Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands.
J Affect Disord. 2020 Mar 1;264:206-214. doi: 10.1016/j.jad.2019.12.028. Epub 2019 Dec 20.
Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder where most patients do not reach full symptomatic remission. Identifying predictors of course can improve patients' care by informing clinicians on prognosis and enhancing treatment strategies. Several predictors associated with improved outcome of OCD were identified. However, research focused mainly on clinical, illness-related predictors of the course of OCD. This study examined the contribution of environmental and interpersonal predictors on the long-term outcome of OCD, in addition to the previously identified clinical indicators.
We used the baseline, two and four-year data of 382 adult OCD patients participating in the naturalistic cohort study of the Netherlands Obsessive Compulsive Disorder Association (NOCDA). Remission was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Predictors of outcome were assessed at baseline, via clinician-rated and self-report instruments.
Remission at two and at four-year follow-up ranged from 11% to 26%. Early age of onset and the presence of childhood trauma predicted a worse four-year course. Secure attachment style emerged as a protective predictor of improved outcome.
The naturalistic design of our study did not enable a systematic estimation the effect of treatments received during the follow-up period. Furthermore, age of onset and childhood trauma were assessed retrospectively, which may contribute to recall bias.
Results coincide with previous prediction research and stress the importance of adaptive interpersonal functioning in the course of OCD. Clinical implications and future research directions are discussed.
强迫症（OCD）是一种慢性精神疾病，大多数患者无法达到完全症状缓解。识别预测因素可以通过向临床医生提供预后信息并增强治疗策略来改善患者的护理。已经确定了一些与 OCD 预后改善相关的预测因素。然而，研究主要集中在 OCD 病程的临床、与疾病相关的预测因素上。本研究除了之前确定的临床指标外，还考察了环境和人际预测因素对 OCD 长期结局的贡献。
我们使用荷兰强迫症协会（NOCDA）自然队列研究中 382 名成年 OCD 患者的基线、两年和四年数据。使用耶鲁-布朗强迫症量表（Y-BOCS）评估缓解情况。通过临床医生评定和自我报告工具在基线评估预后的预测因素。
两年和四年随访时的缓解率从 11%到 26%不等。发病年龄较早和童年创伤的存在预示着四年病程更差。安全依恋模式是改善预后的保护性预测因素。
我们研究的自然设计不能系统地估计随访期间接受的治疗效果。此外，发病年龄和童年创伤是回顾性评估的，这可能会导致回忆偏差。
结果与之前的预测研究一致，强调了适应性人际功能在 OCD 病程中的重要性。讨论了临床意义和未来的研究方向。
