Obsessive-compulsive disorder with poor insight: a three-year prospective study.
Available evidence about the relationship between poor insight and other clinical characteristics in patients with obsessive-compulsive disorder (OCD) is inconclusive and conflicting. There is also a paucity of data on the long-term course and treatment outcome of OCD patients with poor insight. The present study reports the findings of a relatively large sample (n=106) of outpatients fulfilling DSM-IV criteria for OCD, treated with serotonin reuptake inhibitors (SRIs) and prospectively followed up for 3 years. Baseline information was collected on demographic and clinical characteristics, using standardized instruments. Insight was assessed by means of the Brown Assessment of Beliefs Scale (BABS). Eighty-three patients were followed prospectively and evaluated systematically by validated measures of psychopathology. Compared to their good insight counterparts, the OCD patients with poor insight (22%) showed a greater severity of obsessive-compulsive and depressive symptomatology; an earlier age at onset; a higher rate of schizophrenia spectrum disorder in their first-degree relatives; a higher comorbidity with schizotypal personality disorder. During the follow-up period, poor insight OCD patients were less likely to achieve at least a partial remission of obsessive-compulsive symptoms; required a significantly greater number of therapeutic trials; received more frequently augmentation with antipsychotics. The results suggest that the specifier "poor insight" helps to identify a subgroup of patients at the more severe end of OCD spectrum, characterized by a more complex clinical presentation, a diminished response to standard pharmacological interventions, and a poorer prognosis. Further research is needed to identify alternative strategies for the management of these patients.
Catapano
Francesco
F
Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, I-80138 Naples, Italy. francesco.catapano@unina2.it
Perris
Francesco
F
Fabrazzo
Michele
M
Cioffi
Valeria
V
Giacco
Domenico
D
De Santis
Valeria
V
Maj
Mario
M
D000328:Adult; D000987:Antisocial Personality Disorder / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000150:complications* / Q000188:drug therapy / Q000523:psychology*; D010552:Personality Assessment; D011569:Psychiatric Status Rating Scales; D011599:Psychopathology / Q000379:methods*; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D017367:Selective Serotonin Reuptake Inhibitors