Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Psychopharmacology (Berl). 2020 Nov;237(11):3489-3496. doi: 10.1007/s00213-020-05630-9. Epub 2020 Aug 3.
Metacognitions, beliefs that monitor or control thoughts and coping, are considered to be important components for development and maintenance of obsessive-compulsive disorder (OCD).
This study prospectively investigated whether metacognitive beliefs can predict early treatment response after serotonin reuptake inhibitor (SRI) initiation in patients with OCD.
Drug-naïve or medication-free patients with OCD (N = 156) were assessed for various characteristics, including metacognitions. In total, 132 patients were followed for 4 weeks, and their clinical responses to pharmacological treatment were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Early treatment response was defined as a 20% or greater reduction from the baseline Y-BOCS score at 4 weeks. Logistic and linear regression analyses were performed to identify major determinants for the early treatment outcome.
Among participants with OCD, 53 patients (40.15%) were early responders. The logistic regression model revealed two significant predictors, age (beta = - 0.113, p < 0.001) and "positive beliefs about worry," which refers to metacognitive beliefs concerning the benefits of engaging in worry (beta = - 0.067, p = 0.001), for identifying early responders. Moreover, in the linear regression model, lower "positive beliefs about worry" was also shown as a significant predictor for the degree of better early improvement (beta = - 0.566, p = 0.001).
These results suggest that lower metacognition of "positive beliefs about worry" predicts improvement of obsessive-compulsive symptoms seen early on in the SRI treatment, and that pathological metacognitive belief would lead to delayed response to SRI treatment in OCD.
元认知，即监控或控制思维和应对的信念，被认为是强迫症（OCD）发展和维持的重要组成部分。
本研究前瞻性调查了元认知信念是否可以预测 OCD 患者开始使用 5-羟色胺再摄取抑制剂（SRI）后的早期治疗反应。
对未经药物治疗或停药的 OCD 患者（N=156）进行各种特征评估，包括元认知。共有 132 名患者接受了 4 周的随访，并使用耶鲁-布朗强迫症量表（Y-BOCS）评估他们对药物治疗的临床反应。早期治疗反应定义为 4 周时 Y-BOCS 评分比基线降低 20%或更多。进行逻辑和线性回归分析以确定早期治疗结果的主要决定因素。
在 OCD 患者中，53 名患者（40.15%）为早期反应者。逻辑回归模型显示了两个重要的预测因子，年龄（beta=-0.113，p<0.001）和“担忧的积极信念”，这是指与从事担忧有益相关的元认知信念（beta=-0.067，p=0.001），用于识别早期反应者。此外，在线性回归模型中，较低的“担忧的积极信念”也被证明是早期改善程度的显著预测因子（beta=-0.566，p=0.001）。
这些结果表明，较低的“担忧的积极信念”的元认知预测了 SRI 治疗早期强迫症症状的改善，病理性元认知信念会导致 OCD 对 SRI 治疗的反应延迟。
