A 2-year prospective follow-up study of the course of obsessive-compulsive disorder.
BACKGROUND
Surprisingly little is known about the long-term course of obsessive-compulsive disorder (OCD). This prospective study presents 2-year course findings, as well as predictors of course, from the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the observational course of OCD in a large clinical sample.


METHODS
The sample included 214 treatment-seeking adults with DSM-IV OCD at intake who identified OCD as the most problematic disorder over their lifetime. Subjects were enrolled from 2001-2004. At annual interviews, data on weekly OCD symptom status were obtained using the Longitudinal Interval Follow-Up Evaluation. Probabilities of full remission and partial remission over the first 2 years of collected data and potential predictors of remission were examined.


RESULTS
The probability of full remission from OCD was 0.06, and the probability of partial remission was 0.24. Of the 48 subjects whose OCD symptoms partially or fully remitted, only 1 relapsed within the first 2 years. Earlier age at onset of OCD, greater severity of symptoms at intake, older age at intake, and being male were associated with a decreased likelihood of remission. Insight, diagnostic comorbidity, and treatment were not found to be associated with the likelihood of achieving full or partial remission.


CONCLUSIONS
Though one-quarter of the sample had periods of subclinical OCD symptoms during the prospective period, full remission was rare, consistent with the view of OCD as a chronic and persistent illness. Age at onset, OCD symptom severity, current age, and sex emerged as potent predictors of course.
Eisen
Jane L
JL
Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA. Jane_Eisen@brown.edu
Pinto
Anthony
A
Mancebo
Maria C
MC
Dyck
Ingrid R
IR
Orlando
Maria E
ME
Rasmussen
Steven A
SA
D000328:Adult; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012008:Recurrence; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
Am J Psychiatry. 2006 May;163(5):907-12
16648334
J Nerv Ment Dis. 1993 Apr;181(4):238-45
8097229
Compr Psychiatry. 2001 Nov-Dec;42(6):494-7
11704942
J Clin Psychiatry. 1997;58 Suppl 4:2-72
9183300
J Psychiatr Res. 2007 Sep;41(6):481-7
16790250
Arch Gen Psychiatry. 1986 May;43(5):458-66
3083800
J Clin Psychiatry. 1999 May;60(5):346-51; quiz 352
10362449
Arch Gen Psychiatry. 1999 Feb;56(2):121-7
10025435
J Clin Psychiatry. 2005 Jun;66(6):744-9
15960568
Arch Gen Psychiatry. 1989 Nov;46(11):1012-6
2510699
J Clin Psychiatry. 1995 Aug;56(8):368-73
7635854
J Clin Psychiatry. 1998 Aug;59(8):420-5
9721822
Am J Psychiatry. 1994 Mar;151(3):441-2
8109659
Arch Gen Psychiatry. 1987 Jun;44(6):540-8
3579500
Clin Psychol Rev. 2003 Dec;23(7):905-27
14624821
Acta Psychiatr Scand. 2008 Jan;117(1):67-75
17986317
J Psychiatr Res. 1994 Nov-Dec;28(6):531-45
7699612
Psychiatry Res. 2007 Jun 30;151(3):255-8
17368563
J Affect Disord. 1996 Nov 4;41(1):63-70
8938207
J Psychiatr Res. 2006 Sep;40(6):502-10
16904424
Am J Psychiatry. 1996 Apr;153(4):483-9
8599395
Eur Psychiatry. 1999 Dec;14(8):434-41
10683629
Arch Gen Psychiatry. 1989 Nov;46(11):1006-11
2684084
Am J Psychiatry. 1999 Sep;156(9):1409-16
10484953
J Neuropsychiatry Clin Neurosci. 1994 Fall;6(4):467-77
7841817
J Consult Clin Psychol. 2003 Dec;71(6):1049-57
14622080
Depress Anxiety. 2003;17(3):173-9
12768651
Am J Psychiatry. 1998 Jan;155(1):102-8
9433346
J Clin Psychiatry. 2006 May;67(5):703-11
16841619
J Clin Psychiatry. 2001 Jul;62(7):535-40
11488364
Arch Gen Psychiatry. 1992 Oct;49(10):809-16
1417434
Br J Psychiatry. 1975 Oct;127:349-64
241455
Arch Gen Psychiatry. 1969 Feb;20(2):182-7
5763526
Psychiatry Res. 1999 Dec 27;89(3):229-38
10708269
J Clin Psychiatry. 1993 Jun;54(6):213-8
8101186
Acta Psychiatr Scand. 2007 Sep;116(3):201-10
17655562
Am J Psychiatry. 2007 Jul;164(7 Suppl):5-53
17849776
Br J Psychiatry. 1982 Jan;140:11-8
7037100
Depress Anxiety. 2007;24(4):251-5
17006935
Psychiatry Res. 2008 Jul 15;160(1):83-93
18514325
J Clin Psychiatry. 1991 Apr;52(4):150-5
2016246
J Clin Psychiatry. 2005 Nov;66(11):1415-22
16420079
Am J Psychiatry. 1995 Jan;152(1):76-84
7802125