Behavioral Health Matters - Chronic and Relapsing Patients continued...
[Drug Benefit Trends 12(11):2BH-3BH, 2000. © 2000 Cliggott Publishing Co., Division of SCP/Cliggott Communications, Inc.]
Obsessive-Compulsive DisorderThe data for OCD are also compelling with regard to the chronic nature of the underlying disorder. In a recently reported Swedish study by Skoog and Skoog,[4] the investigators prospectively followed 144 patients with OCD during a 40-year period, an average of 47 years after the onset of the illness. This essentially untreated population showed a complete recovery rate of only 20%. Another 20% of patients showed either no improvement or a downhill course. The remaining 60% of patients showed symptoms for more than 40 years but with some amelioration over time, with much of the improvement coming in the first decade after onset. A young age at onset, especially for men, was a marker for a poor outcome. Patients with compulsions or bizarre obsessions also did statistically worse than the rest of the cohort.An intriguing long-term follow-up study of 15 adolescents intensively treated with behavior ther-apy (response prevention with artificial exposure, if necessary, plus clomipramine, if necessary [5 cases]) found remarkable long-term benefits in the 9- to 14-year follow-up period. Of the 14 young people about whom information was obtained, 6 had OCD at long-term follow-up and 8 no longer had the disorder.[5] None of the recovered group was taking medication at the time of follow-up. The authors note that this long-term recovery rate agrees with the 57% rate reported by Leonard and colleagues[6] following a similar combination of behavior therapy with pharmacotherapy in a 2- to 7-year follow-up study. Serotonin reuptake inhibitors, even by themselves, work not only for acute treatment but for maintenance purposes. In a double-blind desipramine substitution study of long-term clomipramine-maintained patients, 8 of the 9 substitution patients, but only 2 of the 11 nonsubstitution patients, relapsed. Maintenance with clomipramine, while effective, did not relieve symptoms completely for most patients.[7]
|
| ||||||
|
