Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria 3168, Australia.
Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista (UNESP), Brazil.
J Affect Disord. 2020 Mar 1;264:181-186. doi: 10.1016/j.jad.2019.12.016. Epub 2019 Dec 10.
There is current interest in the elaboration of early intervention programs for obsessive-compulsive disorder (OCD). To this end, it is important to investigate the speed of progression from subthreshold symptoms to diagnosable OCD. In this study, we have retrospectively investigated the speed of progression towards full-blown OCD and sociodemographic and clinical factors associated with a faster transition.
Patients enrolled in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (N = 954) were interviewed with a comprehensive assessment battery that included the interval (in years) between the onset of subthreshold OCD symptoms and the onset of full-blown OCD.
It took a median of 7 years (interquartile range: 2-13 years) for subthreshold symptoms to convert to diagnosable OCD. Faster OCD onset was associated with lower age at the time of assessment, male gender, being in new romantic states as precipitants for compulsions, greater severity of sexual/religious symptoms and lower severity of hoarding and YBOCS compulsions severity scores, greater rates of generalized anxiety disorder and agoraphobia without panic disorder, and negative family history for OCD.
The retrospective design of this study allowed for susceptibility to memory bias about age at onset of OCD symptoms. We were unable to capture progressions taking less than 12 months.
We could identify a specific phenotype that was more likely to escalate rapidly to clinical levels within this large clinical sample. This phenomenon may be particularly relevant in the context of selecting individuals for early intervention initiatives in situations when resources are scarce.
目前人们对强迫症（OCD）早期干预计划的制定很感兴趣。为此，重要的是要研究从阈下症状发展到可诊断 OCD 的速度。在这项研究中，我们回顾性地研究了向完全性 OCD 发展的速度，以及与更快过渡相关的社会人口学和临床因素。
在巴西强迫症谱障碍研究联盟（N=954）中招募的患者接受了全面的评估，其中包括阈下 OCD 症状发作与完全性 OCD 发作之间的时间间隔（以年为单位）。
阈下症状发展为可诊断的 OCD 需要中位数 7 年（四分位距：2-13 年）。更快的 OCD 发病与评估时年龄较小、男性、强迫冲动的新浪漫状态、性/宗教症状更严重、囤积和 YBOCS 强迫严重程度评分较低、广泛性焦虑障碍和无惊恐障碍的广场恐怖症发生率较高以及 OCD 的家族阴性史有关。
这项研究的回顾性设计容易导致对 OCD 症状发病年龄的记忆偏差。我们无法捕捉少于 12 个月的进展。
我们可以在这个大型临床样本中确定一种更有可能迅速升级到临床水平的特定表型。在资源稀缺的情况下，为早期干预计划选择个体时，这种现象可能尤为重要。
