Nissen Judith Becker, Parner Erik
a Centre for Child and Adolescent Psychiatry , Aarhus University Hospital Risskov , Risskov , Denmark.
b Department of Public Health , Section of Biostatistics Aarhus University , Aarhus , Denmark.
Nord J Psychiatry. 2018 Oct;72(7):489-496. doi: 10.1080/08039488.2018.1486454. Epub 2018 Jul 11.
The primary aim of the present explorative naturalistic study was to examine the association of poor insight, avoidance behavior, and not-just-right sensation with baseline parameters including obsessive-compulsive disorder (OCD) symptoms, baseline severity scores, comorbidity, and personality traits. A second aim was to examine how insight, avoidance and not-just-right sensation influence treatment outcome.
In total, 317 medical records from children and adolescents with OCD referred to a specialized OCD clinic in Denmark were recorded for baseline parameters and treatment outcome. All information was used.
Avoidance behavior and poor insight were associated with an increased baseline severity, whereas not-just-right perception was not. Avoidance behavior was associated with the contamination/cleaning subtype, and a not-just-right sensation with the hoarding/symmetry subtype. Lower insight and avoidance behavior were associated with comorbid conditions. At post-treatment, not-just-right perception was associated with a risk of relapse, whereas lower insight was negatively associated with gaining remission. Avoidance behavior reduced the probability of remission and increased the number of offered sessions as well as and the likelihood of having SRI prescribed. Different personality traits were associated with treatment outcome.
Insight, avoidance behavior, and not-just-right perceptions seem important for baseline severity and post-treatment outcome. Baseline examination should include a systematic description, which could guide treatment. The present study is an explorative study describing a naturalistic clinical population. Therefore, a number of limitations should be taken into consideration when interpreting the results. More systematic studies on the importance of insight, avoidance behavior and not-just-right perceptions are warranted.
本探索性自然主义研究的主要目的是检验洞察力差、回避行为和不适感与包括强迫症（OCD）症状、基线严重程度评分、共病和人格特质在内的基线参数之间的关联。第二个目的是检验洞察力、回避行为和不适感如何影响治疗结果。
总共记录了317名转诊至丹麦一家专门的强迫症诊所的儿童和青少年强迫症患者的病历，以获取基线参数和治疗结果。所有信息均被采用。
回避行为和洞察力差与基线严重程度增加相关，而不适感则不然。回避行为与污染/清洁亚型相关，不适感与囤积/对称亚型相关。较低的洞察力和回避行为与共病情况相关。治疗后，不适感与复发风险相关，而较低的洞察力与获得缓解呈负相关。回避行为降低了缓解的概率，增加了提供的治疗次数以及开具5-羟色胺再摄取抑制剂（SRI）的可能性。不同的人格特质与治疗结果相关。
洞察力、回避行为和不适感似乎对基线严重程度和治疗后结果很重要。基线检查应包括系统描述，这可以指导治疗。本研究是一项描述自然主义临床人群的探索性研究。因此，在解释结果时应考虑到一些局限性。有必要对洞察力、回避行为和不适感的重要性进行更系统的研究。
