent years. […] The aim of the current study was to investigate perfectionism as a predictor of symptom outcome in third-wave group treatments (namely MBCT and MCT-OCD) for OCD. […] We hypothesized that greater perfectionism at baseline would predict greater OCD symptom severity at post treatment and follow-up (H1), controlling for symptom severity at baseline. […] Contrary to our expectations, only reductions in clinical perfectionism (CPQ) predicted recovery from OCD symptoms (Y-BOCS), but not reduction in concern over mistakes (FMPS-CM). Change in clinical perfectionism preceded symptom change.
#29
https://link.springer.com/article/10.1007/s10608-023-10361-0
Identifying predictors of treatment outcome can guide treatment selection and optimize use of resources. In patients affected by obsessive-compulsive disorder (OCD), perfectionism has emerged as one possible predictor, with some data suggesting that cognitive-behavioral therapy outcomes are poorer for more perfectionistic patients. Findings so far are inconsistent, however, and research has yet to be extended to newer treatment approaches. […] Neither concern over mistakes nor clinical perfectionism at baseline predicted OCD symptoms across time points. However, concern over mistakes at baseline did significantly predict comorbid depressive symptoms. Furthermore, exploratory analysis revealed change in clinical perfectionism during treatment as a predictor of OCD symptoms at follow-up. […] These results suggest that initial concern over mistakes may not prevent patients with OCD from benefitting from third-wave treatments. Change in clinical perfectionism may present a putative process of therapeutic change.
#30
https://link.springer.com/article/10.1007/s10608-023-10361-0
Where as concern over mistakes (FMPS-CM) did not predict OCD symptoms in our sample, it did indeed predict depressive symptoms (BDI-II) across time points. […] Taken together, our results highlight the need for further research in order to isolate the role of perfectionism in OCD treatment. Pre-treatment levels of perfectionism may not have such a strong obstructive effect on outcome in third-wave treatments (e.g., MBCT and MCT-OCD) as they do in classic CBT.
#31 Determining prognostic variables of treatment outcome in obsessiveâcompulsive disorder: effectiveness and its predictors in routine clinical care
https://pmc.ncbi.nlm.nih.gov/articles/PMC8866294/
The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive-compulsive disorder (OCD) and to identify predictors of treatment outcome. […] Effect sizes of various outcome variables could be classified as large (g=1.34 of OCD-symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. […] The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors.
#32
https://link.springer.com/article/10.1007/s00406-021-01284-6
The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive-compulsive disorder (OCD) and to identify predictors of treatment outcome. […] Effect sizes of various outcome variables could be classified as large (g=1.34 of OCD-symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. […] The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. […] Therefore, in addition to the above-mentioned effectiveness question, it would seem promising to identify stable predictors of treatment outcome (i.e., prognostic variables) to determine patients at risk for nonresponse.
#33 Determining prognostic variables of treatment outcome in obsessiveâcompulsive disorder: effectiveness and its predictors in routine clinical care
https://pmc.ncbi.nlm.nih.gov/articles/PMC8866294/
The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive-compulsive disorder (OCD) and to identify predictors of treatment outcome. […] Effect sizes of various outcome variables could be classified as large (g=1.34 of OCD-symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. […] The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors.
#34
https://link.springer.com/article/10.1007/s00406-021-01284-6
The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive-compulsive disorder (OCD) and to identify predictors of treatment outcome. […] Effect sizes of various outcome variables could be classified as large (g=1.34 of OCD-symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. […] The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. […] Therefore, in addition to the above-mentioned effectiveness question, it would seem promising to identify stable predictors of treatment outcome (i.e., prognostic variables) to determine patients at risk for nonresponse.
#35 OCD (Obsessive-Compulsive Disorder): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/9490-ocd-obsessive-compulsive-disorder
Obsessive-compulsive disorder (OCD) is usually a life-long (chronic) condition, but symptoms can come and go over time. […] The prognosis (outlook) of OCD can vary. OCD is often a lifelong condition that can wax and wane. […] People with OCD who receive appropriate treatment often experience increased quality of life and improved social, school and/or work functioning. […] If you dont receive treatment, the cycle of obsessions and compulsions is more difficult to break and treat, as structural changes in your brain take place. Because of this, its key to seek medical care as soon as possible if you or your child experience symptoms.
#36 Determining prognostic variables of treatment outcome in obsessiveâcompulsive disorder: effectiveness and its predictors in routine clinical care
https://pmc.ncbi.nlm.nih.gov/articles/PMC8866294/
Therefore, in addition to the above-mentioned effectiveness question, it would seem promising to identify stable predictors of treatment outcome (i.e., prognostic variables) to determine patients at risk for nonresponse. […] Overall, and in line with the previous studies, pretreatment OCD symptom severity and general distress appear to predict post-treatment symptom severity. In general, for symptom-specific change, OCD patients with lower general distress, higher social support, and higher scores on washing behavior appear to benefit most from the treatment. […] This finding is in line with the results of a recent systematic review in which the authors concluded that negative social support appeared to be associated with more severe symptoms whereas positive social support could be beneficial for OCD patients.
