Mancebo Maria C, Greenberg Benjamin, Grant Jon E, Pinto Anthony, Eisen Jane L, Dyck Ingrid, Rasmussen Steven A
Butler Hospital, Providence, RI 02906, USA.
Compr Psychiatry. 2008 Jan-Feb;49(1):43-50. doi: 10.1016/j.comppsych.2007.05.016. Epub 2007 Oct 23.
This study aimed to examine correlates of occupational disability in a large, clinical sample of individuals with a primary diagnosis of obsessive-compulsive disorder (OCD).
A total of 238 individuals with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were interviewed at entry into an observational study of the course of OCD. Primary was defined as the diagnosis that patients identified as the most problematic over their lifetime.
At the time of interview, 38% of the sample reported being unable to work for psychiatric reasons. Obsessive-compulsive disorder with occupational disability was associated with greater functional impairment in completing household duties, social functioning, and quality of life. Few differences in treatments received were found among individuals with and without occupational disability. Although the number of years on psychotropic medications was similar among the 2 groups, those with disability had been on a greater number of serotonin-reuptake inhibitors over their lifetime. Half of individuals with occupational disability had entered cognitive-behavioral therapy at some point, but only one third had received at least 13 sessions. Regression analyses revealed that OCD severity was the most powerful predictor of occupational disability, followed by depression severity and presence of a lifetime substance use disorder.
A substantial proportion of individuals in our sample were unable to work. Cognitive-behavioral therapy was underutilized, and reasons for this remain unclear. Comorbid depression and substance use disorders present additional risk factors for disability. Further advances in biologic and psychosocial treatments are needed to improve functioning and the overall prognosis of the disorder.
本研究旨在调查一大群被初步诊断为强迫症（OCD）的临床样本中职业残疾的相关因素。
共有238名被《精神障碍诊断与统计手册》第四版初步诊断为强迫症的个体在进入一项强迫症病程观察性研究时接受了访谈。主要诊断被定义为患者一生中认为最成问题的诊断。
在访谈时，38%的样本报告因精神原因无法工作。伴有职业残疾的强迫症与在完成家务、社交功能和生活质量方面更大的功能损害相关。在有和没有职业残疾的个体之间，所接受的治疗几乎没有差异。尽管两组在使用精神药物的年限相似，但有残疾的个体一生中使用5-羟色胺再摄取抑制剂的数量更多。一半有职业残疾的个体在某个时候接受过认知行为疗法，但只有三分之一接受过至少13次治疗。回归分析显示，强迫症严重程度是职业残疾最有力的预测因素，其次是抑郁严重程度和终生物质使用障碍的存在。
我们样本中有很大一部分个体无法工作。认知行为疗法未得到充分利用，其原因尚不清楚。共病的抑郁和物质使用障碍是导致残疾的额外风险因素。需要在生物和心理社会治疗方面取得进一步进展，以改善该疾病的功能和总体预后。
