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Application of a staging model in patients with obsessive–compulsive disorder: cross-sectional and follow-up results

Published online by Cambridge University Press:  30 October 2020

Beatrice Benatti*
Affiliation:
Luigi Sacco University Hospital, Department of Neuroscience, Psychiatry 2 Unit, University of Milan, Milan, Italy “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
Giulia Lucca
Affiliation:
Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
Riccardo Zanello
Affiliation:
Luigi Sacco University Hospital, Department of Neuroscience, Psychiatry 2 Unit, University of Milan, Milan, Italy
Fabio Fesce
Affiliation:
Luigi Sacco University Hospital, Department of Neuroscience, Psychiatry 2 Unit, University of Milan, Milan, Italy
Alberto Priori
Affiliation:
“Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
Nicola Poloni
Affiliation:
Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
Camilla Callegari
Affiliation:
Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
Leonardo F. Fontenelle
Affiliation:
Turner Institute for Brain and Mental Health, Monash University, VIC, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ) and D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
Bernardo Dell’Osso
Affiliation:
Luigi Sacco University Hospital, Department of Neuroscience, Psychiatry 2 Unit, University of Milan, Milan, Italy “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche”, University of Milan, Milan, Italy
*
*Author for correspondence: Beatrice Benatti, MD, Email: beatricebenatti@gmail.com

Abstract

Introduction

Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition with frequent chronic course. Staging models applied to psychiatric disorders seek to define their extent of progression at a particular time-point and differentiate early, milder clinical phenomena from those characterizing illness progression and chronicity. In OCD patients, a staging model has been recently proposed but not tested yet. This was the aim of the present study.

Methods

From an overall sample of 198 OCD patients, recruited across two psychiatric clinics in Northern Italy, 70 patients on stable treatment completed a follow-up assessment ranging from 12 to 24 months. At follow-up initiation, patients had been divided into four staging groups, according to the model proposed by Fontenelle and Yucel. At the end of the follow-up, patients were subdivided into three groups (no stage change, improved stage, or worsened stage) compared with statistical analyses.

Results

At the end of the follow-up, 67.1% patients showed no stage changes, 24.3% a stage improvement, and 8.6% a stage progression. Worsened patients showed higher rates of comorbid disorders and higher rates of unfavorable employment characteristics compared to the other subgroups (P < .05). Patients with worsened stage showed higher prevalence of somatic obsessions (P < .05), while patients with improved stage showed higher rates of magical thinking and violence/harm obsessions compared to other groups (P < .05).

Discussion

The present results provide epidemiologic and clinical correlates of the first application of a staging model in a sample of OCD patients, encouraging further studies to assess the utility of this approach in the field.