#37 LONG-TERM OUTCOME IN ADULTS WITH OBSESSIVE-COMPULSIVE DISORDER – PMC Lock
https://pmc.ncbi.nlm.nih.gov/articles/PMC3932438/
Obsessive-compulsive disorder (OCD) is a chronic condition that often produces lifelong morbidity, but few studies have examined long-term outcome (greater than 5 years) in adult patients. Available studies suggest that 32â74% of adult OCD patients will experience clinical improvement over the long term. […] Only 20% (17 of 83) of subjects had experienced a remission of their OCD symptoms at follow-up (Y-BOCS â¤ 8). Forty-nine percent (41 of 83) of subjects were still experiencing clinically significant OCD symptoms. […] Despite the introduction and dissemination of several evidence-based treatments for OCD, most adult OCD patients do not achieve remission. Initial response to pharmacotherapy was strongly associated with long-term outcome. […] This study examined long-term clinical outcomes in OCD patients since the introduction of modern pharmacological and psychotherapeutic interventions with demonstrated efficacy. Unfortunately, our results confirm that, despite the availability of such treatments, a very small proportion of adults with OCD achieve clinical remission over the long term. We found that initial response to SRI pharmacotherapy was strongly predictive of long-term outcome. Thirty-one percent of responders to their initial SRI trial achieved remission at follow-up (defined as Y-BOCS â¤ 8), compared to 0% of nonresponders.
#38 Network Analysis for Predicting Treatment Response in Patients with Obsessive-Compulsive Disorder
https://brieflands.com/articles/ijpbs-137119
High resistance-to-treatment rates in obsessive-compulsive disorder (OCD) and various treatments remain significant obstacles to psychiatric disorder treatments. […] The current study used network analysis to predict treatment response by psychiatric symptoms in the contamination/cleaning and danger/checking OCD subtypes. […] Psychiatric symptoms can predict treatment responses in OCD subtypes. So, it is necessary to consider psychiatric comorbidities regarding OCD subtypes. […] Due to the limitations of available treatments, researchers are trying to identify predictors of treatment response or resistance in patients with OCD. […] Recent studies showed that psychiatric comorbidities are significantly higher in treatment-resistant patients than in responders. […] Insomnia was the most significant predictor for categorizing patients as resistant at the post-test.
#39 A 7 year follow-up of children and adolescents with obsessive-compulsive disorder: an analysis of predictive factors in a clinical prospective study
http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632014000300006
A 7 year follow-up of children and adolescents with obsessive-compulsive disorder. An analysis of predictive factors in a clinical prospective study […] Background and Objectives: Obsessive compulsive disorder (OCD) is a frequent psychiatric disorder. Despite its significant influence on personal development, little is known about its long-term course in children and adolescents. The aim was to follow children and adolescents with OCD for 7 years and to compare patients gaining remission with patients experiencing symptoms. […] Important predictive factors included predisposition to OCD, the occurrence of comorbid disorders and older referral age. The occurrence of magic obsessions and repetitive compulsions increased the risk of OC symptoms at follow-up. […] Overall, studies on long-term follow-up of OCD in children and adolescent have shown that a substantial portion of patients experience remission at follow-up. As such, the prognosis in children and adolescents seems to be better than in adults. However, most studies show that 40-60% may continue having symptoms of varying degrees of severity, which indicates that OCD may be a chronic condition in some patients. […] Poor prognostic factors included the phenotypic presentation of magic obsessions and repeating compulsions, a positive family occurrence of OCD, depressive symptoms and hyperkinetic disorder, and referral after the 10th year of age. […] The present study showed that, for some patients, OCD may be a persistent disorder demanding close follow-up. The study confirmed several previous findings. In addition, the study has added new knowledge concerning the importance of phenotypic presentation, personality traits and quality of life. Furthermore, the late responder group has been described in relation to the group with persistent symptoms.
#40 Determining prognostic variables of treatment outcome in obsessiveâcompulsive disorder: effectiveness and its predictors in routine clinical care
https://pmc.ncbi.nlm.nih.gov/articles/PMC8866294/
Therefore, in addition to the above-mentioned effectiveness question, it would seem promising to identify stable predictors of treatment outcome (i.e., prognostic variables) to determine patients at risk for nonresponse. […] Overall, and in line with the previous studies, pretreatment OCD symptom severity and general distress appear to predict post-treatment symptom severity. In general, for symptom-specific change, OCD patients with lower general distress, higher social support, and higher scores on washing behavior appear to benefit most from the treatment. […] This finding is in line with the results of a recent systematic review in which the authors concluded that negative social support appeared to be associated with more severe symptoms whereas positive social support could be beneficial for OCD patients.
#41 Network Analysis for Predicting Treatment Response in Patients with Obsessive-Compulsive Disorder
https://brieflands.com/articles/ijpbs-137119
High resistance-to-treatment rates in obsessive-compulsive disorder (OCD) and various treatments remain significant obstacles to psychiatric disorder treatments. […] The current study used network analysis to predict treatment response by psychiatric symptoms in the contamination/cleaning and danger/checking OCD subtypes. […] Psychiatric symptoms can predict treatment responses in OCD subtypes. So, it is necessary to consider psychiatric comorbidities regarding OCD subtypes. […] Due to the limitations of available treatments, researchers are trying to identify predictors of treatment response or resistance in patients with OCD. […] Recent studies showed that psychiatric comorbidities are significantly higher in treatment-resistant patients than in responders. […] Insomnia was the most significant predictor for categorizing patients as resistant at the post-test.