Bloch Michael H, Craiglow Brittany G, Landeros-Weisenberger Angeli, Dombrowski Philip A, Panza Kaitlyn E, Peterson Bradley S, Leckman James F
Child Study Center, Yale University School of Medicine, PO Box 2070900, New Haven, CT 06520, USA.
Pediatrics. 2009 Oct;124(4):1085-93. doi: 10.1542/peds.2009-0015. Epub 2009 Sep 28.
The aim of this study was to determine the childhood clinical predictors of early adult outcomes in pediatric-onset obsessive-compulsive disorder (OCD) and to assess whether dimensional subtypes of OCD and the presence of comorbid tic symptoms influence long-term outcomes.
We conducted a longitudinal cohort study in which 45 of 62 eligible children with OCD were reassessed an average of 9 years later, in early adulthood. Main outcome measures included expert-rated, obsessive-compulsive (OC) symptom severity and time to remission of OC symptoms. Baseline clinical characteristics were evaluated in terms of their influence on OCD severity in adulthood and time to remission of OC symptoms.
Forty-four percent of subjects were determined to have subclinical OC symptoms at the follow-up evaluation. The absence of a comorbid tic disorder and the presence of prominent hoarding symptoms were associated with the persistence of OCD symptoms. Female gender, earlier age at childhood assessment, later age of OCD onset, more-severe childhood OCD symptoms, and comorbid oppositional defiant disorder also were associated with persistence of OCD symptoms into adulthood.
These results confirm that a significant proportion of treated children with OCD experience remission by adulthood. The presence of comorbid tics heralds a positive outcome, whereas primary hoarding symptoms are associated with persistent OCD.
本研究旨在确定儿童期起病的强迫症（OCD）成年早期结局的临床预测因素，并评估OCD的维度亚型及共病抽动症状是否会影响长期结局。
我们开展了一项纵向队列研究，对62名符合条件的OCD患儿中的45名在平均9年后成年早期进行了重新评估。主要结局指标包括专家评定的强迫症状严重程度和强迫症状缓解时间。评估了基线临床特征对成年期OCD严重程度和强迫症状缓解时间的影响。
在随访评估中，44%的受试者被判定有亚临床强迫症状。不存在共病抽动障碍及存在明显的囤积症状与强迫症状持续存在有关。女性、儿童期评估时年龄较小、OCD起病年龄较大、儿童期OCD症状较严重以及共病对立违抗障碍也与强迫症状持续至成年期有关。
这些结果证实，相当一部分接受治疗的OCD患儿在成年期会缓解。共病抽动预示着良好结局，而原发性囤积症状与持续性OCD有关。
