title: Long-term outcome in adults with obsessive-compulsive disorder.
abstract: BACKGROUND
  Obsessive-compulsive disorder (OCD) is a chronic condition that often produces lifelong morbidity, but few studies have examined long-term outcome (greater than 5 years) in adult patients. Available studies suggest that 32-74% of adult OCD patients will experience clinical improvement over the long term. However, these studies were conducted before validated OCD rating scales were established and the development of evidence-based treatments for OCD.
  
  
  METHODS
  We investigated the 10-20 year outcome of 83 of 165 eligible subjects previously enrolled after participation in placebo-controlled trials of serotonin reuptake inhibitor (SRI) medications for OCD. We examined the association between clinical characteristics at initial assessment and OCD symptom severity at follow-up. We hypothesized that primary OCD symptom dimension and initial response to pharmacotherapy with serotonin reuptake inhibitors would be associated with later symptom severity.
  
  
  RESULTS
  Only 20% (17 of 83) of subjects had experienced a remission of their OCD symptoms at follow-up (Y-BOCS ≤ 8). Forty-nine percent (41 of 83) of subjects were still experiencing clinically significant OCD symptoms. Response to initial SRI pharmacotherapy was significantly associated with long-term outcome: 31% (13 of 42) of subjects who responded (CGI < 3) to initial SRI pharmacotherapy were remitted at follow-up, compared to 12% (3 of 25) of partial responders and none of the 16 subjects who had no response to initial SRI pharmacotherapy. We did not find a significant association between long-term clinical outcome and any of the OCD symptom dimensions.
  
  
  CONCLUSIONS
  Despite the introduction and dissemination of several evidence-based treatments for OCD, most adult OCD patients do not achieve remission. Initial response to pharmacotherapy was strongly associated with long-term outcome.
authors.affiliation: Child Study Center, Yale University, New Haven, CT, USA. michael.bloch@yale.edu
authors.forename: Michael H
authors.initials: MH
authors.lastname: Bloch
authors.forename: Christy
authors.initials: C
authors.lastname: Green
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Kichuk
authors.forename: Philip A
authors.initials: PA
authors.lastname: Dombrowski
authors.forename: Suzanne
authors.initials: S
authors.lastname: Wasylink
authors.forename: Eileen
authors.initials: E
authors.lastname: Billingslea
authors.forename: Angeli
authors.initials: A
authors.lastname: Landeros-Weisenberger
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kelmendi
authors.forename: Wayne K
authors.initials: WK
authors.lastname: Goodman
authors.forename: James F
authors.initials: JF
authors.lastname: Leckman
authors.forename: Vladimir
authors.initials: V
authors.lastname: Coric
authors.forename: Christopher
authors.initials: C
authors.lastname: Pittenger
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000523:psychology* / Q000628:therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: OCD/obsessive compulsive disorder; anxiety/anxiety disorders; pharmacotherapy; treatment; treatment resistance