Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Viale C. Pepoli 5, 40123, Bologna, Italy.
Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy and San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy.
Eur Psychiatry. 2019 May;58:19-26. doi: 10.1016/j.eurpsy.2019.01.017. Epub 2019 Feb 11.
The duration of untreated illness (DUI) is a potentially modifiable parameter associated with worst prognosis in several psychiatric disorders, but poorly investigated in Obsessive-Compulsive Disorder (OCD). Our aims were to estimate the mean DUI in a large sample of individuals with OCD and its impact on response to the first ever adequate SRI treatment.
We retrospectively examined records of 251 patients with OCD (SCID-I, DSM-IV) who referred to our Department and were prospectively and naturalistically treated according to International Guidelines. The DUI was defined as the interval between age at onset and age at which patients received their first adequate pharmacological treatment. Response rates were compared in subjects with brief (≤24 months) versus long DUI. Logistic regression models predicting response and 12-week Y-BOCS score were run with DUI (among others) as independent variable.
The mean DUI was 106.19 ± 118.14 months, with a mean interval between onset of the disorder and when patients sought professional help of 82.27 ± 112.30 months. Response rates were significantly reduced in subjects with a long DUI, using both the cut-off of 24 months and the median value of 60 months. Regression analyses confirmed that a long (>24 months) DUI predicts poorer response and higher Y-BOCS scores at 12 weeks.
Our results, although preliminary, seem to suggest that a longer duration of untreated illness in OCD is associated with poorer outcome in terms of response to SRI treatments. It is imperative to do all the possible to shorten the DUI, both by improving access to mental health services, improving the ability of primary care physicians and mental health professionals to recognize OCD, and disseminate best-practice prescription guidelines.
未治疗疾病持续时间（DUI）是与几种精神障碍的最差预后相关的潜在可改变参数，但在强迫症（OCD）中研究甚少。我们的目的是在大量 OCD 患者中估算平均 DUI，并评估其对首次充分使用选择性 5-羟色胺再摄取抑制剂（SRI）治疗的反应的影响。
我们回顾性地检查了 251 名强迫症患者（SCID-I，DSM-IV）的记录，这些患者向我们部门就诊，并根据国际指南进行前瞻性和自然性治疗。DUI 定义为从发病年龄到患者接受首次充分药物治疗的年龄之间的间隔。将 DUI 较短（≤24 个月）与 DUI 较长（＞24 个月）的患者进行比较，以评估反应率。使用 DUI（以及其他因素）作为自变量，运行预测反应和 12 周 Y-BOCS 评分的逻辑回归模型。
平均 DUI 为 106.19±118.14 个月，疾病发作和患者寻求专业帮助之间的平均间隔为 82.27±112.30 个月。使用 24 个月的截止值和 60 个月的中位数，DUI 较长的患者的反应率明显降低。回归分析证实，较长的（＞24 个月）DUI 可预测 SRI 治疗 12 周时反应较差和 Y-BOCS 评分较高。
尽管我们的结果是初步的，但似乎表明 OCD 中未治疗疾病持续时间较长与 SRI 治疗反应较差的结果相关。缩短 DUI 至关重要，这需要通过改善心理健康服务的可及性、提高初级保健医生和心理健康专业人员识别 OCD 的能力以及传播最佳实践处方指南来实现。