Type
Original Research
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Robbins, TW, Vaghi, MM, Banca, P. Obsessive-compulsive disorder: puzzles and prospects. Neuron. 2019;102(1):2747.10.1016/j.neuron.2019.01.046CrossRefGoogle ScholarPubMed
Vigne, P, Fortes, P, Dias, RV, et al. Duration of untreated illness in a cross-diagnostic sample of obsessive-compulsive disorder, panic disorder, and social anxiety disorder. CNS Spectr. 2019;24(5):526532.10.1017/S1092852918001281CrossRefGoogle Scholar
Fineberg, NA, Hollander, E, Pallanti, S, et al. Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive-Compulsive Spectrum Disorders. Int Clin Psychopharmacol. 2020;35(4):173193.Google ScholarPubMed
de Bruijn, C, Beun, S, de Graaf, R, et al. Subthreshold symptoms and obsessive-compulsive disorder: evaluating the diagnostic threshold. Psychol Med. 2010;40(6):989997.10.1017/S0033291709991012CrossRefGoogle ScholarPubMed
Lochner, C, Fineberg, NA, Zohar, J, et al. Comorbidity in obsessive-compulsive disorder (OCD): a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Compr Psychiatry. 2014;55(7):15131519.10.1016/j.comppsych.2014.05.020CrossRefGoogle Scholar
De Berardis, D, Serroni, N, Marini, , et al. Alexithymia, suicidal ideation, and serum lipid levels among drug-naïve outpatients with obsessive-compulsive disorder. Rev Bras Psiquiatr. 2014;36(2), 125130. doi:10.1590/1516-4446-2013-1189.CrossRefGoogle ScholarPubMed
De Berardis, D, Di Natale, S, Carletti, S, et al. Alexithymia, childhood maltreatment and suicide risk: an update. Evid Based Psychiatr Care. 2019;5:4448.Google Scholar
Janardhan Reddy, YC, Sundar, AS, Narayanaswamy, JC, Math, SB. Clinical practice guidelines for obsessive-compulsive disorder. Indian J Psychiatry. 2017;59(Suppl 1):S74S90.10.4103/0019-5545.196976CrossRefGoogle ScholarPubMed
Karas, PJ, Lee, S, Jimenez-Shahed, J, et al. Deep brain stimulation for obsessive compulsive disorder: evolution of surgical stimulation target parallels changing model of dysfunctional brain circuits. Front Neurosci. 2019;8(12):998.10.3389/fnins.2018.00998CrossRefGoogle Scholar
Sharma, E, Math, SB. Course and outcome of obsessive–compulsive disorder. Indian J Psychiatry. 2019;61(Suppl 1):S43S50.10.4103/psychiatry.IndianJPsychiatry_521_18CrossRefGoogle ScholarPubMed
Fineberg, NA, Dell'Osso, B, Albert, U, et al. Early intervention for obsessive compulsive disorder: An expert consensus statement. Eur Neuropsychopharmacol. 2019;29(4):549565.10.1016/j.euroneuro.2019.02.002CrossRefGoogle Scholar
McGorry, PD. Staging in neuropsychiatry: a heuristic model for understanding, prevention and treatment. Neurotox Res. 2010;18:244255.10.1007/s12640-010-9179-xCrossRefGoogle ScholarPubMed
Cosci, F, Fava, G. Staging of mental disorders: systematic review. Psychother Psychosom. 2013;82(1):2034.10.1159/000342243CrossRefGoogle ScholarPubMed
Storch, EA, De Nadai, AS, Conceição Do Rosário, M, et al. Defining clinical severity in adults with obsessive-compulsive disorder. Compr Psychiatry. 2015;63:3035.10.1016/j.comppsych.2015.08.007CrossRefGoogle ScholarPubMed
Fontenelle, LF, Yücel, M. A clinical staging model for obsessive–compulsive disorder: is it ready for prime time? EClinicalMedicine. 2019;7:6572.CrossRefGoogle ScholarPubMed
First, MB, Reed, GM, Hyman, SE, Saxena, S. The development of the ICD-11 clinical descriptions and diagnostic guidelines for mental and behavioural disorders. World Psychiatry. 2015;14(1):8290.10.1002/wps.20189CrossRefGoogle ScholarPubMed
Hirschtritt, ME, Bloch, MH, Mathews, CA. Obsessive-compulsive disorder: advances in diagnosis and treatment. JAMA. 2017;317(13):13581367.CrossRefGoogle ScholarPubMed
Koran, LM, Hanna, GL, Hollander, E et al.; American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007;164(suppl 7):553.Google ScholarPubMed
Storch, EA, Rasmussen, SA, Price, LH, et al. Development and psychometric evaluation of the Yale–Brown obsessive-compulsive scale—second edition. Psychol Assess. 2010;22(2):223232.10.1037/a0018492CrossRefGoogle ScholarPubMed
Busner, J, Targum, SD. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont). 2007;4(7):2837.Google ScholarPubMed
Hollander, E, Doernberg, E, Shavitt, R, et al. The cost and impact of compulsivity: a research perspective. Eur Neuropsychopharmacol. 2016;26(5):800809.10.1016/j.euroneuro.2016.02.006CrossRefGoogle ScholarPubMed
Van Oudheusden, L, Eikelenboom, M, van Megen, HJGM, et al. Chronic obsessive–compulsive disorder: prognostic factors. Psychol Med. 2018;48(13):22132222.CrossRefGoogle ScholarPubMed
Dell’Osso, B, Vismara, M, Benatti, B, et al. Lifetime bipolar disorder comorbidity and related clinical characteristics in patients with primary obsessive compulsive disorder: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). CNS Spectr. 2019;27:17.Google Scholar
Dell’Osso, B, Mundo, E, Marazziti, D, et al. Switching from serotonin reuptake inhibitors to duloxetine in patients with resistant obsessive compulsive disorder: a case series. J Psychopharmacol. 2008;22(2):210213.10.1177/0269881107079865CrossRefGoogle ScholarPubMed
Perugi, G, Toni, C, Frare, F, et al. Obsessive-compulsive-bipolar comorbidity: a systematic exploration of clinical features and treatment outcome. J Clin Psychiatry. 2002;63(12):11291134.10.4088/JCP.v63n1207CrossRefGoogle ScholarPubMed
Cederlöf Poyraz, CA, Turan, Ş, Sağlam, NGU, et al. Factors associated with the duration of untreated illness among patients with obsessive compulsive disorder. Compr Psychiatry. 2015;58:8893.10.1016/j.comppsych.2014.12.019CrossRefGoogle Scholar
Jakubovski, E, Diniz, JB, Valerio, C, et al. Clinical predictors of long-term outcome in obsessive-compulsive disorder. Depress Anxiety. 2013;30(8):763772.10.1002/da.22013CrossRefGoogle ScholarPubMed
Blom, RM, Koeter, M, van den Brink, W, et al. Co-occurrence of obsessive-compulsive disorder and substance use disorder in the general population. Addiction. 2011;106(12):21782185.10.1111/j.1360-0443.2011.03559.xCrossRefGoogle ScholarPubMed
Mancebo, MC, Grant, JE, Pinto, A, et al. Substance use disorder in an obsessive compulsive disorder clinical sample. J Anxiety Disord. 2009;429435.CrossRefGoogle Scholar
Thamby, A, Khanna, S. The role of personality disorders in obsessive-compulsive disorder. Indian J Psychiatry. 2019;61(Suppl 1):S114S118.CrossRefGoogle ScholarPubMed
Dell’Osso, B, Berlin, HA, Serati, M, et al. Neuropsychobiological aspects, comorbidity patterns and dimensional models in borderline personality disorder. Neuropsychobiology. 2010;61(4):169179.10.1159/000297734CrossRefGoogle ScholarPubMed
Marazziti, D, Dell’Osso, L. Why have early investigational therapies of obsessive–compulsive disorder failed to materialise? Expert Opin Investig Drugs. 2015;24(4):455458.CrossRefGoogle ScholarPubMed