Brennan Brian P, Lee Catherine, Elias Jason A, Crosby Jesse M, Mathes Brittany M, Andre Marie-Christine, Gironda Christina M, Pope Harrison G, Jenike Michael A, Fitzmaurice Garrett M, Hudson James I
Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA, USA; Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
J Psychiatr Res. 2014 Sep;56:98-105. doi: 10.1016/j.jpsychires.2014.05.008. Epub 2014 May 23.
Intensive residential treatment (IRT) is effective for severe, treatment-resistant obsessive-compulsive disorder (OCD). We sought to characterize predictors and course of response to IRT.
Admission, monthly, and discharge data were collected on individuals receiving IRT. We examined the association between baseline characteristics and percent change in OCD symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) using linear regression. We compared baseline characteristics of IRT responders (≥35% reduction in Y-BOCS) versus non-responders, and of patients who did versus those who did not achieve wellness (Y-BOCS ≤ 12) using non-parametric tests. To examine the course of OCD severity over time, we used linear mixed-effects models with randomly varying intercepts and slopes.
We evaluated 281 individuals admitted to an IRT program. Greater baseline Y-BOCS scores were associated with a significantly greater percent reduction in Y-BOCS scores (β = -1.49 ([95% confidence interval: -2.06 to -0.93]; P < .001)). IRT responders showed significantly greater baseline Y-BOCS scores than non-responders (mean (SD) 28 (5.2) vs. 25.6 (5.8); P = .003) and lower past-year alcohol use scores than non-responders (1.4 (1.9) vs. 2.1 (2.2); P = .01). Participants who achieved wellness displayed lower hoarding factor scores than those who did not (5 (4.6) vs. 9.53 (6.3); P = .03). OCD symptoms declined rapidly over the first month but more slowly over the remaining two months.
Higher baseline OCD severity, lower past-year alcohol use, and fewer hoarding symptoms predicted better response to IRT. IRT yielded an initial rapid reduction in OCD symptoms, followed by a slower decline after the first month.
强化住院治疗（IRT）对严重的、难治性强迫症（OCD）有效。我们试图确定IRT反应的预测因素和过程。
收集接受IRT治疗的个体的入院、每月及出院数据。我们使用线性回归分析了基线特征与耶鲁-布朗强迫症量表（Y-BOCS）测量的强迫症症状变化百分比之间的关联。我们使用非参数检验比较了IRT反应者（Y-BOCS降低≥35%）与无反应者，以及达到康复（Y-BOCS≤12）与未达到康复患者的基线特征。为了研究强迫症严重程度随时间的变化过程，我们使用了具有随机变化截距和斜率的线性混合效应模型。
我们评估了281名入住IRT项目的个体。更高的基线Y-BOCS评分与Y-BOCS评分的显著更大百分比降低相关（β=-1.49（[95%置信区间：-2.06至-0.93]；P<.001））。IRT反应者的基线Y-BOCS评分显著高于无反应者（均值（标准差）28（5.2）对25.6（5.8）；P=.003），且过去一年的酒精使用评分低于无反应者（1.4（1.9）对2.1（2.2）；P=.01）。达到康复的参与者的囤积因子评分低于未达到康复的参与者（5（4.6）对9.53（6.3）；P=.03）。强迫症症状在第一个月迅速下降，但在接下来的两个月下降较慢。
更高的基线强迫症严重程度、更低的过去一年酒精使用量以及更少的囤积症状预示着对IRT的反应更好。IRT使强迫症症状最初迅速减轻，随后在第一个月后下降较慢。
